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The Long Term Plan for the NHS in England

24 March 2019
Health staff discuss the long term plan with UK Prime Minister Theresa May
The UK National Health Service has just published its latest plan for how the NHS in England should be organised over the next five years and beyond. This 136-page document represents a vision of a future health service that is based more on treating patients outside of hospitals, with a larger role for new digital technology and, in theory at least, a much smaller role for market competition.

By Guy Collis

Overall, the plan represents a mixed bag of laudable intentions and daunting challenges for a system that remains beset by financial problems and a staffing crisis.

From a trade union point of view, there are some clear positives, including the potential for legislative change to remove the worst elements of the NHS market in England that were established by the abhorrent Health and Social Care Act of 2012.

It should, however, be noted that such plans are only suggestions from the NHS itself rather than clear commitments from government. It remains to be seen how realistic it is to expect politicians to push through legislation at this time, given that the UK Parliament remains deeply divided and dominated by Brexit.

Another positive aspect of the report is a focus on improving mental health services and an understanding of the need to halt the fragmentation of England’s ambulance and emergency services.

But there are less positive aspects too, such as the continuing desire to drag yet more “efficiency savings” from administrative budgets, despite the fact that most hospitals have already been cut to the bone.

And, as waiting times for treatment continue to grow, there is a renewed drive to offer private sector treatment to patients if they have been waiting too long for care.

Perhaps most important of all, however, is what is missing from the Plan, most tellingly the relatively meagre commitments for the workforce.

An accompanying strategy for the future health and care workforce has still not surfaced and until it does, it remains hard to see how the NHS will be able to implement many of the worthwhile ambitions contained within the Plan. 

Beyond this, the continued failure by the government to publish its proposals for social care, along with ongoing cuts to public health services, threaten to undermine the goal of a more cohesive health and care service for England.

There is of course further uncertainty stemming from the UK’s impending exit from the European Union and the lingering fear that the extra funding the government has committed to the NHS, while welcome, will only be enough to keep services from collapsing rather than allowing the system to make the much-needed improvements.

UNISON will be working hard in the coming months to keep up the pressure for a meaningful workforce strategy and to ensure that the voice of healthcare staff is heard in the way the Plan is implemented.


Guy Collis is the health policy officer of UNISON

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