Overtaken by events: COVID-19 and progress towards the NHS Long Term Plan Q&A with Ruth Thorlby

1 October 2021

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Nearly 3 years on from the launch of the 10-year strategy for improving and reforming the NHS in England, our new report The NHS Long Term Plan and COVID-19 takes an in-depth look at the progress made so far. We spoke to lead author Ruth Thorlby, Assistant Director of Policy at the Health Foundation, about the impact that the pandemic has had on delivering the main aims of the NHS Long Term Plan and what needs to happen to get back on track. 

What impact has the pandemic had on delivering the aims of the NHS Long Term Plan? 

The pandemic struck just over a year after the plan was published, a year designed to lay the groundwork for many of the plan’s commitments. Some of this had progressed, for example new Primary Care Networks were created, but work on delivering many of the plan’s goals had only just begun when COVID-19 arrived. It’s clear that no part of the NHS Long Term Plan has been unaffected by the pandemic. Current waiting lists for hospital care are the worst on record, standing at over 5.6 million at the end of July 2021. But the disruption hasn’t just been to hospitals – there’s been unprecedented disruption across the whole health system, with exacerbated staff shortages, widescale redeployment of staff and completely new ways of working.  

COVID-19 has exposed and widened the inequalities in health and care that exist across England, so even though implementation of the plan has been disrupted, the principles that underpin the plan – which include taking more action to prevent ill health and reduce health inequalities – are more relevant than ever. The challenge now is to take a step back and consider how we move forward with the pledges made in the NHS Long Term Plan, given the backlog in care and the constraints the health system is still facing. 

Are there any parts of the plan where delivery has been accelerated by the COVID-19 response? 

We’ve seen a rapid escalation in the use of remote consultations, particularly in primary care. This represents a significant step towards the NHS Long Term Plan goal of ‘digital first’ primary care, but it’s important to recognise that the transformation happened through necessity. Even though some face to face consultations continued, a large proportion of GP care started being delivered through phone or video consultations in order to reduce the risk of infection – and this change happened almost overnight.  

While this will have been a positive experience for many patients, it may have been a less positive experience for others, including those who don’t have a reliable internet connection, or lack access to a private space to use for the call. Work is already being done to evaluate the effectiveness of remote consultations, and the impact on patients and staff. Evaluation is vital to ensure that the move to remote care doesn’t unintentionally widen existing health inequalities.  

How has the pandemic affected attempts to redesign care to improve health and inequalities? 

There has been progress in building new collaborations, but the pandemic has disrupted a lot of plans. For example, the NHS Long Term Plan led to the formation of over 1,200 Primary Care Networks (PCNs) with a remit of redesigning care to improve health and reduce inequalities. Some of the work that PCNs were expected to undertake has been delayed, but many of them played a central role in COVID-19 response, such as leading on the vaccination programme.  

All parts of the country are now covered by Integrated Care Systems (ICSs), which form a key plank of the Long Term Plan, but there have been delays to their work on preventing ill health and reducing inequalities. As not all ICS plans have been published at a local level, there are still a lot of unanswered questions about what these organisations will be focusing on, how we’ll know if their work is delivering results, and how they will be held to account.  

Given the additional demand on services following the pandemic, is there enough money in the pot to meet the aspirations of the plan? 

Although significant additional investment in the NHS has been promised, it’s unlikely to be enough to achieve the commitments set out in the Long Term Plan and recover from the pandemic. One challenge is that right now we don’t know exactly how big the backlog for hospital care will be, since many patients didn’t come forward for care during the pandemic and hospitals can’t function at full capacity while COVID-19 is still circulating. We’re also seeing evidence that some of the targets that were set in the plan, for example those around expanding access to mental health care, will need to be revised to account for greater demand for these services. 

Tackling the waiting lists will need to be a priority, but it can’t be the only focus – work also needs to move ahead on prevention and inequalities. Tackling the roots of ill health, by increasing spending on housing, education and employment, as well as better social care, will be critical here, as the NHS won’t be able to achieve this goal on its own. 

What changes are going to be needed to deliver on the NHS Long Term Plan in light of the pandemic? 

The first thing we need to understand is the scale of the care backlog and how long it will take to clear it. This can then feed into an updated strategy for delivering the reforms and improvements set out in the Long Term Plan. The updated strategy will need to include revised ambitions which take into account the impact of the pandemic and the new demands that it has created, while also maintaining a focus on preventing disease and reducing health inequalities. As well as increased spending on the NHS, there’ll need to be wider government investment in social care, public health, and other services that shape health. 

Shortages across the NHS workforce existed before the pandemic but there’s now an urgent need for a fully funded, long-term plan for expanding and supporting the NHS workforce. And more work needs to be done to produce data that measures progress against the NHS Long Term Plan objectives – not just for headline areas such as cancer care but in the areas where we have significant data gaps at the moment, such as in primary care and community services. Transparent reporting on progress on all of the long-term commitments is needed to guide effective work at both a national and local level. 

Find out more 

Download the report The NHS Long Term Plan and COVID-19 

This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.

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