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16 January 2019

In a fitting start to the New Year, May’s NHS Ten-Year Plan is full of unrealistic resolutions

The ring-fenced £22.5bn over five years is less than the service needs simply to stand still, let alone make up for a decade of cuts.

By Phil Whitaker

First expected in the autumn, then Brexit-delayed until at least December, there was something fitting about Theresa May finally unveiling her NHS Ten-Year Plan on 7 January. The New Year sees people up and down the land resolving to clean up their acts and do better things in future, so why not the government?

In much the same way that many smokers will have announced to friends and family that this year, for certain, they are going to break the habit, the Tories have vowed to give up a couple of dangerous addictions. Most significantly, the Ten-Year Plan signals an end to the ruinous competition imperative enshrined in Andrew Lansley’s 2012 Health and Social Care Act. Those responsible for commissioning services will now be expected to foster collaboration between providers, rather than pitting them against each other in competitive tenders every time a fragment of the system comes up for redesign. This should see an end to the cyclical “takeovers” of services by different providers every few years, which has wasted so much money and demoralised the workforce, squandering the public service ethos on which the health service relies.

The other addiction May’s plan promises to break is the NHS’s dependency on hospital care. Here the Ten-Year Plan sounds more like a booze-soaked uncle vowing to go teetotal after failing to do so on any number of previous occasions. Everyone knows what needs to happen: care of frail elderly patients with multiple long-term conditions has got to be shifted from hospitals to the community. It’s been a recurrent theme of long-term planning coming from the centre for many years, but we’re no closer to achieving it.

What would unlock the situation? In a nutshell, adequate funding for both primary and community care. The headline-catching sum for the NHS as a whole – £22.5bn over five years – is actually less than the service needs simply to stand still, let alone make up for a decade of real-terms cuts. And while £4.5bn is supposedly ear-marked to transform primary and community care, it has got to reach core services, something that previous funding intended for the same purpose manifestly failed to do. And we’re still awaiting another much-delayed piece of the jigsaw: the government’s green paper on social care. It doesn’t matter what bold schemes might be designed to shift more health care into the community; without a huge investment in social care there simply isn’t going to be the necessary support to keep people safely in their homes.

While the Ten-Year Plan promises an end to some destructive addictions, there is one that the government seems intent on pursuing. The lessons of NHS 111 – a nationwide experiment in trying to provide primary health care on the basis of computer algorithms – are being wholly ignored by the Babylon-obsessed Health Secretary, Matt Hancock. Yes, the Ten-Year Plan encourages new technology to improve patient access and convenience, and this is welcome. But alongside this, we are to have “digital first” general practices rolled out nationwide, copying the model that Babylon Health has shown to be so popular among Londoners who haven’t got much wrong with them.

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The NHS has launched its own app, which initial testing has shown to be every bit as woeful as its progenitor, Babylon’s GP at Hand. Hancock has an unshakeable belief that apps such as these will be able to do doctors’ and nurses’ jobs for them, solving the workforce crisis at a stroke. But beneath their shiny new AI clothes, these apps are just as effective as the software that powers NHS 111, the lamentable inadequacy of which has helped stoke the ongoing crisis in ambulance and A&E services.

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The idea of superseding NHS 111 with ‘‘digital first’’ apps is akin to that booze-sodden uncle renouncing whisky and swearing henceforth to drink only red wine, because he’s heard it’s so much better for you. It’s not going to end well. Happy New Year. 

This article appears in the 16 Jan 2019 issue of the New Statesman, How Brexit trapped Britain