Long Term Plan
Last Updated: July, 2019

The NHS Long Term Plan is an overarching 10-year plan for the NHS, which follows on from the  Five Year Forward View . It was published in January 2019 and written by  NHS England  Chief Executive  Simon Stevens . It was backed by then Tory Prime Minister Theresa May.

The NHS Long Term Plan does not discuss - in any significant depth - the severe problems facing the NHS. It is overwhelmingly focussed on restructuring the NHS. In 2018, shortly before the Long Term Plan was published, the government announced extra funding for the NHS up to 2024. This is not money for front-line services, it is money to facilitate the restructuring outlined in the Long Term Plan (see  Big Picture - NHS Funding ).

US-Style Health Care System

The Long Term Plan sets out plans for a top-down re-disorganisation of the NHS into 44  Accountable/Integrated Care Systems (ACSs/ICSs) . They are to be policed by regional directors and a network of joint NHS England and NHS Improvement regional directorates. As proposed in the Plan, none of these new structures will be in any way accountable to the local people and communities they cover.

The Plan also requires more forced mergers or other measures to reduce the existing  Clinical Commissioning Groups (CCGs)  to just one CCG per ICS. CCGs are also required to cut their management costs by another 20 percent, ensuring they are reduced to rump bodies with residual token power, in practice accountable to nobody.  Foundation Trusts  will also be required to collaborate with the wider ACS/ICS.

Explicit Privatisation

The Plan contains proposals for increased use of private hospitals to deliver NHS funded care in order to limit waiting times (this is already being actioned by NHS England under the radar), as well as new pressure on Hospital Trusts to increase their links with the private sector to grow their external (non-NHS) income and work towards securing the benchmarked potential for commercial income growth.

Hospital Foundation Trusts are told they must also aim to increase the funds they get from charging patients for treatment - overseas visitor cost recovery - a policy which will raise little money in relative terms, but which will deter some patients from accessing the services they need, and which undermines the principles and values of the NHS.

The Plan dovetails with existing plans to cut costs by selling land and buildings, and from restrictions on GPs prescribing a growing list of drugs and treatments. Some CCGs have already gone well beyond the initial list of exclusions drawn up by NHS England, and in a number of cases the private sector is eagerly lining up to offer to sell patients the operations and treatments they can no longer routinely get on the NHS.

The End of the Family Doctor

GP practices will have to sign up to new  Primary Care Networks .

The Plan proposes big changes in how we access GP services: patients will be given a new right to switch from their existing GP to a digital first provider, and all patients in England will be offered access to on-line or video consultations by 2023. There is no corresponding right to insist on a face-to-face consultation, and switching to an on-line GP service will reduce the funding for real GP services.

From the  Path to Excellence  document "Working Together for Clinical Excellence: Phase-2 Case for Change"

The Plan proposes a third type of emergency care, alongside Urgent Treatment Centres and the existing Emergency Departments: a poorly-defined system of Same Day Emergency Care is supposed to be rolled out to every hospital with a full A&E, aiming to discharge patients on the day of attendance. However this new model further fragments an already highly stressed service and requires significant investment in expanded diagnostic services. There is also no guarantee that patients would get anything other than assessment before being packed off home, to the mercies of cash-strapped community and  social care  services.

The NHS Long Term Plan appears to bring together the elements required for large scale  privatisation  of our health services, through the implementation of Accountable Care Systems and Primary Care Networks, both being ideas imported from the USA. In case you have any doubts that this Plan is anything other than the next step along the established privatisation trajectory, then it is worth noting that the Plan does not address:

  • The declining actual performance of Trusts.
  • The inexorable rise in emergency case-load.
  • The insufficient capacity in acute and mental health services and bed shortages.
  • The disastrous financial plight of most hospital Trusts.
  • The workforce crisis compounded by the Brexodus of EU-trained staff.
  • The £8-billion and rising bill for backlog maintenance.
  • The cuts inflicted in mental health and community services.
  • The impact of repeated cuts in public health budgets.
  • The widening gap in society between rich and poor and the resultant inequalities in health - exacerbated by unchanged austerity and reactionary government policies on housing, welfare, education, local government, and of course the gathering crisis of a dysfunctional social care system (see  Prevention ).