|
No one plans to fail, they just fail to plan.
If you ask me, big chunks of the NHS are in free-fall simply because there is no plan.
The 8.5yr plan (undeliverable), the workforce plan (parked), the redundancy plan (non existent)…
… so, it is with a good deal of cheer that we should welcome the arrival of the Medium Term Planning Framework.
A good old-fashioned bit of proper planning. If it could speak I think it would have a Geordie accent… if you know what I mean.
I have ploughed through it so you don’t have to. I think there are eight important points. Here goes:
1. Are the performance trajectories realistic?
The framework sets demanding recovery targets across almost every major access measure by 2028/29:
- 92% of patients treated within 18 weeks
- 85% for the 62-day cancer standard
- 1% or less waiting over six weeks for a diagnostic test
- 85% seen within four hours in A&E
- 18-minute Category 2 ambulance average
With the exception of the ambulance targets that I do think are likely to be achieved, these represent dramatic gains in a system still battling the daily limitations we all know about.
The NHS history books tell us the danger is; steep trajectories encourage gaming, creative accounting, or demoralisation rather than sustainable reform.
2. Tight financial and productivity squeeze
All ICBs and trusts must achieve break-even or surplus positions while delivering 2% annual productivity gains. With no deficit support.
Ouch!
In a high-inflation environment, this is near-impossible. Efficiency targets on this scale risk cutting into quality or frontline provision.
A ‘fairer funding distribution’ is promised but there’s no formula. Uncertainty is the enemy of planning.
3. Multi-year planning versus central control
A major rhetorical shift from annual planning cycles to three to five-year system plans.
Gordon Brown did this and it worked, it creates certainty.
More autonomy for local leaders. Milburn pushed an earned autonomy schtick 20 years ago and it ended up with mid-Staffs.
Genuine local autonomy depends on central behaviour. The framework is vague on what rules, approvals, or reporting will actually be removed. Forget it.
4. Digital-by-default and NHS App ambitions
By 2028/29, 95% of appointments after triage are expected to be available through the NHS App...
... which will become the patient’s 'primary portal’.
Including two-way messaging with patients on waiting lists, a virtual ‘NHS Online’ service linking GPs to an ‘online hospital’.
Risks;
-
Sit in a GPs waiting room and watch the people come in. A lot ‘just can’t do’ the technology thing. They’re not old, or stupid. They just can’t cope.
-
For many their concept of personal services for intimate issues makes the App incongruous and perhaps anathema... meaning the risk of...
-
Over reliance on digital uptake across a digitally divided population
-
Integration headaches across incompatible systems
-
Hype-to-delivery-gap if expectations outpace capability
The App strategy could be transformative… or not… dunno.
5. Hospitals still dominate despite community rhetoric
Although the plan repeats the mantra of ‘care closer to home,’ the measurable priorities all centre on acute-sector constitutional standards.
Resources and leadership attention will inevitably follow what’s counted.
Expect community and preventive services to be crowded out by the gravitational pull of hospital performance management.
6. Mental health protection quietly omitted
The Mental Health Investment Standard, important because it guarantees spending growth at least in line with overall NHS growth... where is it? Dunno.
In an era of tight finances, the absence of a clear safeguard leaves mental health budgets exposed to acute-sector pressures.
Politically, this omission will become a flashpoint if waiting-times or crisis-care deteriorate and related benefit payments continue to rise.
7. Culture change… collaboration under stress
The framework calls for ICBs, providers and local authorities to ‘deliver change together.’..
... yet current system relationships are strained by funding inequity, workforce shortages, a threat of job losses and target pressure.
True collaboration takes trust, time and shared incentives.
Mandating joint working from the centre risks performative compliance rather than genuine integration… add to that new contracting models scheduled for November… I’m not sure.
8. Data, workforce and realism gap
All ambitions rest on two fragile pillars… reliable data and a sustainable workforce.
The framework assumes both will improve, yet the workforce plan remains only partially implemented and digital infrastructure clunky and uneven.
Will the plan deliver? Is it plausible? Can it be done? Probably, maybe, perhaps. Dunno.
But I do know...
... it'll take a warrior-leader to deliver an ambitious organisation for the future...
...but that leader would do well to be a worried-leader; doing it with people who have been shown so little respect…
… and who, themselves are worrying about their own future.
| 
