The 10 year plan | our thoughts

So, after much consultation, feedback, and discussion, the government today released its new 10 year plan. Here at Inflammatory Neuropathies UK, I have taken some time to have a look through the proposals, and to outline my initial impressions and thoughts. 

On initial viewing, the new 10 year plan is pretty much as we expected, with the foundation of the plan being around the three shifts outlined during consultation, hospital to community, analogue to digital, and sickness to prevention.

Our members, the organisation, and I welcomed these shifts at the time, so again, welcome them now. However, the real shift will be in what these mean in reality, if they can be delivered well with improvements for people, and if some of the inherent dangers attached to them (and flagged by people impacted by Inflammatory Neuropathies) can be avoided. 

I have had a more detailed look at those three shifts outlined in the plan, and the proposals that have now been attached. I’ve outlined some thoughts below on each one. 

Hospital to community 

The plan outlines a radical change from a ‘hospital-centric’ model to one based around a neighbourhood health service. This is something that I personally have been advocating for at some time, with a more person-centred model in place that delivers at home, or in local services (with hospitals only involved where necessary. The plan outlines a move away from funding hospitals to funding hospital services, and while I expected this to be a long-term target, the promise is for this to begin within the next 3-4 years. The proposal is to end outpatients in hospitals by 2035. In my view, this is most welcome, and will both bring support to people, and relieve capacity issues in hospitals where they are needed. I also welcome the announcement that agreed care plans for people with complex needs will be introduced.  

I do have concerns around funding of new community facilities, and capacity to deliver in the community, so we will need to see how this develops. Also, while I welcome the focus on digital tools, the right infrastructure and access will be essential to deliver it. 

Analogue to digital 

Talking of data, the second shift is all about updating the NHS for a digital world. There is a real focus on data, which I have been calling for on for some time.

However, the focus is on building on good NHS data. My argument is that NHS data isn’t very good (where it is most needed) so this could be a longer journey than presumed. Also, the NHS has been notoriously bad at developing tech solutions, and there is no real discussion on how this will be delivered. 

The plan has a real focus on a better NHS App which will be the key entry point and tool for people accessing support through the NHS. It even talks about a ‘doctor in your pocket’. I agree that this should be the key way forward, and for most people will be a key breakthrough, especially in terms of accessing specialists where there are not any locally. However, we need to keep highlighting issues around digital inclusion, access, and ability, three areas where the UK has real issues, and which will need to be tackled before we can fully rely on digital tools.  

I was really pleased to see that better management of Long Term Conditions is highlighted as a key digital priority, along with access to more tools to self-manage, and to access and provide better support. 

Sickness and prevention 

I was more disappointed to see that the prevention plans were more focused around general health prevention, than specific or targeted prevention. This is a real missed opportunity and something that I have spent most of my career advocating for. While smoking, drinking, and obesity are all important general health issues, I wanted to see the plan tackle prevention in terms of stopping needs increasing, avoiding relapse or returns, and tackling the reduction of the impact of impairments and disabilities. 

Other areas in the plan 

Also in the plan, there were a few areas that I had some concerns about, but which may not be of as much concern to the Inflammatory Neuropathies Community.

In particular, there was a promise to build the capacity of Integrated Care Board (ICB) and ensure they become responsible for strategic commissioning. This comes in a plan released on the same day as many ICBs and beginning to deliver plans to reduce their size, scope, and budgets considerably (based on a neither government plan). We need to ensure that the right capacity is in place to deliver this plan, but are we asking those responsible to shed staff, only to replace them. Not a good strategy.  

Also, and related to this, the plan lays out a commitment to place more funding directly in the hands of NHS providers. This goes in stark contrast to the above, and in my view is a dangerous way of giving control to the hands of someone who may have an incentive to spend on their own services (would you give Tesco your debit card and tell them to do your shopping for you). 

In better news, there are plans to speed up clinical trials, and calls for better financial management in the NHS, something I think we would all like to see. There is also a big shift in terms of choice, and feedback from patients impacting finances and service delivery. This should be good for giving people more control. 

All in, I think it’s a good plan with some concerns and issues to look out for. My biggest take aways are that it seeks to narrow health inequalities (probably the biggest issue faced by our community) and that it talks about more partnership working with Civil Society and the Community Sector. 

We will of course look at the plan in more detail in the coming weeks and months, and will seek to be involved, have influence on, and support its delivery. We will keep you updated as things progress, but in the meantime welcome your thoughts and views through hello@inflammtoryneuropathies.uk