Is the 10 year health plan the route we’re already travelling?

Two months on from the launch of the 10 year health plan, Martin Farrier ponders how much difference it has made

I’ve been wondering why the NHS chose a plan for 10 years.

Most NHS organisations are stuck within a perpetual groundhog year. We go around the same sequence of crisis events and pop out in April with the same resolutions and outcomes as last year. Our longest planning cycle took a stab at three years. Long enough to encompass a building project. Most of our exec team will leave long before 10 years are up.

Where will a decade take me? There will be, perhaps, some changes in direction. But I’ll still be a doctor. There will still be patients. 10 years feels like a long time – almost the whole of my remaining career.

When I consider the 10 years just passed, I’m surprised at how little changed within the NHS.

Covid took up so much of the last decade. When the world returned after Covid, it did so brutally.

We had aged. The queues in A&E filled the corridors. Discharges were much more difficult. We employed more people but didn’t do more work. We deployed ever more technology: I can access everything from everywhere. My patients have more accurate genetic diagnoses and diseases that had no treatment now sometimes do, but at a cost.

But the odd thing is that I don’t see more patients.

Groundhog cycle

The NHS 10 year health plan felt like flight directions. It’s been two months since it went up on the departure board and I haven’t noticed any change. Our one-year groundhog cycle is still rolling. So are the waiting lists.

Perhaps not everything is the same. We are implementing ambient AI. But that would have happened with or without the 10 year plan

But perhaps not everything is the same. We are implementing ambient AI. That arrived in a storm.

We are finding the money for Ambient AI because it offers better productivity, but that would have happened with or without the 10 year health plan. Perhaps the plan is describing the route we are already travelling: more patients seen without employing more people.

A decade ago, we complained that we didn’t have the workforce we needed. Now, if we choose, we could have enough staff with better technology and better productivity.

This coming decade we could focus expenditure on the people who provide care and less on the administration of care. We could invest less in buildings because they are less essential.

Once, I trained to be a GP. I wonder how I would have viewed the 10 year health plan if I had stayed in general practice.

GP surgeries have already grown dramatically since I worked there. They are larger hubs now. The one I worked in was physically extended years ago.

Under the plan’s shift to a neighbourhood health service, they will continue to expand. I think I would have welcomed the further expansion but worried that it was just greater expectation.

A 10 year plan at least demonstrates commitment. It allows us to shape ourselves to a future that we can imagine.

Cynically, it’s too long for any one government to be held to. It straddles more than one party. All the same, the plan tells us that we will still be here in 10 years.

Productivity is paramount. Most of the improvement in productivity has to come from technology.

The most productive of us are the health centres and especially the GPs. The plan tells us that frail elderly people are going to be an ever-increasing problem to society but they are not the focus of healthcare. It tells us to progress ever faster with healthcare technology and link it to our patients in every way we can.

10 years from now

Imagine where we will be 10 years from now. Hospitals aren’t expanding. Outpatient care provides most healthcare benefits. We all wear technology, and it links us together. Patients with no tech ability are connected with wearable virtual monitoring.

In my organisation we are building predictive modelling using the data we hold. Using it I’m three times better at predicting death and ICU admission. The prevention in the 10 year health plan is rather easier if you have data predictions of the future.

What is unlikely to change, is the problem of social care. And the very specific problems of corridor care and impossible discharge. There is also the problem of how to pay for the cost of care at home. Travel is one of the big costs of caring for patients at home.

I wonder if technology help us with this. Then I remember Uber. I didn’t see that coming. It was a job allocation system that accounted for travel and gave the job to the most appropriate person. Taxis became more productive and because they were more productive the costs dropped.

The NHS plan depends on technology driven improvements in productivity. It asks us to improve access to care and make it simpler and more accurate.

It is a plan for 10 years, but perhaps we shouldn’t worry about the feasibility of planning for a decade or be disappointed that little seems to have changed since the July launch.  Perhaps the plan’s strength is that is has confirmed a direction of travel many of us have been working towards for years.

Consultant paediatrician Martin Farrier is chief clinical information officer at an NHS trust.