It is tempting to see strategic plans as radical calls to arms but generally they are not. A long sea voyage in uncertain waters is a more apt metaphor. The great merit of the new NHS Long Term Plan is that it is presented as a journey – one that does not underplay the many risks but does build on what we know, keeps us on a consistent course, and lays down a number of challenges.
There are parallels with Captain Cook’s three great expeditions of the 18th Century. Firstly he bought a significant degree of clarity to the topography of the regions he explored; secondly he took with him scientists and explorers from many disciplines, which meant that the learning transcended a number of scientific boundaries, bringing benefits in the fields of oceanography, astronomy, natural history and even elemental anthropology; thirdly he was a great planner, planting forests of pine trees on the Hawaiian islands (now called Cooks Pines) so he would always have access to mast replacements for his ships; and lastly he learned as he went, showing an aptitude for flexibility without losing sight of the principle aims of his voyages.
If the Five Year Forward View was rather like Cook’s first voyage – bringing order to chaos and setting out the art of the possible – the Long Term Plan is more like his second. It is based on a multi-professional approach; takes us further, in particular using the benefits of new technology (Cook’s deployment of John Harrison’s Marine Chronometer was as revolutionary in its time as the smartphone and the internet of things); it is more informed by experienced and arguably better resourced; and perhaps most telling, it does not propose any unexpected restructuring.
The last is particularly important. Cook benefited enormously from the fact that there was no change to the fundamental design of his ships, which were rather unglamorous Whitby coal boats whose enduring claim to fame was stability. Similarly the underlying architecture of the Long Term Plan is familiar and we are not going to be distracted by another upheaval of the sort that we were required to collectively deliver in 2013. Stability and continuity are key.
Three things stand out from the Ten Year Plan for me:
- There seems to be a general consensus that the priorities are reasonable, particularly with regard to areas such as maternity and mental health and the general focus on intervening downstream.
- No-one is underestimating the workforce challenge, in particular the complexities of an increasingly specialised workforce against the background of Brexit and a historical skills deficit. Politicians will inevitably dispute the resource requirements but there is a willingness to get the workforce algorithm right.
- The Digital Age is upon us and we have both a Secretary of State for Health and Social Care and a head of the NHS that are committed to making it central to the next ten years in a very practical way.
It is worth noting that, largely on the basis of a successful first voyage and because of a number of political imperatives, Cook’s plans for his second journey were not only approved but put in motion immediately. The NHS Long Term Plan fits closely with the ambitions we have locally and which we expect to publish shortly as part of a new ten year plan for Surrey. At both local and national level we should endeavour to follow the 18th century example and get on with the tasks of integrating and transforming care without delay so we can make a real long-term difference for local people.
Dr Claire Fuller
Senior Responsible Officer
Surrey Heartlands Health & Care Partnership