So how have the other more recent (2014-2019) long-term NHS plans fared?

In yesterday’s post I stated that I was a lot less interested in what NHS Plans said than what they did.

And that the way in which they were created had a major impact on their ability to actually do anything.

Andrew Lansley’s 2010 NHS Plan contained a great deal of direct legislative power. But it faltered when it encountered reality because it was developed with a very small group of people (perhaps in that case only 1 person).

OK, that person had a lot of power, but as it turned out not enough to change the NHS.

My argument is that since we are going to have a long-term NHS plan in the next year or so, how it is developed will have an enormous impact on both what it says and whether it achieves anything.

Today I want to look at the two most recent NHS plans. The Five Year Forward View – produced in 2014, and the 2019 NHS Long Term plan.

My main reason for focusing on these two plans is because they were, as written, very, very, good plans. They describe a future that is very different from the present and are genuinely visionary.

If the NHS had spent the five years between 2014 and 2019 implementing the Five Year Forward View, it would be in a much better position now. The same goes for the 2019 long-term plan.

What is important about them both is not what they said but the fact that they didn’t happen.

They both outlined a future in which much more would be spent on prevention. But the public health grant was cut.

They both outlined a future which had primary and community care as a much more crucial part of the NHS. But as a proportion of NHS spend it has declined

They both argued for a future with much greater integrated care. Whilst we now do have integrated care boards, as I argued last week an 85-year-old woman with three long-term conditions still needs a spreadsheet to keep track of the different health care professionals with whom she must make appointments. And she still has to tell her story many times over.

The organisation that published the plan (NHSE) was the same one that failed to develop its implementation. This disjuncture between the direction of a plan and real activity in the NHS undermines many people’s belief in the purpose of planning.

One really important legacy from the experience of these plans not happening is that a lot of people now don’t believe that what people say in plans has any relevance to what happens.

So when the next plan puts at the centre of the NHS.

    • The importance of prevention
    • The movement of care out of hospitals.
    • The introduction of comprehensive new technology and
    • The development of a greater skill mix amongst care professionals

people look back at the 2014 and 2019 plans and think “Naah that’s just not going to happen”.

This leads to a really important paradox which the next plan must cut through.

Which is that whilst nearly everyone would agree that if, in the next decade the NHS and social care doesn’t comprehensively tackle these issues, the future looks very grim, many people believe they just can’t be achieved.

Everyone can reasonably ask – what is the point of having another plan that says we need to do these 4 things when two really well written plans said the same thing  in 2014 and 2019? Already having had two very good plans arguing for comprehensive change that didn’t take place rather begs the question “What is the point of another one?”

This could lead to people perhaps feeling that there is nothing we can do.

    • We can’t prevent.
    • We can’t move care out of hospitals.
    • We can’t introduce comprehensive new technology and
    • We can’t really take on the traditional mix of skills.

Given that my and many other people’s argument is that in the next 10 years we have to make these changes work, this understandable pessimism about the limits of change has to be confronted.

My take from the 2010, 2014 and 2019 experiences is that the nature of the plan, the process of its development and how it contains its own implementation is key.

2010 is an object lesson for the Labour Party. Simply having a plan developed in opposition (as Lansley did) and then, within weeks, pushing legislation through based on those ideas may fit well with the idea of an electoral mandate, but on its own has insufficient power to succeed.

2014 and 2019 provide different lessons. It may seem an odd thing to say but simply being right isn’t enough. Most people would agree with most of the themes of change in both of those plans, but they didn’t happen. The forces ranged against them didn’t have to argue their case – they just didn’t change.

One of the roles of the plan must be to mobilise the power that makes its implementation inevitable.

The next few blogs will be about how to do that.