Praise for 'ambitious' NHS plan but experts warn patients may wait longer as funding decisions bite

NHS plan wins acclaim but emergency doctors warn it is light on detail of targets

Plan lacks detail on how waiting time targets not hit since 2015 will be recovered (Reuters)

After a weekend-long dissection of the NHS long-term plan’s headline ambitions, it was hoped that Monday would fully flesh out what’s in store for the health service as it invests a £20.5bn budget increase over the next decade.

The final document, which runs to 136 densely-typed pages, has commitments for every corner of the NHS and has received near-universal praise for its ambition and detail.

In particular it sets out that a £4.5bn slice of the budget increase will be spent on GP and community care to diagnose diseases early and treat people closer to home.

But the NHS has been clear the £20.5bn increase – by 2023 – is less than the health service needed to repair eight years of austerity. And responding to the plan health system leaders have been equally clear that there are significant questions unanswered about what will be cut to allow the NHS to recover performance and meet its new ambitions.

Dr Chris Moulton, vice-president of the Royal College of Emergency Medicine said committing to relieve pressure on A&E by having GPs and nurse’s care for patients at home was “commendable”. However this could fundamentally change the job, and the hours, that doctors and nurses are asked to do.

“If this change is to work, then this care must be available, like emergency care, 24/7,” he said. “This will need serious commitment on the part of other specialities and agencies.”

He also expressed concern that the plan had been shorn of expected detail on flagship waiting time standards, like the four-hour target for patients to be treated or discharged at A&E.

Changing the target could mean patients wait longer at A&E with complaints that aren’t life-threatening.

Launching the plan at Alder Hey Hospital on Monday, Theresa May said targets had been “slipping”, adding: “We are looking at what are the right sort of targets for the future.”

This will be delivered in a separate clinical standards neview, but NHS bosses warn the need to make money stretch could override the best interests of patients.

“There is little emphasis at all on reducing waiting times for patients except for those waiting longer than a year,” said Professor Derek Alderson, president of the Royal College of Surgeons.

Meeting the 18-week standard for patients to be treated for non-urgent conditions after a GP referral is not included in the plan and waits have ballooned after last year’s unprecedented winter crisis.

“There is therefore a risk that focusing on one-year waits will lead to much greater variation in waiting times across the country,” Prof Alderson said.

Patients in pain will wonder how longer waits fit vision of improved health service

 Professor Derek Alderson

“Patients in pain needing a heart, brain, or any other type of operation will wonder how a longer wait fits with today’s vision of an improving health service.”

However there was more welcome news in the plan's calls for the government to scrap “damaging” NHS reforms implemented in 2012 by Conservative health secretary Andrew Lansley. These required NHS groups to compete with private organisations for contracts, creating costs and posing barriers for organisations to collaborate.

The British Medical Association said: “[We] have consistently called for such a wasteful use of resource to be scrapped, so to see NHS England recognise this is long overdue.”

The biggest beneficiaries of the plan are those areas which have been neglected too long in previous budgets, but even here the plan makes clear that tough choices lie ahead about what will be prioritised.

Mencap welcomed commitments to close “shocking health and care inequalities” experienced by people with learning disabilities, by targeting them in staff training and offering patients annual health checks.

But Oonagh Smyth, the organisation's executive director of strategy, said it was “disgraceful” that a government commitment to cut numbers locked away on secure mental health wards had been delayed until 2024.

Scrapping this wasteful use of resources is long overdue

British Medical Association on NHS competition rules

Mental health services have been allocated a £2.3bn chunk of the new funding, which along with new waiting time targets is intended to help ensure fewer vulnerable patients reach crisis point.

Sean Duggan, chief executive of the Mental Health Network, said extra spending on young people’s mental health was particularly welcome and “will help treat 345,000 more children and young people by 2023-24”.

While the plan has aspirations for solving the workforce challenges, a more detailed report being drawn up outside NHS England – and also due on Monday – has been delayed.

Alongside the uncertainty about the impact of Brexit on future costs and staffing, and the issue of social care for the growing number of older people who need daily support, the NHS’ best intentions could still be sunk.

"While NHS leaders have done what was asked of them within the constraints of the funding settlement provided by the government, some significant pieces of the jigsaw are still missing,” said Richard Murray, chief executive of the King’s Fund think tank.

“There should be no illusions about the scale of the challenge ahead.”