A Ten Year ... Manifesto from Labour

Last month, at NHS Confed Expo, Sally Warren dropped a hint about the way we should view the Ten Year Plan.

One of the key figures behind Wes Streeting’s blueprint told us we should remember it is a “Government White Paper not NHS planning guidance”.

I’ve been saying for a while the plan will likely underwhelm but if ever we saw an exercise in expectation management this was it.

I cannot fault the Secretary of State’s three shifts - analogue to digital, hospital to community and sickness to prevention - and they sensibly run like a watermark through the document.

A lot of the content - supervised tooth brushing, digital telephony for GP's and community outreach door-to-door - has of course long since been announced but generally speaking, I welcome the concept of a 'Neighbourhood Health Service' to "bring the NHS closer to home ... under one roof."

Many will however, not unreasonably, echo Sarah Woolnough from the King's Fund in asking when exactly it will be mean you can see a GP more easily, or get mental health support for your child or not wait hours in A&E.

I commend all the stuff around the 'next gen' NHS App, use of AI to track disease and aid patient safety so long as it is user friendly, actually prevents ill health and makes even a modest in-roads into the billions of pounds each year clinical failings cost the NHS.

But there is a sense, not least on commissioning and structures which are crucial to reassure investors of course, we still have as many questions as answers.

The challenge now for Ministers however is as much political as it is health.

The Welfare Bill climbdown, and the bad feeling it has created between Downing Street and its own backbenchers, could impact right across domestic policy. And public sector reform, especially for a Labour Government, should always be seen in the wider political context.

Will this Prime Minister, and his ambitious Health Secretary, have the stomach to embark on the kind of service transformation they say is required to ‘save’ the ‘broken’ NHS?

When it comes to tough choices on moving resources from secondary to primary care, finally admitting to dozens of Labour MPs the new hospital they campaigned on isn’t going to happen, will they choose reform?

When it comes to embracing the independent sector - and really burning through those elective waiting lists - will they be able to resist an ‘NHS first’ amendment to the forthcoming health bill from their newly emboldened MPs?

When it comes to resisting the resident doctors’ latest pay demand, will they say no this time or blow the extra money allocated in the spending review on appeasing the BMA?

And when it comes to taking on the ‘nanny state’ argument, so often deployed to thwart genuine cross-government prevention efforts, are they up for the fight given the nervousness of backbenchers facing a threat from Nigel Farage in the old red wall?

Until now, government health policy has been the Whitehall equivalent of a US ‘write in’ ballot where, under cover of an emerging Ten Year Plan, it can be whatever you want it to be. Now, with the clock ticking towards the next election, the rubber hits the road as never before.

If you were to sum of the Ten Year Plan in two bites you’d chose ‘NHS App’ and 'Neighbourhood health'. They are important but Ministers will need to be brave and even consider a rebirth of NHS Digital as NHSE bites the dust and they will need more money from the Chancellor.

There are a great many threads in the plan which are worthy of consideration and invite discussion. That is an opportunity for the wider health sector to engage with the system and Ministers.

What is missing is a ten year funding plan (last month’s CSR only covers the next 3-4 years) that includes new capital spend, a revised workforce plan and an answer to social care.

Above all, it needs an implementation plan. Or put another way, for the White Paper to morph into NHS planning guidance.