NHS 10 year plan focuses on community care and prevention

The Government has published its 10-year plan for the NHS, which focuses on moving care from the hospital to the community and placing a greater emphasis on primary prevention.

The 10 Year Health Plan for England: fit for the future states that the NHS has too often been fatalistic about its role in prevention, and today’s NHS is more of a ‘sickness service’ than ‘health service’. But throughout this plan, that will need to change.

The report adds that disabled people often do not get the health support they need and face stark health inequalities, including poorer life expectancy. Individuals with learning disabilities die about 20 years earlier on average, but care from a neighbourhood team will improve their life outcomes through more holistic, ongoing support.

For children and their parents, the plan aims to ensure that health visitors fully support children’s broader development as part of this government’s plan to give children the Best Start in Life, including in supporting higher uptake of and better quality early childhood developmental checks.

Over the past eight months, the government received over a quarter of a million contributions from the public, health and care staff, health system leaders and organisations with an interest in health and care. This was part of the Change NHS initiative.

• Easy read: 10 year plan

Lord Darzi’s report on the NHS

The 10-year Plan follows Lord Darzi’s Independent investigation of NHS performance in England, commissioned by the Secretary of State for Health and Social Care in July last year. This investigation sought to examine patient access to healthcare, the quality of healthcare being provided, and the overall performance of the health system.

The conclusions were damning, finding that the NHS is currently in a critical condition and has been chronically weakened by a lack of capital investment, which has lagged behind that of other similar countries by tens of billions of pounds.

It found that there were important and severe variations in care for people with a learning disability, including:

• People with a learning disability are twice as likely to die from preventable causes and four times as likely to die from treatable causes, with areas such as respiratory care and cancer care of particular concern.
• There are multiple barriers that prevent people with learning disabilities from accessing the care that they need.
• Around three-quarters of people with a learning disability are not on the GP learning disability register.

It also made reference to the 2,000 people with severe learning disabilities and/or autism who continue to be detained in inpatient mental health settings, adding that: “the 2024-25 NHS Planning Guidance re-states the target to reduce inpatient numbers by 50 per cent, but this is in the context of failure to meet 2014, 2019, 2020 and 2024 targets.” Current estimates suggest that it may not be achieved until 2030 or even later.

Responses to the 10-year Plan

Tim Nicholls, Assistant Director of Policy, Research and Strategy at the National Autistic Society, said: “We welcome the Government’s ‘three shifts’ in healthcare, but there is no clear plan for the key issues impacting autistic people and the crisis in waiting times for autism assessments. We, and many autistic people and their families, are worried by this lack of clarity.

“Autistic people face some of the most extreme inequalities in the healthcare system. For an NHS that is truly ‘fit for the future’, we need to see access to timely autism assessments, accessible physical and mental health services, and an end to autistic people being locked away in mental health hospitals by providing sufficient community services that can meet the needs of autistic people.

“For too long, autistic people have been misunderstood and misdiagnosed by the healthcare system, without the support they need. We will keep campaigning for an NHS that provides true health equality for autistic people.”

Jon Sparkes OBE, chief executive of Mencap, said: “This is a bold, ambitious and promising plan and we’re pleased it acknowledges the stark health inequalities that people with a learning disability face. They die on average 23 years younger than the rest of the population and are twice as likely to die an avoidable death. There are still over 2,000 people with a learning disability and autistic people locked away in mental health units – they need homes, not hospitals.

“There needs to be more work to set out what this plan means for people with a learning disability.  The shift to prevention, community and digital could be transformative, but only if they are involved in shaping what comes next.

“Mencap supported over 1,000 people with a learning disability and their families to respond to the Government consultation on this plan, and we look forward to working with them to ensure these reforms really do tackle the health inequalities they face.”

Dr Rhidian Hughes, Chief Executive of the Voluntary Organisations Disability Group (VODG) sais: “We know that disabled people face significant barriers and inequalities when accessing healthcare. The shifts and commitments in this plan provide a welcome blueprint for change, which should improve the options available to people, reduce duplication and enhance inclusion. The focus on improving access through neighbourhood settings and increasing support based in and on the needs of communities also sounds promising, but only if the NHS looks beyond itself and truly embraces partnership with the third sector.

‘Many of the solutions the plan seeks to implement are already delivered by the voluntary, community and social enterprises (VCSE) sector, but without the investment and scalability needed to maximise their potential. We hope as part of the plan’s ambitions for a more responsive and person-centred system; the NHS is encouraged to harness third sector expertise.

‘Only by reframing relationships, as well as systems in the NHS, will this plan fully address the inequity experienced by disabled people and improve outcomes for all.’

Sarah Woolnough, Chief Executive of The King’s Fund, said: “There are more than 150 pages of a vision of how things could be different in the NHS by 2035, but nowhere near enough detail about how it will be implemented. Without this detail, it is hard to judge how the ambitions written on the page will make a difference to the reality of the care we receive over the next few years. From what we can see in the plan, there will be regional pilots for some proposals, which means some areas of the country will see improvements to NHS services before others.’

“Unless the relationship between health and social care services is urgently addressed, the failures of the social care system will continue to put huge pressure on the health service. The challenge may be whether the government is willing to act more urgently – or indeed at all – to implement social care reforms.

“The government’s prior announcement of the Independent Commission on Adult Social Care, led by Baroness Casey, offers a real opportunity to truly reform fundamental issues, such as the very tight means test. But we urge the Commission not to wait until its ultimate 2028 deadline before making its recommendations.”

Dr Jennifer Dixon DBE, Chief Executive of the Health Foundation, said: “The 10-year health plan sets out the government’s positive ambition to make the NHS sustainable for future generations. We welcome many of the changes in the plan – more integrated services, boosting primary and community care, harnessing innovation and technology, reducing health inequalities – but these are not new ideas and questions remain about how will be implemented and whether they will be backed by sufficient resources.

‘On the face of it, proposals to develop more integrated neighbourhood health services look similar to a long line of NHS policy initiatives, and it’s unclear whether past lessons have been learned to enable the latest versions to succeed. Plans to abolish or merge a swathe of NHS bodies and change the roles of many others might promise a less fragmented structure, but the NHS risks getting lost in organisational change when it should be focused on improving patient care.

‘Without investment and reform of the threadbare social care system, or co-ordinated action to address the wider social and economic causes of ill health, the plan remains largely a vision for the NHS, rather than a plan for rebuilding the nation’s health. The government’s health mission – which promised just such an approach – is currently missing in action and is in urgent need of resuscitation.

“The NHS is not broken but it is in a critical condition, so we welcome the scale of the government’s ambition. We now await the concrete action needed to turn rhetoric to reality.”

Alison Bloomer

Alison Bloomer is Editor of Learning Disability Today.

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