Yesterday, the Government published its policy paper ‘Fit For The Future: 10 Year Health Plan for England‘, which announced:
[I]nvestment has to be accompanied by reform. The NHS has to be redesigned around the needs of the patient. Local hospitals cannot be run from Whitehall. There will be a new relationship between the Department of Health and the NHS […]
The principles of subsidiarity will apply. A new system of earned autonomy will devolve power from the centre to the local health service as modernisation takes hold. […]
A Modernisation Agency will be set up to spread best practice. Local NHS organisations that perform well for patients will get more freedom to run their own affairs.
Or actually, it didn’t. That quote is from ‘The NHS Plan: A plan for investment. A plan for reform‘, published almost exactly 25 years ago today, during Tony Blair’s first term.
Reading the two documents side by side is a stark reminder of how little ever changes in healthcare. Over long passages, you would not be able to tell which document is which, unless there is some obvious giveaway. For example, the 2000 document talks about how ‘[t]he digital TV revolution will enable people to tune into channels dedicated to health issues’, while the 2025 document talks about how ‘[t]he digital era is democratising knowledge. […] Advances like AI will only increase patients’ ability to directly access health information’.
One of the big themes of the 2025 plan is ‘Shifting from hospital to community’, on the grounds that ‘evidence is unequivocal that more care in the community is cheaper and more effective than defaulting to all care in hospitals’. Fair enough. But then, this was already a theme in the 2000 plan, which said, for example: ‘By 2004 patients who currently have to go to hospital will be able to have tests and treatment in primary care centres as staff numbers and skills expand: by 2004 consultants who previously worked only in hospitals will be delivering approximately 4 million outpatient consultations in primary care and community settings’.
Another big theme of the 2025 plan is prevention:
Prevention will be how we restore the means to lead a healthy life in places […] where it has become most difficult. In turn, it will be our route to create a healthier, fairer, more prosperous country. We stand at the cusp of a historic transformation in our means to deliver on the promise of prevention.
But this was already a theme in the 2000 plan, which said, for example:
The NHS will focus efforts on preventing, as well as treating ill-health. […] [T]he NHS will work with other public services to intervene not just after but before ill health occurs.
The 2025 plan repeatedly laments that the NHS is overcentralised:
Power is concentrated in Whitehall, rather than with local providers, staff and individual citizens. […] [W]e will require a new operating model that supports rather than impedes the redistribution of power from the centre to the frontline.
Nothing new under the sun. The 2000 plan already contained a promise for ‘local services to have more control over the way they were organised, with less control from Whitehall’.
The section ‘From analogue to digital’ in the 2025 report describes the NHS as a technological laggard:
Modern technology has given us more power over our everyday lives. […] Across the economy, technology has shifted power from producer to consumer, giving us the ability to choose. That change is yet to come to the NHS. […] [T]he NHS remains a distinctly analogue service.
If the report is to be believed, this will change radically over the coming years. But then, the 2000 report already promised that soon:
The NHS will have the most up-to-date information technology systems to deliver services faster and more conveniently for patients. We are already investing £200 million in modernising IT systems. As a result of this NHS Plan there will be:
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- an extra £250 million invested in information technology in 2003/04
- electronic booking of appointments for patient treatment by 2005
- access to electronic personal medical records for patients by 2004.
It short, it all feels a bit Groundhog Day.
Maybe I’m being too harsh. The fact that certain themes keep reappearing does not mean that there is never any progress in these areas. Maybe some of these are more like ongoing challenges rather than one-off ones which have an obvious endpoint. The fact that we keep making the same New Years’ resolutions year after year does not mean that those resolutions are useless either.
There are good things in the plan, even if they are not genuinely novel. The NHS App, which was useful enough during the pandemic, has largely been lying dormant since, because there was not much that one could do with it. The 10-year plan wants to add extra functions to the app, so that it becomes a tool for conveniently choosing healthcare providers, and a source of information about them. NHS Trusts will be given greater autonomy over their budgets, and payment formulas will be changed, to strengthen the principle that the money follows the patient. When patients are strongly dissatisfied with the care they receive, it will even be possible to withhold a part of the payment from the provider. These are all sensible extensions of Blair-era reforms.
And that is, perhaps, the most generous reading of ‘Fit For The Future’: it is a revitalisation of an earlier reform agenda, combined with some evergreen topics that, within the current system, never truly get sorted out.
In the current context, this is probably as good as it gets. But it comes nowhere near justifying the Government’s bombastic rhetoric of ‘transformational change’ or a ‘break with the past’. It is Blairism with a smartphone, nothing more, nothing less.
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