NHSE sets long-term plan priorities

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NHSE sets must-do actions for long-term plan
Set out alongside other commitments where local leaders will have more freedom

NHS England has split its priorities between “critical foundations” the service must deliver under “nationally defined” timing and requirements, and other commitments where areas will have “substantial freedoms”.

The division is set out in the NHS long-term plan implementation framework, published at an NHSE and NHS Improvement joint board meeting today.

Sustainability and transformation partnerships and integrated care systems are expected to use the guidance to produce five-year system plans, to be submitted in draft in September and finally in November.

Today’s document has few additional details, but includes timetables of phasing information. It is understood specific LTP programmes are likely to issue their own guidance separately in coming weeks. Today’s document does, however, include indicative allocations for various workstreams, worth £3.3bn by 2023-24.

The programmes NHSE says are “critical foundations” are:

Community services and primary care, including primary care networks and new community health services;
Urgent and emergency care;
Personalised care;
Digital primary care and outpatients;
Cancer;
Mental health;
Doing more planned surgery, cutting long waiters, and reducing the elective waiting list; and
All systems becoming ICSs by April 2021, including setting out “how they see the provider and commissioner landscape developing”. This may include a “new fast-track approach to assessing transactions for [provider] groups”.

In these areas, “additional detail, trajectories, and expectations of progress in the early years of the long-term plan implementation are expected”.

In a range of other areas, the document says these are not being set yet and there will be more flexibility. This may be because “national enabling actions are required”, there are “varying starting points”, or a need to reflect local priorities.

These include; prevention; maternity and neonatal services; children and young people; learning disabilities and autism; cardiovascular disease; stroke care; diabetes; respiratory disease; research and innovations; genomics; volunteering; and wider social impact.

Asked at today’s meeting whether systems would have flexibility on how to spend LTP investment, NHSE chief executive Simon Stevens said: “Not on mental health and primary medical and community services… frankly there is no part [of England] that is doing so brilliantly on its mental health services [that we can say], ‘Ok, take the foot off the gas.’” He said these requirements covered “a minority of the total growth… therefore people have got very significant discretion”.

The guidance tells all areas to produce a “strategy delivery plan” and “supporting technical material”. After a September “initial submission”, they should “agree their plans by mid November 2019 and publish them shortly thereafter”.

Digital details

Health systems are being asked to develop another round of regional IT plans outlining how they bring lagging organisations up to “minimum standard” by 2024.

The long-term plan implementation framework requires local leaders to develop a strategy that “describes how digital technology will underpin their local system’s wider transformation plans over the next five years”.

The strategy must include a plan for digitising secondary care and bring trusts up to a “defined minimum level of digital maturity”. The plan does not include a definition of this minimum level.

It must also include plans outlining how the system will use “digital blueprints” developed by trusts involved in the global digital exemplar programme, and share IT systems across organisations.

Systems will also have to outline how they will use “approved commercial vehicles” such as the health system support framework to ensure technology vendors and platforms comply with national standards.

The plan states: “On top of significantly higher local investment in technology, central funding (revenue and capital) will support the delivery of these strategies. Access to this will be managed and coordinated by our regional teams who will support ICS/STPs in establishing an affordable and realistic pipeline of digital investment in each region within the funding envelope available.”

No additional central funding has been announced for NHS tech since the publication of the long-term plan and the centre has consistently spent less than promised on digitising trusts in recent years.

The digital plans are part of wider system plans that must be submitted to NHS England by the end of September and agreed in November.