The NHS Long Term Plan – will it help ensure our future NHS is fit for an ageing society?

Jan 10, 2019 | BLOG

The long-awaited NHS Long Term Plan has finally been published – but will it help ensure our future NHS is fit for an ageing society?

136 pages of Plan, reams of commentary, blogs, twitter threads and even song lyrics later, I’m not sure we’re much closer to knowing, but here are a few thoughts and some links to some other key commentators who might enlighten you further.

In general the consensus seems to be that NHS England has got the right idea when it comes to preparing the NHS for ageing. The plan reflects the longstanding consensus that a shift towards earlier intervention, and health promotion and away from acute services; towards integration and away from duplication, disjunction and competition; and towards support in the community and away from hospitals is the way forward.

So far, so good, but then these principles were included in the Five Year Forward View. So, has the NHS learnt anything about how to put these principles into practice in the last four years?

Perhaps, a bit. The vanguards have pointed some ways forward and these are now going to be rolled out, and the health system seems to have overcome its reluctance to do more of the patently sensible things that were already happening in some parts of the country – like social prescribing.  And there are other positive steps forward such as increased investment in mental health and plans to provide Living Well services for older people identified via the frailty index.

But along the way the NHS also seems to have forgotten a few things too – like the voice of patients, and the need to speak to colleagues in local government. And then, of course, there’s the fact that we’re also no further forward in the quest for a sustainable solution to social care funding, and our investment in public health is heading in the wrong direction.  And the NHS is facing serious workforce challenges, with shortages across the health system, not least within the GP workforce, on which older people particularly rely.

It is also frustrating that the hand of many authors reads clearly through the plan and, as you wade through the pages, you can feel a distinct clunk after the first chapters which talk the talk on integration, and shifting from acute care to primary and community care, back to an NHS rooted in medical model and focusing on a small (though admittedly growing) list of “favoured conditions”, and then another clunk as the NHS retreats in on itself to talk about how change will be achieved.

This matters because the majority users of the NHS are already older people, and older people tend to be ill-served by a condition-specific focus, because by the time we reach late age most of us live with multiple long-term conditions. Of course, the NHS needs specialist services that can respond appropriately to specific conditions, but increasingly they will need to do this in the context of a wider package of support that responds to the person and addresses what matters to them.

It is also important that the NHS looks outside because the change the Plan envisages will require partnership not only with local authorities, and voluntary and community organisations but also with people and communities – something the NHS seems struggle with – and about which it could learn a thing or two from local government.

So perhaps the fairest conclusion is that the Plan is a mixed bag, it sets out a good summary of the challenge ahead and points in the right direction, but has yet to fully embrace the scale of change that is required. Of course, with any policy plan, the real test is whether it makes any difference to people and communities. Until social care and public health underfunding and workforce shortages are addressed, this feels unlikely. But at least we agree where things should be, even if there’s still way to go to get there.  

Kate Jopling

Director of Programmes, ILC-UK

Kate is a policy and strategy consultant, with particular expertise in the fields of loneliness, ageing and equality. Since starting her consultancy in 2010, she has worked with a wide range of voluntary sector organisations to support them to develop and influence policy and practice across the ageing, health and care agenda.

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