The continued focus on primary and community services, backed by a clear funding commitment, is very welcome but will be a challenge to deliver. Critical interdependencies exist between the NHS and local government, wider public services and communities. This needs truly integrated medical psychiatric and social care. Many of the chosen clinical priorities, including mental health and primary and community services, have also been singled out for attention in recent years. Work in this area should encourage bottom-up approaches that empower staff and connect the service with communities. Integrated care is the right way forward and it needs honest kind caring compassionate leaders with integrity and courage to held everyone to account and to deliver the plan. Local areas will need to set out how they will achieve this, drawing on a menu of evidence-based interventions developed by NHS England, Public Health England and others. The five-year financial settlement for the NHS provides much needed investment, but is not enough to meet key. Further detail on how the commitments in the long-term plan will be implemented will be set out in a national implementation framework, due to be published in spring 2019. NHS England and the British Medical Association’s general practice committee have negotiated an update to the five-year GP. The commitment of the NHS to play its part in improving prevention and reducing health inequalities should be applauded but these aims cannot be achieved by the NHS in isolation. Patients will notice changes to the front door of the urgent care system and to the configuration of hospitals in some places. 10-year plan for how this funding will be used. This will see some patients admitted from A&E undergo diagnosis and treatment in quick succession so that they can be discharged on the same day, rather than staying in hospital overnight. clocking in at a weighty 120 pages. Taken together, these commitments signal a welcome continuation of the direction of travel set out in the Forward View, with ICSs playing an increasingly important role in planning and managing services. This article is from the online course: It can not. Some action will depend on other government decisions, for example, on the training budget, and the UK’s future immigration policy. explainer looks at the number of critical care beds, how critical care units work and how they are staffed. ICSs will also be supported by changes to funding flows and performance frameworks. The plan reiterates the Department of Health and Social Care’s commitment to increase medical school places from 6,000 to 7,500 per year and suggests that this figure could increase if further funding is provided in the Spending Review. An overview of the key milestones in the recent history of devolution in relation to health and social, Making the case for public health interventions, A set of infographics that describe key facts about the public health system and the return on investment, Women and medical leadership infographics. This means that much is riding on the ability of local systems to deliver. The plan’s focus on acute mental health services in particular will depend on recruiting enough appropriately skilled staff. View Course. The total budget for the Department of Health and Social Care in England and how it has changed, As part of the new five-year funding deal announced for the NHS in 2018, national NHS bodies have. Sustainability and transformation plans (STPs) explained, STPs outline how health and care services will work in partnership across 44 areas of England. National leaders deserve credit for targeting measurable improvements in health outcomes and the focus on child health is very welcome. Taken together, this adds up to an ambitious agenda for change that could provide significant benefits for patients. To support general practice, the intention is to continue to increase the number of other members of the primary care team, such as clinical pharmacists and physiotherapists, although much of the detail on this is again left to the forthcoming workforce implementation plan. The NHS will continue to face tough choices about how to prioritise resources. It is firmly focused on the future, rather than simply shoring up current models of care, and sets the right direction for the NHS by focusing on delivering joined-up, personalised, preventive care, and expanding primary and community services. So how can the system build on this learning to bring about positive change and renewal? When will these ideas be taken more seriously and implemented? With thanks to the policy leads and other colleagues for their contribution to this explainer. A ‘renewed’ NHS prevention programme will focus on maximising the role of the NHS in influencing behaviour change, guided by the top five risk factors identified by the Global burden of disease study: smoking, poor diet, high blood pressure, obesity, and alcohol and drug use. Whether they continue after the transition phase will depend on the outcome of the ongoing negotiations. The main challenge will be to translate this into delivery. Staffing is the number one issue on the King’s Fund list; 55,000 of the 1.3 million NHS workforce and 80,000 of the 1.3 million workers in adult social care are from countries within the EU. See other articles from this course. Encouragingly, the plan backs this goal with money: by 2023/24, funding for primary and community care will be at least £4.5 billion higher than in 2019/20 – ensuring that their share of NHS spending increases over the period. Among a range of commitments, continuity of care during pregnancy, birth and after birth will be improved, bed capacity in intensive neonatal care will increase in areas where this is currently lacking and mental health services and other support for pregnant women and new mothers will be improved. The King’s Fund has published an explanatory report, Fit for the Future, that sets out the main commitments in the plan. The cost of running a virtual conference is similar to that of a physical event. For example, the number of places on the Diabetes Prevention Programme will double over the next five years. We're doing it now, over half of episodes now starting digitally. The NHS is mainly funded from general taxation and National Insurance contributions. It is called just culture. From 2019/20 onwards, further reforms will give ICSs greater control over their resources will be introduced, through a process of ‘earned financial autonomy’, to be assessed on the basis of their financial and operational performance. For example, NHS Digital’s latest estates publication tells us that two NHS hospitals still use coal-fired boilers; the occupied floor area of Addenbrooke’s Hospital would cover 58 football pitches; and Barts Health NHS Trust spent £13.9 million on inpatient food in 2019/20. Perhaps this is how they win their contracts, so that year on year, you have the same or similar group of old boys and girls being commissioned to review high profile situations with big promises and short on delivery, waste of public fund, waste of time. There will also be a review of the Better Care Fund. National expectations are made clear and local systems will be accountable for contributing to national programmes on a ‘comply or explain basis’. The King's Fund is committed to tackling inequalities through the work we do and by using our voice to encourage change within the health and care system. One of the most important of these decisions – what to do about recovering waiting times standards – has been postponed. The government should be spending more time trying to find out why such a high drop out rate for nursing students and newly qualified nurses and how to support them and make their working environment suitable so that students want to stay, when student stay it leads to more qualified nurses and this in turn makes the profession more attractive, (word of mouth) more people taking up the profession, less dependency on foreign nurses, less money spent on foreign recruitment and retraining for nurse recruits. NHS long term plan is the only solution but it needs leaders with values, good governance, excellent staff and patient engagement. The commitment to establishing specific goals for reducing inequalities, which focus on the NHS’s role in this, is particularly welcome. This explainer outlines the changes and explains what they mean for the future of general practice. Why do delayed transfers of care occur? Health and care explained (February 2021). Waiting times in accident and emergency (A&E) departments are a key measure of how the NHS is performing. In the video, Siva talks about some big financial figures such as the £1 billion deficit across NHS care providers in 2017/18. More than 1,900 delegates have attended Health and care explained, ranging from chief executives of charities to NHS leaders, students and representatives from government bodies. The commitment to reduce long waits is given teeth by the reintroduction of fines for providers and commissioners where patients wait 12 months or more. We explored how a wide range of organisations – across local government, the voluntary sector, the private sector and local communities – have it within their power to improve people’s health. The KingsFund: The NHS long-term plan explained On 7 January, the NHS long-term plan (formerly known as the 10-year plan) was published setting out key ambitions for the service over the next 10 years. Watch, An alternative guide to the urgent and emergency care system in England, This animation explains how the urgent and emergency care system fits together and shows how solving problems in. Consequently, it is a plan for the NHS, not the whole health and care system. It also recognises that NHS organisations will need to work in partnership with local authorities, the voluntary sector and other local partners to improve population health. The plan aims to cut the average number of daily delayed transfers of care (DTOC beds) to around 4,000 and maintain that level over the next two years before reducing it further (DTOC beds averaged 4,580 in November 2018). Long read The potential changes to the legislative framework also seek to remove barriers and accelerate change but the prospect of parliament passing new legislation remains unlikely in the short term. Since then its work has evolved in response to the creation of the NHS … The ambition is to deliver a step change in the recruitment of international nurses, increasing the number recruited by ‘several thousand’ each year over the next five years. explainer looks at how these bodies are structured and the progress made before the Covid-19 (coronavirus) outbreak took hold. The maternity and neonatal section builds on the measures being implemented following the National Maternity Review with the aim of halving still births, maternal mortality, neonatal mortality and serious brain injury in newborn babies by 2025. Overall, the plan’s commitments on digital and data largely confirm the existing direction of travel set in 2016 by the Wachter Review and updated in 2018 by the Future of Healthcare strategy. Collaborative, inclusive and compassionate leadership is essential to deliver the highest quality care for patients and tackle deep-seated. cultural issues in the NHS, including unacceptable levels of work-related stress, bullying and discrimination. There are a number of measures aimed at supporting delivery of integrated care and incentivising system-based working to improve population health. Summary. What is a 'population health' approach? With changes to legislation unlikely to take place in the short term, the immediate priority for ICSs will be to continue making as much progress as possible within the existing legislative framework. I am constantly frustrated at why the NHS estate - its bricks and mortar - is not recognised as a key part of the NHS "resource". First, delivery is dependent on additional funding given that the current technology funding settlement ends in 2021. NHS leaders should be applauded for focusing on improving services outside hospitals and moving towards more joined-up, preventative and personalised care for patients. Significantly, the plan indicates that the NHS and government will consider whether the NHS should have a ‘stronger role’ in commissioning sexual health services, health visitors and school nurses (currently commissioned by local government). Workforce shortages are widespread, with more than 100,000 whole-time equivalent staff vacancies in hospitals, including more than 40,000 nurse vacancies. In 2020, a new waiting time standard will be introduced requiring that most patients get a clear ‘yes’ or ‘no’ diagnosis for suspected cancer within 28 days of referral by a GP or screening. What's the NHS annual budget? The training for professionals is a significant step forward and should draw on the expertise of patient leaders. The social care Green Paper is expected to set out options for social care funding and proposals for health and social care integration. 70 staff came to meet the leaders in confidence as we empowered staff to speak up and we had to dismiss few bad doctors, remove few bad bullying managers and change many leaders. Subscribe to our newsletters to keep up to date with the world of health and social care and hear the latest news and views from The King's Fund. Delivering it will require skilful leadership and a concerted effort to involve patients and communities. Why does integrated care matter? There is also a strong focus on children and young people’s health. The plan explicitly recognises the scale of this challenge and sets out a number of specific measures to address it. However, the funding settlement for social care will not be known until the Spending Review later this year. The long-term plan calls for a ‘fundamental shift’ in the way that the NHS works alongside patients and individuals. A plan for the NHS cannot fully address this wider context, particularly when there is so much uncertainty about the future of social care and public health budgets are being cut. It was founded in 1897 by the Prince of Wales – later King Edward VII – to help London’s voluntary hospitals. Much rests on primary care networks which are still a relatively untested model. Improving core community mental health services has been neglected in previous plans and represents a significant (although as yet undefined) commitment. Spending in these areas is not covered by the plan as it is routed through local authorities. are contracted to deliver, and the different streams of funding they receive. And in any case, patients have been able to order repeat prescriptions, see their records and allegedly book appointments online for some years now. The penultimate chapter of the plan sets out how this will be achieved. Health and care explained (February 2021), Our jargon buster includes common terms used in the health and sector. and outlines seven key issues for the new standards that have been proposed for emergency departments. This process prevents patients and staff to mindlessly go through the motions just for being told to do so. Plan is only a plan and leadership is making the plan a reality. Alongside this, the plan aims to improve the advice available to patients over the phone and extend support for staff in the community by introducing a multidisciplinary clinical assessment service (CAS) as part of the NHS 111 service in 2019/20. It provides a view of what they might mean, highlighting the opportunities and challenges for the system as it moves to put the plan into practice. This was followed by subsidiary strategies, covering general practice, cancer, mental health and maternity services, while the new models of care outlined in the Forward View have been rolled out through a programme of vanguard sites. This explainer looks at the community pharmacy sector in England, explaining how pharmacies are contracted and funded, the types of services they provide and future trends in the sector. In 2019/20, as part of the process of moving towards system control totals, sustainability and transformation partnerships (STPs) and integrated care systems (ICSs) will be given more flexibility to agree financially neutral changes to control totals for individual organisations within their systems. To achieve this, as well as the previously announced 25 per cent increase in nurse undergraduate placements, the plan commits to funding a 25 per cent increase in clinical nursing placements from 2019/20 and an increase of up to 50 per cent from 2020/21. How is A&E performance measured and what influences how long people wait? As the plan acknowledges, this cannot be done in isolation and the NHS will need to work closely with partners, especially local government and the voluntary sector. The focus on ICSs and expanding new models of care builds on the agenda set by the Forward View. We answer some of the most frequently asked questions we receive about social care. An introduction to the NHS; An introduction to the NHS. Without good governance and accountability nothing will change. As we head towards the 2019 general election, what are patient and public perceptions of the NHS? Community pharmacy is a critical part of primary care in England, but its role and relationship to the wider NHS is often poorly understood. It is widely acknowledged that the NHS is already struggling to recruit and retain permanent staff with a shortfall of nearly six per cent in 2014. But does it work? Expectations about waiting times will only become clear when the clinical review of standards is published. While the funding settlement is a significant improvement on the constraints of recent years, it is not a panacea. However, with leadership vacancies currently widespread, shifting the culture to where it needs to be will take time, along with investment and relentless commitment from leaders at every level of the system in their everyday practice. Overall, the long-term plan amounts to an ambitious set of commitments within the constraints of the funding available. This is in the context of an increase in the aggregate deficit among NHS providers and commissioners from £554 million in 2014/15 to £1.85 billion in 2015/16. Instead, over five years, the volume of planned activity will increase year-on-year to reduce long waits and cut the number of people on the waiting list (currently more than 4 million). A series of diagrams explaining how funding flows in the NHS and how providers are regulated and commissioned. The ambition to deliver more personalised, joined-up and proactive care – if it can be delivered – could make a significant difference to patients and change how they interact with health services. Primary care networks will also roll out the successful approach pioneered by the enhanced health in care homes vanguards so that by 2023/24, all care homes are supported by teams of health care professionals (including named GPs) to provide care to residents and advice to staff. Instead, its plans for hospital bed numbers and staffing assume that acute care will grow broadly in line with the past three years (although the plan does not specify what figure it is using for this). New episodes monthly. at the commissioning process in more detail, the organisations involved and how it is changing. The plan commits to a ‘more concerted and systematic approach to reducing health inequalities’, with a promise that action on inequalities will be central to everything that the NHS does. The move towards a more interconnected NHS will be supported by a ‘duty to collaborate’ on providers and commissioners, while NHS England and NHS Improvement will continue efforts to streamline their functions. As with primary and community services, national leaders have used the long-term plan to reassert their commitment to improving mental health services, both for adults and for children and young people. How are they funded and held accountable? The plan sets a long-term ambition to train more staff domestically. The King’s Fund is an independent charity working to improve health and care in England. The plan is consistent with recent policy in signalling continued change for acute services. Treating 'mental health' seperately from 'physical health' is a major missed opportunity. This begins with funding: the plan reaffirms that mental health funding – provided through a ring-fenced investment fund – will outstrip total NHS spending growth in each year between 2019/20 and 2023/24 so that by the end of the period, mental health investment will be at least £2.3 billion higher in real terms. Reducing delayed discharges from hospital remains a priority. The plan sets out a number of actions to improve detection and care for people with cardiovascular disease (CVD) and respiratory disease, prevent diabetes and improve stroke services. Also significant is the absence of any commitments to current waiting time targets - these are on hold until the clinical review of standards is published later in the year. An alternative guide to mental health care in England. These plans will be ‘brought together in a detailed national implementation programme’ in the autumn of 2019. 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