Published: 22/04/2002, Volume II4, No. 5902 Page 3

Senior policy makers have started work on a five-year plan for the NHS, outlining the direction the service will take should Labour win the next election.

Five key areas have already been identified for this July's all-important public service agreements. The PSAs form the basis of the Department of Health's commitment to the Treasury on what it will achieve following the three-year comprehensive spending review, which starts next year.

Significantly, two new PSAs are included this year: chronic-disease management and improving patient experience. Neither featured in the last PSA round in 2002.

The other three are access to treatment, health of the population (or public health) and value for money.

According to Richmond House sources, the five areas will also form the basis of the DoH's fiveyear plan proposals. Drawn up on the demand of prime minister Tony Blair (who has made similar requests to other government departments), they are likely to be published as a formal policy document this summer. The plan was also the subject of two meetings between the prime minister and health secretary John Reid at Chequers, the prime minister's country residence.

HSJ has also been told of highlevel discussions on the possible targets which could end up attached to July's PSAs and as part of the five-year plan.

Although many proposals remain in draft form, they could include introducing a maximum four-month wait target from point of referral to treatment.

This move would strip out the hidden waits for diagnostic services which have often prevented current waiting times reflecting real patient experience. The current 2008 target of maximum three-month waits only applies for treatment from the patient's initial consultation.

And officials have also discussed a new target to reduce inappropriate hospital admissions by 30 per cent.

This, it is argued, would offer a strong incentive for both primary and secondary care to improve chronic disease management.

There will also be a new 2.5 per cent efficiency saving target. The NHS is currently expected, but has traditionally struggled to deliver, 2 per cent savings year on year.

A consultation with the NHS on the proposals is expected to begin next month.

Director of patient experience and public involvement Harry Cayton said he could not comment on the specific PSAs to be set by government. But he said he was keen to see a greater focus on CDM and targets which better reflected the patient experience. '[A target from referral to treatment] has got to be one of the steps forward because targets have been very helpful in focusing us on some issues that matter.

But we need to refine them to make sure they are useful and effective and do not have those perverse incentives, and I think that people are thinking very hard about that.'

He said that if patients were waiting three months for a diagnosis before they even got on the waiting list for treatment, that needed to be taken into account.

Mr Cayton said strengthening the emphasis on patient experience in government policy required a 'deepening' of existing efforts, already going in the right direction. But he suggested CDM was a bigger challenge.

Mr Cayton said: 'This [subject] is newer and more radical and there is a debate still to be had. First, there is how does the health service manage people with chronic disease? We need to look at that, but more importantly how do patients with CDM manage themselves and the health service?

'I think we will see a real push to expand the expert patient programme as part of that [action on CDM], ' he added.

A copy of a presentation given last month by Simon Leary, a member of the DoH strategy unit, entitled DH Strategic Priorities and the Five-Year Plan, has been leaked to HSJ. It places the work at Richmond House alongside three of the most important policy developments of the Labour government - the NHS plan, Delivering the NHS Plan, and choice/payment by results.

There are two statistics influencing the shift to chronic-disease policy. The first is a graph contained in Mr Leary's five-year plan presentation showing just 5 percent of inpatients account for 42 per cent of inpatient bed days (see page 5). Mr Blair drew attention to this statistic during the Labour Party's Big Conversation public meetings, when he promised an announcement on CDM (news, page 8, 25 March). The other is the cost of illness to the jobs economy.

And Mr Cayton suggested the cost of chronic disease to the economy could provide an important driver for change. He said the expert patient programme - which will come under his control from 1 May - had already demonstrated how patients could get improved care in a scheme which also reduced misuse and overuse of healthcare resources.

'Where the CDM has a real resonance at a political level is that there are wins across the system.'

NHS Confederation policy director Nigel Edwards said: 'The question being asked about this five-year plan is whether it is just a refreshment of the NHS plan and whether it is going to be radical enough for the next step forward.'