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NHS plan: still not fit

15 January 2019

Junior doctors in dispute over contracts and patient safety, Bradford Royal Infirmary, April 2016. Photo Workers.

The government published its overdue NHS Long Term Plan for England on 7 January. This details significant spending over the next five years, and it creates opportunities to improve the service. But there are several critical weaknesses those working in the NHS have to deal with.

The health service desperately needs long term planning. The attacks in recent years on health and social care finances, wages and pensions have lowered staff morale and undermined patient care. And in turn this has affected recruitment, retention and training. It will indeed take a decade to rectify the damage.


In 2010/11, just 5 per cent of NHS providers overspent their annual budgets. By 2015/16, two-thirds of trusts were in deficit as the slowdown in NHS funding took its toll. The injection of £20.5 billion over the next five years will not transform the service, but it’s welcome support.

Lifting of the pay cap is an important step too. The junior hospital doctors dispute in 2016 played its part in enabling these changes. Their contribution should be acknowledged.

When Britain leaves the EU without a deal it would save £39 billion that would otherwise have been spent on the divorce bill. Part of this must be secured for health and social care, although there are other competing priorities. More importantly there must also be planning to ensure that part of the money spent on our current annual payments to the EU is earmarked for health and social care


However welcome extra expenditure on the health service, a “long-term plan” must be strategic and comprehensive. The government’s plan is problematic in several ways.

One limitation is obvious in the title – this is a plan for England, while the NHS is national. Devolving health matters to Scotland and Wales constantly interferes with rational planning.

Equally frustrating is that the long-term plan does not engage with the crisis in social care. The King’s Fund, responding to the plan pointed out that the NHS and social care are “two sides of the same coin, yet the publication of the social care Green Paper has been delayed yet again”.

"The plan’s failure to address workforce issues exasperates NHS staff."

The plan includes worthwhile commitments to promote public health. And yet local government funding for public health services continues to be cut. But what most exasperates NHS staff is the plan’s failure to address the many workforce issues. It feels as if the government has decided to spend the money on a new conservatory while the roof is leaking.

The plan frequently refers to how new technology can enhance health care but that alone is not enough. As the BMA says “Fundamental to the expansion of cutting-edge treatments and digital consultations is to first get the basics right, such as the workforce. There is no use in opening the digital front door to the health service if we don’t have the healthcare staff behind it.”

Unison also highlights this as the most disappointing aspect. It points out that although the long-term plan recognises that workforce planning is “disjointed at a national and local level,” there is no detailed workforce strategy contained in that plan.


This failure to include the workforce strategy must be deliberate. A draft workforce strategy was published nearly a year ago. The final version was due to be published in July 2018 to coincide with the 70th birthday of the NHS.

At the time Workers welcomed the draft strategy as it was the first time the government acknowledged publicly that nurse recruitment numbers had been cut. The draft said “….had the rate [of UK nurse recruitment] remained at 2012 levels through to 2017, we would have 16,000 more nurses working in the NHS today – that’s almost half of our currently vacant nurse posts filled.”

That document also made the important historical admission that “maximising the self-supply of our workforce is critical. It cannot be right for the NHS to draw staff from other countries in large numbers just because we have failed to plan and invest.”

At the launch of the long-term plan in Sheffield, the Prime Minister announced she has appointed Baroness Dido Harding to produce a workforce strategy. But she made no reference at all to the 2018 draft workforce strategy. It seems the government wants to forget the home truths it let out last year.

The reality is that NHS workers and their trade unions have to work their hardest to address the workforce strategy deficiencies in the plan. For this they need their own short and long-term planning goals.


The most obvious urgent need is retention of current staff. That means improving staff pay and conditions and assistance with accommodation costs. The plan includes only a small amount of money to aid retention of current staff. Pressing for an increase and expansion to this funding must be an immediate priority for trade unions.

Solutions for the medium and long term can only come from NHS staff themselves. For example, doctors point to one post referendum achievement namely the expansion of the number of medical school places this September.

Since its inception the NHS has imported doctors yet there is no shortage of UK applicants with the enthusiasm or academic qualifications to meet our own needs. The aim of the long-term plan and the yet to be seen workforce strategy must be self-sufficiency in health care staffing.