Something slipped under the radar last week which has relatively significant implications for the NHS. The Chief Executive of NHS England, Simon Stevens, said in an interview to the Health Service Journal that he will publish a Five Year Forward View delivery plan, reaching up to the end of this parliament (2020), in February or March 2017. Stevens said that the plan will set out explicitly “what the NHS is going to do over the next several years”, while also “recognising the circumstances the NHS is facing [including] pressures from social care [and] other pressures in the system.” This could just be a document repeating promises already made: explaining how the NHS will implement the plan it’s been working towards (rather than through) since 2014 with the money it was given in 2015. Planning a plan seems a bit longwinded though – the reality could be more nuanced.
At the very least, this delivery plan should put meat to the bones of the proposals emerging through Sustainability and Transformation Plans (STPs) over the last few weeks. Painted as groundbreaking documents which will pave the way for reconfiguring NHS services to meet the challenges of 21st century healthcare, the reality has been slightly more woolly. Glancing at each STP as they currently stand, you’re likely to see familiar language around prevention, public health and making efficiencies rehashed without many concrete plans for how their proposals will be achieved.
It’s worth noting though that STPs are likely to encounter a great deal of local political wrangling between now and next spring, as many controversial proposals for service closures and restructures have been exacerbated by the fact that they have been discussed thus far behind closed doors. Many areas are now embarking on public consultations on the documents, and there is potential for this to turn tricky. As an example, Shropshire Council and Telford and Wrekin Council have already said they are unlikely to approve their local plan because of a lack of resources for primary care. Therefore, the likelihood that Stevens’ plan will consider STPs alone is slim – how can it be written about changes that might not have been finalised before its publication?
What’s more probable is the timing of this publication is crucial, as the Chancellor’s Spring Budget will – if tradition is followed – happen on the third Wednesday of March, or the 22nd of the month. It’s not a huge leap of imagination that setting out a plan for how the NHS will achieve its strategic objectives and make use of its funding over the coming years, only weeks before the country’s funding settlement for the year ahead is published, is not simply a coincidence. Reports this week have suggested that the Government is revisiting social care funding (albeit in a manner one could argue will not be sufficient to meet need) by looking at allowing local authorities to raise council tax to pay for social care. I would bet that similar considerations are simultaneously being made for the NHS’s funding settlement.
Simon Stevens was noted for his constructive working relationships with David Cameron’s government, but NHS funding was conspicuously absent from the Autumn Statement last month. It may well be that he has been nurturing the type of rabbit the Chancellor will pull out of his hat next spring, rather than failing to plant one at all. Because Philip Hammond has made clear of his need to be certain of the fiscal credibility of an idea, rather than the political expedience of it, Stevens may have been working on meeting the Chancellor in the middle on this one: by making clear how additional NHS funding will be spent while applying for it.