This month’s Fit for the Future: 10 Year Health Plan for England will constitute the most ambitious attempt to reset and reform the NHS for a generation.
The Government’s Health Plan, spearheaded by Wes Streeting, is not merely tinkering and tweaking around the edges of reform – it is a frank and comprehensive attempt to steer Britain’s health service for the next quarter of a century.
As the Health Secretary wrote in the days before he launched the plan: “It really is change or bust. We chose change”.
On Monday [14th July] this week, Wes Streeting, together with the Chief Executive of NHS England, and the Director General of the 10 Year Plan face the House of Common’s Health and Social Care Committee, to answer questions on the plan.
The shoots of reform: Growing a ground up health service
If the Secretary of State’s committee appearance made one thing clear, it was that shifting the balance of power in the NHS is the crux of his vision.
From Whitehall to Trusts, ICSs and to patients. In the opening minutes of proceedings, MPs probed for detail on how this would be delivered in practice.
Responding to a question from Joe Robertson MP, Streeting confirmed that local systems would receive new strategic autonomy, and that this would be matched with equal financial freedom, saying: “We are trying to do a few things.
“One is to shrink the size of the centre, make its focus more strategic, hold the system to account on outcomes, and devolve as much power, resource and responsibility to as close to the frontline and at the frontline as we possibly can.”
He continued: “We also want to make sure that our financial flows and incentives are aligned with our public policy objectives. If there is one thing I have learned about the system, in the last few years that I have been in this portfolio, it is that money talks”.
Yet Wes Streeting was keen to convey that while he views decentralisation, and the slashing of bureaucratic constraints as crucial to future success of the NHS – he sees guardrails that accompany such decentralisation as equally important: “The worst thing we could do is take the plan and the end state that we are aiming towards and try to impose it all in one go now.”
He went on to explain how changes to transition to a decentralised NHS would come from visionaries within the system – not civil servants.
He said: “We are not interested in going in and bulldozing through things that are working in pursuit of the thing that we think will be the future. It is far better to let people opt to be the pioneers themselves, show how it will work in practice, and inspire other people to follow.”
A quiet revolution of effective delivery?
During his committee appearance, Wes Streeting repeatedly reflected on previous examples of ambitious attempts to reform the National Health Service. The three shifts at the core of the 10 Year Health Plan (from analogue to digital, from sickness to prevention and from hospital to community), he admitted, are nothing radical. They’ve been proposed many times before. But, he said, “delivering on them really would be [radical].”
That’s why, he stressed to the committee, his Department are working with stakeholders on designing the implementation of the Health Plan.
When Joe Robertson MP pressed for more details on delivery – telling the Health Secretary “there is so little in here about how you are going to deliver”, he explained that his collaborative approach would be what enabled the vision of the 10 Year Health Plan to be turned into a reality, and that, when appropriate, innovators within the NHS would be permitted to lead the way and show how delivery could be manifested.
“On everything, from the new governance arrangements for the reinvigorated foundation trust model, to how integrated health organisations will work, to how we will deliver neighbourhood health, we
will be doing it with system leaders.
“We will set some people free to go faster than everyone else and show us what the future looks like, and others will follow,” he added.
A new paradigm of prevention
As the Secretary of State himself stated, the three shifts at the heart of the 10 Year Health Plan are not new, and radical ideas. Prevention in particular has been a priority of growing salience for successive Governments.
But, going forward it will be an indispensable North Star for the Health Service, as it aims to become truly sustainable.
In the committee, Wes Streeting laid bare the costs of preventable conditions, and the cost of harmful lifestyle choices: £7.3 billion a year for obesity, £4.9 billion for alcohol, and £1.9 billion for tobacco. He stated that these are not just abstract figures – they’re the “price for failure.”
The 10 Year Health Plan’s focus on prevention is in some senses conventional and bold simultaneously. Familiar public health levers such as sin tax and smoking cessation are included in the Health Plan, but so are novel interventions such as a mandatory nutritional reporting system for supermarkets – aimed at changing the contents of shopping baskets for the better.
In this 10 Year Health Plan Prevention is no longer an auxiliary strategy, existing alongside traditional healthcare approaches – it has now been reframed as central to the NHS’ future survival.
Featured image via Simon Dawson / No 10 Downing Street
