NHS 10-year plan: Promises and Challenges

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NHS 10-year plan: Promises and Challenges

Cong Minh Nyugen



The new plan indicates an additional 20 bn pounds to the NHS by 2023, a third of which will be spent of improvements GP consulting, community care, and mental health[1]. This means a shift of the budget away from hospitals, which is taking up around 50% of the £114 bn frontier budget, towards these three sectors that currently only account for less than a quarter of spending [2]. Compared to the Five Year Forward View of Simon Stevens, the Chief Executive of NHS England, 5 years ago, he now provides more detailed commitment rather than a solely strategic vision. The most eye-catching pledges are [2]:

1  Provision of round-the-clock advice from NHS 111 by 2023 and targeted services for 345,000 more young adults through community services and schools in England to improve mental health care.

2  One in five new mothers are now struggling with mental health in the first year of her baby’s life, so there is a push for a leading ‘world-class’ maternity care by enhancing safety and giving more mental health support to new parents.

3  Expansion of the use of personal budgets to provide the elderly with greater choices and controls over their healthcare to reduce cases ending up in hospitals.

4  Quicker detection and prevention of disease through better testing, especially of cancer. The aim is to increase the number of early detections from 1 in 2 cancers to 3 in 4 by a comprehensive DNA test, which in turn will enhance the rate of survival.

5  Expansion of the NHS workforce, whose rate of vacancy now is 1 in 11 posts.

6  Modernising the NHS by digital technologies, including online GP booking, prescriptions management and health records to improve access to healthcare by reducing hospital outpatient appointments and increasing screen-based consultations for patients at home.

This plan is then called by Mr Stevens as a “practical, costed and phased route map” for the coming decade for the sustainability of the NHS [1].

However, there are three main challenges to be addressed for the future of this plan:

Firstly, what is the source for £20bn extra? May said it was partly from the ‘Brexit dividends’ as what Leavers regarded in 2016 as the savings of £350 million per week from stopped payments to the EU [2]. However, the chaos of Brexit and the defeat of the Prime Minister’s news means that such a promise can be offset by a much bigger catastrophe of the divorce bills as well as a further damaged economy. Indeed, The Treasury has dismissed such a suggestion, warning the risk of a future tax rise to pay for the plan[2].

Secondly, there is hardly a guarantee that £20 bn is enough to truly meet the new commitments as well as patient’s rising demands. The proposed 3.4% real term annual increases in funding for the next five years indeed only equals to the long-term average for the NHS, albeit more than under the coalition and Conservative governments, so efficiency savings must be made to free up more resources to turn the transformation of NHS’s services into reality [3].

Thirdly, staff shortages remain a huge problem for the NHS. Mr Stevens reassured his plan to train between 25% and 50% more nurses and establish five new medical schools to train doctors. However, this is a long-term solution while hospitals clearly shows an urgent need to balance their books and patients are suffering from long waiting time in A&E, for routine and cancer operations mainly due to staff shortages [3]. This can be worsened by Brexit. Europeans account for 5% of the NHS workforce [3]. Despite the government’s promise to give them a ‘settled status’ to stay in the country and also plan a new skilled migrants system, it is pointed out by unionists that since the cut-off for this status is an earning of at least £30,000 per year, some lower-paid non-clinical staff and nurses are left out [4].

As long as these three problems persist without solutions, the 10-year plan can hardly do much to improve the quality of NHS in real terms.



[1] New NHS plan ‘to save 500,000 lives’. [online] Available at: https://www.bbc.co.uk/news/health-46777387 [Accessed 17 Jan. 2019].

[2]  NHS plan ‘lacks funding and staffing’. [online] Available at: https://www.bbc.co.uk/news/health-46771200 [Accessed 17 Jan. 2019].

[3] Will NHS long-term plan deliver the goods?. [online] Available at: https://www.bbc.co.uk/news/health-46783621 [Accessed 17 Jan. 2019].

[4] Are Lansley’s NHS reforms being binned?. [online] Available at: https://www.bbc.co.uk/news/health-46827981 [Accessed 17 Jan. 2019].

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