The NHS long term plan lays out a strategy for the modernisation, redesign, and expansion of the NHS. The plan focuses on priority areas for improvement, covered in seven chapters:
- a new service model for the 21st century
- more NHS action on prevention and health inequalities
- further progress on care quality and outcomes
- NHS staff will get the backing they need
- digitally-enabled care will go mainstream across the NHS
- taxpayers’ investment will be used to maximum effect
- next steps.
The plan guides strategy for the entire NHS, but the role of specialised commissioning remains essential to delivery of many aspects of the plan.
Cancer survival is at the highest level it has ever been, and 1-year survival has improved significantly since the millennium. The long-term plan identifies that one of the greatest priorities in the NHS to improve cancer survival is to achieve earlier diagnoses; it sets ambitious targets, planning to increase the proportion of cancers diagnosed at stages one or two to three-quarters of patients by 2028 (an increase of around 55,000 people), by:
- lowering GP referral thresholds
- increasing awareness of cancer symptoms
- accelerating access to diagnosis and treatment
- expanding the number of cancers identified through screening.
A number of action points are aimed at improving care for children and young people with cancer. Survival rates in this population have doubled over the past 40 years, but cancer is nonetheless the most common cause of premature death in people aged 5–14 years. The NHS intends to:
- offer whole genome sequencing for all children with cancer from 2019
- support the implementation of the new generation of chimeric antigen receptor T-cell therapy
- increase teen and young adult participation in clinical trials to 50% by 2025
- offer all boys aged 12–13 vaccination against HPV-related diseases, including oral, throat, and anal cancer
- match-fund CCGs who increase their investment in local palliative and end of life services over the next 5 years.
- Other focuses of the plan to improve cancer care include:
- speeding up the implementation of new techniques and technologies
- providing safer, more precise treatments such as advanced radio- and immunotherapy, including reforms to specialised commissioning payments for radiotherapy hypofractionation to support further upgrades
- extending the use of molecular diagnostics and routinely offering genetic testing to all people who will benefit
- a target, by 2021, to provide every person diagnosed with cancer (where appropriate) with access to personalised care, including a needs assessment and care plan.
Some strides are already being made in providing new cancer treatments. On 23 January 2019, a 15-year-old boy with a rare form of brain cancer began proton beam therapy (PBT), a state-of-the-art form of precision radiotherapy, at new £125 million facilities in The Christie hospital in Manchester. This centre is the newest and most up-to-date PBT facility in the world, with a second due to open at University College Hospitals London in 2020. Prior to becoming available in the UK, the NHS paid for patients to receive PBT abroad.
NHS England also published updated service specifications for the provision of adult external beam radiotherapy services in January 2019, laying the foundations for:
- improved access to modern radiotherapy techniques
- improved experience of care
- increased participation in research and clinical trials
- reduced variation in quality of services and equipment.
Mental health is an essential part of modern holistic healthcare, and the relationship between physical and mental health has become much better understood. The plan includes a significant investment in mental health services of at least £2.3 billion by 2023/24. This will include support for community services, information sharing, and digital interventions.
During pregnancy and the 2 years following birth, around a quarter of women experience mental health problems. A lack of access to high‑quality perinatal care is believed to cost the NHS and social care £1.2 billion annually. Many aspects of the plan’s ambitions for perinatal mental health will be the responsibility of the mental health national programme of care, including:
- expanding access to evidence-based care for women with moderate-to-severe perinatal mental health difficulties and a personality disorder diagnosis to 24,000 by 2023/24, in addition to an extra 30,000 women receiving specialist help by 2020/21
- extension of post-birth perinatal mental health services from 12 months to 24 months following birth
- expanding access to evidence-based psychological therapies to include parent-infant, couple, co-parenting, and family interventions
- offering support to fathers and partners of women accessing services, to help care for the 5–10% of fathers who also experience perinatal mental health difficulties.
Mental health support for children and young people is another feature of the long-term plan, acknowledging that many mental health problems develop early in life. This includes support for community-based services and educational institutions, increasing the availability of preventative support to reduce the demand on child and adolescent mental health services.
Neonatal critical care
As part of the plan, neonatal critical care services will be redesigned and expanded to address shortages of capacity and improve triage within expert maternity and neonatal centres. The aim of this restructuring is to make the right level of care available as close to the family home as possible.
The expert neonatal nursing workforce will be expanded, including roles for some allied health professionals to support the work of neonatal nurses. To enhance the experience of families during neonatal critical care, care coordinators in clinical neonatal networks will be expected to work with families to be more involved in the care of their children from 2021/22 and invest in improved parental accommodation.
Stroke is the fourth leading single cause of death in the UK, and the largest single cause of complex disability. The plan acknowledges that hyper-acute interventions, including thrombolysis and brain scanning, are best delivered as part of a 24/7 networked service. A number of goals have been set for centralised hyper-acute stroke care:
- increase the number of stroke patients receiving care at a specialist stroke unit to 90%
- expand mechanical thrombectomy availability from 1% of stroke patients to 10%
- work with Health Education England to modernise the stroke workforce.
Research and innovation
The NHS plan acknowledges that patients benefit enormously from the NHS working in partnership with the life sciences industry, with research and innovation providing access to essential breakthroughs that can improve services across all stages of care.
The NHS endorses and supports the Life sciences sector deal between the Government and industry to implement the next phase of the 2017 Life sciences industrial strategy. The deal will build on the achievements of 2018 and makes major new commitments and investments in the UK.
The NHS will also take an active role in research and innovation by:
- increasing the number of people participating in health research, to 1 million by 2023/24
- supporting investment in potentially transformative areas, particularly genomics—the NHS will be the first national health system to offer routine whole genome sequencing where appropriate, aiming for the new genomics service to sequence 500,000 genomes by 2023/24
- expanding infrastructure for real‑world data collection
- investing in dissemination of new ideas, including guaranteed funding until April 2023 for Academic Health Science Networks (AHSNs), which have succeeded in spreading proven innovations.
The new Voluntary scheme for branded medicines pricing and access (VPAS) published in December 2018 is also mentioned as a way to help patients ‘benefit from faster adoption of cutting-edge and best value drugs, demonstrating [the NHS’] commitment to innovation while also supporting the sustainability of the NHS.’ The plan also aims to create a simple, clear system for medtech and digital innovations to speed up the pipeline and deploy innovations to patients faster, including:
- a new advisory service for innovators, linked to AHSNs
- a unified approach to ‘horizon‑scanning activities’
- a new medtech funding mandate to accelerate the uptake of proven, affordable innovations, which will apply to medtech products assessed as cost-saving by NICE.
The NHS has faced significant challenges in recent years, with both funding and workforce stretched in many sectors; the long-term plan will no doubt pose a significant challenge, but it contains a framework to improve staffing levels and funding, including the reinvestment of any efficiency savings directly back into front-line services. Specialised services will play a key role in providing cutting‑edge care and be an essential driver of innovation and the implementation of new therapies and technology.