The government bills its ten-year NHS plan, published last week, as one of the most significant healthcare transformations since the NHS’s creation. It is a hefty response (168 pages) to the pressures facing the service, documented by Lord Darzi’s independent investigation, and a public consultation which has attracted nearly a quarter of a million responses.
The document is explicit that the service is in crisis. An ageing population is making increasing demands; a quarter of the population now have long term conditions; productivity has fallen by 20% since Covid; public satisfaction with the service has fallen from 70% to 21% since 2010; and staff have been leaving under pressure of growing workloads and decreasing autonomy.
The plan reaffirms the commitment to a publicly funded service, free at the point of use, but proposes three broad and radical changes:
- shifting much care from hospital to community,
- shifting from analog to digital delivery, and
- refocusing from sickness to prevention.
From hospital to community
A central plank of the strategy is a shift “from hospital to community”. The aim is that by 2035, most outpatient care will be outside hospitals, with two-thirds of current outpatient appointments shifting to digital alternatives. This is to be achieved through Neighbourhood Health Centres, operating 12 hours a day, six days a week. These are to provide a wide range of services locally, including diagnostics, mental health support, post-operative care and nursing services.
Primary Care Networks will be key to this transformation, with GP practices encouraged to work across larger geographies. There will also be encouragement for close working with commercial partners, universities, councils and mayors. But there may be difficulties in doing this when local government is itself undergoing reorganisation in Norfolk, Suffolk and Essex.
From analog to digital
The plan anticipates substantial benefits from digital developments. The NHS app is to become a front door to many services, linked to a single digital patient record. In time it is expected that this will be enhanced with genomic data to provide personalised and predictive care.
In the East, the NHS Research Secure Data Environment Network centre is providing a foundation for advanced data analytics and AI implementation, and September will see the first meeting of an East of England AI Forum to foster collaboration among digital leaders to support AI adoption in healthcare. A dedicated digital workforce plan is to be incorporated into the broader Long-Term Workforce Plan, to be refreshed in autumn 2025.
From sickness to prevention
Most of the resources of the ‘health’ service are devoted to managing sickness, not promoting health. But, faced with growing demand and rising costs, sustainability will only be possible if more can be done to prevent illness in the first place. So the plan includes ambitious targets on smoking, obesity and children’s diets. It will also call for different prevention strategies across widely varying demographic profiles, from the rapidly growing young population of Milton Keynes to the aging population of rural Norfolk. And work is needed to tackle significant health disparities, with areas like Thurrock and Luton having poorer outcomes linked to deprivation and ethnicity.
The plan highlights the potential of community health workers and peer support workers in preventative work at local level, and local areas are to be given flexibility to trial innovative approaches suited to their specific populations. The Family Hubs announced this month will also have a key role to play.
Workforce development and training
Many staff are leaving the NHS because of heavy workloads and lack of autonomy. The plan proposes less top-down direction and greater control for frontline staff, whose skills will be upgraded. To achieve this, it proposes a radical overhaul of initial and in-service training, including building digital skills into training for all. The aim is that, by 2035, there will be fewer staff than projected in the 2023 Long-Term Workforce Plan, but those staff will be better treated, more motivated, have better training and more scope to develop their careers. The plan wants the NHS to be “not only the country’s biggest employer, but its best”.
New structures
The proposed transformation is to be led by Integrated Care Boards (ICBs), which will lose their current operational responsibility, and become ‘strategic commissioners’ of services. They will be expected to understand population health needs in their areas and create long-term strategies to improve outcomes, using a wide range of data sources, and developing a set of population health measures to monitor results. They will be encouraged to innovate and support new models of delivery.
The current six Integrated Care Boards (ICBs) in the Eastern region will be reduced to just three, with a halving of the running costs, but over 3,000 staff are potentially affected by redundancy or redeployment.
The plan emphasises closer collaboration between NHS services and local government, with strategic authority mayors becoming ICB board members. The region’s combined authorities and Local Enterprise Partnerships will play crucial roles in supporting the shift to prevention and addressing wider determinants of health. They will also be able to draw on the expertise of the region’s universities, which are at the heart of the UK’s life sciences sector.
Future outlook and implementation risks
In the East of England, these reforms will be a real challenge. Despite a recent real terms increase in funding the service still faces severe financial constraints, and it has to undertake major structural change at a time when key strategic partners in local government are themselves being reorganised.
There are real risks. One is the potential loss of local expertise during ICB reorganisation. Existing transformation programmes may lose momentum, and it will be critical to maintain staff morale during uncertainty about redundancy and redeployment.
However, the region also has significant strengths, including world-class research institutions, strong life sciences clusters, and established collaborative relationships between health and care organisations.
The service is in crisis. This is an ambitious programme for change. We all need it to work.
