NHS Long Term Plan impact

Elements of the Plan  released show it represents a top-down imposition of tighter central control – and contains a dangerous new step towards forcing trusts to sell “surplus” land and assets to reduce deficits, along with an explicit instruction to trusts to increase “commercial” (private) external income – with benchmark targets set for each trust – and charge patients for treatment.

All of these points emerge from the 21-page document Preparing for 2019/20 Operational Planning and Contracting, issued to NHS bodies by NHS England on 21st December

These guidelines set extremely tight deadlines for the first stage of the process, with “planning assumptions” in each of the 44 “Sustainability and Transformation Partnership” areas to be agreed by 14 January – just 13 working days after the document was published, making any real local consultation impossible.

It also hands considerable powers to a newly created network of “joint regional teams”, which will not meet in public or publish Board papers but only be accountable upwards to NHS England, not to local communities. Yet these bodies are supposed to “ensure local accountability”, police the financial performance in each area, with powers to intervene – and vet any plans they produce.

They will enforce tough new targets, including a switch of resources to mental health, and especially frontline mental health and ensure trusts “grow their external (non-NHS) income” (p12). This is the first time NHS England has specifically pushed trusts into seeking “commercial income growth” to the “benchmarked potential”.


In addition, there is a requirement for trusts to set up systems to raise money by charging patients for treatment (“overseas visitor cost recovery”) – a policy recently denounced by several medical Royal Colleges because of its impact on public health.

John Lister, editor of Health Campaigns Together said:

“All of the main lines of what has been published or leaked about the Plan are a depressing re-run of previous plans and gimmicks: the only novel proposals are for more central control and less accountability, for trusts to run more like and with private businesses seeking profits, and to raise money by undermining the principles and values of the NHS through charging overseas visitors – a government policy widely condemned by NHS professional staff and campaigners as discriminatory and a step backwards from prevention and public health.

“There is no reason to believe this plan, with even less local accountability and no serious plans for public consultation, will prove any more acceptable to the public or successful in implementation than the secretive STPs in 2016 or other previous failed efforts.

“Campaigners have yet to see anything to recommend the new plans, or any indication NHS England is willing to come to grips with the crisis fuelled by chronic austerity limits on funding – or demand an end to chaos and fragmentation of the Health & Social Care Act.”

KONP Co-chair Dr Tony O’Sullivan, a retired consultant paediatrician, said:

‘The government has cut £7bn to social care and has underfunded the NHS by £20bn in annual funding over the last 9 years. There is no plan to repair the damage done. Platitudes about prevention and better health are exposed by the £1bn cuts to the public health budget responsible for prevention. After 9 years undermining mental health, the ‘extra’ now committed is not new money but comes from elsewhere within NHS funding. Theresa May’s assertion that the NHS has never received higher funding is simply not true in relation to NHS funding required to meet need. Over 210,000 vacancies in NHS and social care and unacceptable stress carried by staff, dangerous waits for A&E, cancer care and surgery, all tell the true story. And the fact that private health providers get 50% of their funds from treating patients diverted from an NHS deprived of the resources to treat them itself exposes the policy direction of government. We cannot accept this situation.’