Thoughts on the Long Term Plan

blog | 15 Mar 2019

In January NHS England published the Long Term Plan for the NHS. It set out its position on what the NHS should focus on between now and 2028 – how our most beloved institution should change, what it should invest in, and what its priorities should be.

It turns out that the changes NHS England want to see aren’t new. Rather, the Plan sets out the express intention to take the best of what the NHS is already doing and to do them in more places, with more consistency for greater impact.

We’re excited to see this shift, and in this blog series we’ll share our insights about how to scale great practice, drawing on our experience of doing this with a range of partners in recent years.

January already seems a long time ago, and much of the new year optimism and best intentioned resolutions are a rapidly fading memory.

But let’s take ourselves back to those frosty mornings for a moment. The NHS started off the year, as many of us did, with a new vision for itself. And it followed the advice that accompanies most new year resolutions – that the key to good change is to make it sustainable and ‘long term’.

The content of the (very long) Long Term Plan has been widely documented and well summarised (see Carnall Farrar’s plan on a page and The Kings’ Fund’s detailed explainer for digestible versions). Some of what it contains has been welcomed, such as the increased focus on community care and commitment to digital ambitions, but there are also some notable absences, such as the workforce plan that will enable this change and the integration with social care.

At Innovation Unit, one of the many parts of the Plan that caught our attention was the assertion right at the beginning that “almost everything in this plan is already being implemented successfully somewhere in the NHS”. This marks a significant shift for the NHS – away from a focus on designing new solutions to known challenges, to scaling known solutions to known challenges.

There are many drivers behind this shift (which merit a blog post in and of themselves), but in short: the last two decades have seen us move from a time of economic prosperity when there was freedom and funding to explore, to a time of constraint, challenge and uncertainty (Brexit anyone?). There is now much to gain by exploiting the rich knowledge generated during those times when the system could afford experimentation. We’re excited to see this at the heart of the Long Term Plan.

This shift from creating to growing ideas feels familiar for the IU team. On our tenth birthday, two years ago now, we thought hard about what our contribution should be to social change over the next decade. As experts in disciplined innovation we have incubated some fantastic public sector innovations but we realised that we needed to shift our focus within an increasingly pressured public system. Yes we need to keep developing new solutions, but also to create greater impact by scaling up solutions that we know work (read more about our work to scale the Lambeth Living Well model here).

Our ideas about how to do this are summarised in our model for scale, and have come from our experience of taking fantastic innovations to scale elsewhere (for example in children’s social care), and our research with The Health Foundation on how to scale innovation within the NHS ‘Against the Odds’.

One of the key findings from that research was that if you want to take evidence based practice to scale, you need to align with national and local system priorities.

The NHS Long Term plan gives a clear set of national system priorities for improving care quality and outcomes – it lists the ‘major health conditions’ that the health system must focus on in order to improve poor health and reduce burden on the NHS. These ‘major health conditions’ are set to be the focus of funding and attention over the next ten years, and the proven solutions that will be taken to scale will most likely be those that address these health conditions. And herein lies a problem.

The Plan has siloed improvement priorities into individual conditions, and in doing so have woefully under recognised the multimorbidity faced by a significant (and costly) proportion of the British population. If the funding attached to these priority areas is similarly oversimplified and siloed, it is likely that the approaches that are spread across the NHS will be too – and therefore will not address the true complexity of the health challenges we face. To have real impact on people’s lives, and relieve the pressure on the NHS, we need to identify and scale solutions that deal with the actual complexity of multimorbidity.

With a wish to prevent this, we have some specific ideas about how to realise impact at scale on some of the Long Term Plan’s priority areas. At the heart of each of these is a recognition that we need to focus more on solutions that look at people (not conditions), how they live their lives and what kind of support they need.

1. Developing integrated, neighbourhood working: based on our experience of working with West London CCG, and applying these lessons in Southwark, to create more effective, more efficient health and care provision in the places in which people live, our neighbourhoods.
2. Better meeting the changing and growing needs of ageing: based on our experience of working with health and care systems to help them really understand what older people want in terms of their lives, care and support.
3. Supporting people with learning disabilities: based on our work around the Named Social Worker, developing personalised social care support to people with learning disabilities.

We will do a deep dive into each of these priority areas in a series of blogs over the next few weeks. We’ll aim to offer insights on both how the Long Term Plan can realise its ambitions within the challenge areas it has identified, and how it can do so through the method it proposes: spreading what is already being implemented “successfully somewhere” to the whole of the NHS.