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Why we can’t yet judge the Long-Term Plan

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As a great start to 2019, the NHS has a £20.5bn annual budget increase – and the Long-Term Plan will determine how it is spent. The Government pledges to keep the NHS a world-class service and to prioritise this investment over all other public services.

The plan outlines new services, priorities and working practices. Out-of-hospital care is heralded as the means to improve the nation’s health and the highest-ever proportion of the total NHS budget is to be assigned to primary and community services.

The improvements to the health of the population promised by the Long-Term Plan will require a considerable increase in numbers and skilling of the nursing workforce. The plan sets out ideas for an increase in nurse training – more apprenticeships, an online nursing degree, ‘earn-as-you-learn’ support for qualifications in mental health and learning disability – but no specifics on funding and implementation. This is disappointing.

The workforce implementation plan is due after budgets have been agreed with Health Education England. The Long-Term Plan cannot be achieved without a dramatic increase in nurses to meet the needs of an ageing population. Poor planning has left more than 40,000 NHS nursing vacancies, with CPD funding cut by 60%. 

Now the Government has pledged an increased spend on workforce development and CPD for primary care and community settings, and to increase the CPD budget over the next five years, which may help with the shift of care. Yet 55% of nurses do not work directly for the NHS: the plan must include nurses in general practice and care homes.

To retain skilled staff, the Prime Minister indicated the plan would contain flexible working models and career development that would ‘reset the deal the NHS has with its staff’. But delaying the workforce element has not inspired confidence. Investing in the nursing workforce, undoing divisions between healthcare providers and increasing health promotion are all laudable, but continued cuts in public health budgets may hamper the lifestyle changes to improve health. Moreover, the Government plan for social care is absent. Without joined-up services and investment, bed-blocking and unnecessary admissions may jeopardise progress.

I impatiently await the workforce plan this year.