Insider tales and must-read analysis on how integration is reshaping health and care systems, NHS providers, primary care, and commissioning. This week by integration correspondent, Sharon Brennan.

reported this week that the five-year system plans – setting out how each area will implement the NHS-long term plan, are being delayed by at least a month. Purdah rules and a need to “refine” them has been cited by the centre as the reason for the delay.

For months now I’ve been hearing that it was the timeline itself, and the different submissions and templates required to respond to the 77 deliverables in the long-term plan, that was a distraction from the actual business of developing sustainability and transformation partnerships into integrated care systems. That’s not been helped by the fact that regional teams have been going back to some local areas to ask them to make the plans more stretching.

There did seem a commitment among STP leaders to meet the previous 15 November final deadline, though, if only to ensure they can get on with other things. So the extension is likely unwelcome, not least because it will extend the ongoing work well into winter pressures management. 

Looking a few months further ahead, the national implementation programme for the long-term plan, which had been due in December and will be an aggregate of the local plans, may also face a much longer extension than the NHS would like.

The election may have diverted the nation’s attention from Brexit, but the country is still currently expecting to leave the EU with or without a deal at the end of January. Whatever government is formed before Christmas, signing off an implementation plan for the NHS will not be top of its agenda.

In line with this, Brexit might too delay the first submission of local system draft operational plans for 2020-21, which are due at the start of February. It seems this initial, short, delay in finalising system plans may well create an unwanted domino effect to the rest of the timeline.

Filling in the blanks

I’ll be spending time most months looking at what is missing from the long-term plan and its and implementation plans.

While the long-term plan identified the growing number of people with multiple long-term conditions as a driver to increased healthcare costs, it was fairly silent on what local systems are expected to do about managing them.

Indeed, it seemed counterintuitive for the plan to segregate major long-term conditions into their own sections: cardiovascular, stroke, diabetes and respiratory diseases. This is especially true when, for example, diabetes causes 530 heart attacks and 680 strokes in the UK every week.

Leaders will recognise the financial costs that people with multiple conditions bring to the system, but the link with health inequalities is not always so obvious. In England around one in four people have two or more long-term conditions, and this number is growing, yet in more deprived areas people develop multiple conditions 10-15 years earlier than in more affluent places.

Next week a taskforce on multiple conditions, led by the Richmond Group of Charities, will publish work on how some local systems are working with people who have multiple conditions.

Neil Tester, director of The Richmond Group, told me: “We have found that health and care services can struggle to meet the needs of people living with multiple conditions if they are organised around a single disease or need. This can fragment care and result in a high ‘treatment burden’ as people self-manage, take treatments, interventions and have appointments for many different conditions individually.”

Some of this treatment burden may be tackled through the expansion of the personalised care and personal care budgets, but a lot of this needs new thinking about how to integrate care around a person: and not just at GP level but by different secondary care providers too, a much tougher ask. It will be interesting to see if these concerns have been picked up in the local system plans once they are finally published.