The Health and Social Care Act was passed in 2012 and caused the biggest upheaval of the NHS in its history. It did this at great speed, while at the same time trying to make unparalleled financial savings. The Act abolished NHS primary care trusts (PCTs) and Strategic Health Authorities (SHAs) across England, transferring between £60 billion and £80 billion of commissioning, or healthcare funds, from the abolished PCTs to several hundred clinical commissioning groups (CCGs), partly run by GPs. Executive agencies were also established under the Act. At its heart was the notion that more competition in the NHS would create a service fit for the 21st Century. The level of determination raised alarm bells. The scale of efficiency savings expected of the NHS was without precedent (House of Commons Health Committee, 2011). On completion of the Lansley reforms in 2015 health visitors were moved into local government and this accomplished the transfer of public health from the NHS to local councils.
Another historic event was the arrival of the 136-page, 10-year NHS Long Term Plan (NHS England and NHS Improvement, 2019) at the beginning of this year. This sets out a vision for how services in England will be transformed over the next 10 years. It also outlines how the £20.5 billion annual funding boost for our NHS will be spent. How the funds are spent needs much consideration as healthcare spending is a continuously moving target—as we age, as the population grows and as we develop more chronic diseases, there will be a need for extra funding just to stand still. If successfully implemented, the plan could save 500 000 lives but there must be a focus on prevention and early detection.
The NHS Long Term Plan has called for integrated care systems (ICSs) to be created across England by 2021. ICSs are partnerships that can bring together hospitals, CCGs, community services, charities and councils; the goal is to permit these organisations to work together as opposed to working against each other. The number of ICSs is growing, in 2-3 years they will be well established as the number of CCGs declines.
As the NHS Long Term Plan is implemented over the coming years this could see the unravelling of the Lansley reforms. Those reforms have been and are being judged as one of the worst policy failures of all time. The 2012 Health and Social Care Act and the changes that ensued were vehemently opposed by various Royal Colleges and trade unions. Such a vast reform programme prompted a former NHS chief executive to say it was ‘so big it could be seen from space’. With a future change in legislation and a review of statutory functions the NHS Long Term Plan could be paving the way for a whole new structure and new ways of working, begging the question: how on earth did the 2012 Health and Social Care Act ever become law?
The NHS Long Term Plan is, without doubt, going in the right direction. It could bring with it the prospect of creating a unifying national service for health and it is packed with a number of good ambitions. In order for these ambitions to come to fruition, however, and for these good intentions to be converted into better treatment and care for patients, there will need to be the right number of nurses with the right skills in the right place across our NHS. Worryingly, nowhere in the plan is there any money for nurses to develop their skills and the specialisms that patients need. The provision of online courses (as good as some of them are) will not be the panacea for our workforce crisis—currently, in England there are 41 000 nurse vacancies in the NHS (Royal College of Nursing, 2019).