Ill Prepared: The strengths and weaknesses of the government’s 10 Year Health Plan for England
The government has announced its vision for health policy in England, with a plan to create a new model of care, fit for the future, that reimagines how the NHS provides care.
Alice Billin, our Head of Public Affairs and Campaigns, assesses what the 10 Year Plan gets right and what it is currently missing.
They say a week is a long time in politics. So a decade can eclipse a political lifespan. But while governments might fear tomorrow’s headlines, their vision must be to the long-term future if they want to deliver meaningful change.
And so it is welcome that the 10 Year Health Plan for England, published this week, is the latest in a number of announcements from the government that indicates a willingness to grapple with the long-term structural and systemic challenges this country faces.
This week the Prime Minister announced that, as part of the plan, millions of patients will be treated and cared for closer to their home by new Neighbourhood Health Service teams.
Part of the reforms will also see the development of the NHS App which will become the “complete digital front door” to the NHS, where patients book appointments, manage medicines, and view data.
In general, the Centre for Ageing Better welcomes the direction of travel of this vision with its focus on prevention and community. But naturally, there are concerns too.
A large part of the context and rationale for this significant reform is a recognition that things cannot carry on as they are with an ever-rising bill to run the NHS.
The 10 Year Plan opens with a reference to our ageing population: “Demographic change and population ageing are set to heap yet more demand on an already stretched health service.”
At Ageing Better, we welcome the recognition of this substantial change, something that not all governments or major policy announcements have taken into consideration in the past.
And yes the UK’s population is undergoing a massive age shift. By 2050, one in four people will be over 65. But there is a concern in the tone used here that risks pointing the finger at older people and stoking intergenerational conflict.
The fact that many of us are living longer is a great achievement. And a crying shame that, for the lack of preventative healthcare and equal opportunity for healthy ageing, that many more are deprived of the chance for long lives.
The vision should not be how do we stop too many older people overburdening the NHS, the vision should be how do we help everyone to have the best chance of a living a long and healthy life.
It is right that a significant focus of the 10 Year Plan is to move care back into the community. In many cases, a hospital is no place for a sick person. But much resource has been removed from communities in recent times and so we need to ensure that there are sufficient financial resources for the role we want community to play.
Our own research has shown how community organisations, when properly resourced, contribute to healthy ageing, in particular with a preventative element of providing opportunities to remain living independently, active and aiding social participation.
With the ambition to move care from hospital to community, there also needs to be recognition that increased care at home means increased pressure on informal carers. We need to make sure systems are in place to support carers, such as paid carers’ leave to help more people balance paid work with caring responsibilities.
We agree with the government’s assessment that the current health inequalities, which mean that certain people are more likely to experience worse NHS access, worse outcomes and to die younger, is an intolerable injustice that should not be allowed to continue.
It is absolutely imperative that the 10 Year Plan helps to significantly reduce the huge gap in healthy life expectancy. But it will only be possible if the government also tackles the wider determinants of health across people’s lives, ensuring that everyone has the same opportunities to have a good job, financial security and a decent home, and to develop and maintain connections to family, friends and a supportive wider community.
We want to see the government establish a Commissioner for Older People and Ageing to ensure that older people’s needs are considered across measures to build a healthier nation.
And we cannot hope to tackle health inequalities, if we can’t properly measure and understand them. The current lack of good national quantitative data about the experience of many groups currently contributes to a lack of understanding on how and when to target interventions on those most at need.
The NHS and IT systems have a chequered history with many examples of big spending and big promises amounting to very little. So experience tells us to be wary of the promises of how much easier engaging with the NHS will be with the newly developed app.
The government says the 10 Year Health Plan will align with the Digital Inclusion Action Plan to deliver reach out to socially excluded groups. It is absolutely vital that the pursuit of technological advances does not lead to digital exclusion, making it harder for some people to get the support and treatment they need, and potentially increase their social isolation.
In taking forward its reforms, the government must recognise that not everyone is a digital native and there are many reasons why digital-first is not the straightforward option for everyone including wealth, locality, accessibility, connectivity and familiarity with technology. Some people never will be digital only and we need inclusion plans to acknowledge that and ensure the continuation of non-digital options.
The 10 Year Health Plan makes only fleeting reference to housing as part of its future vision. This is a significant omission.
Avoidable illness or injury that occurs as a result of a person’s home costs the NHS and social care billions of pounds every year. There are 3.5 million homes in England that are a serious threat to their occupants’ health and safety because of trip hazards, overcrowding, a lack of adequate facilities, and dangerous levels of cold and damp.
Evidence suggests home improvement services (such as aids and adaptations, repairs and maintenance, and energy efficiency) are an effective and cost-effective intervention to prevent falls and injuries for older people, improve mental health and improve performance of everyday activities. If we do not fix our nation’s homes, we cannot fix our nation’s health.
We do welcome that the 10 Year Health Plan recognises the importance of health to employment and good work and that keeping people in work will now be an explicit and intended outcome for the NHS.
The NHS will have a vital role to play in arresting a dangerous trend. The UK is headed in the wrong direction for older workers with ill-health. The likelihood of being out of work due to ill-health is on the rise in the UK while falling elsewhere in Europe.
The UK boasts a high employment rate for those without health conditions, keeping pace with best-performing peers in Europe, but the gap between those with and without health conditions is one of the widest.
So the publication of the 10 Year Plan is a promising step in the right direction. But the real work starts now.