Following his victory, Boris Johnson used his first acceptance speech to recognise the 'overwhelming priority of the British people' to focus on the NHS and to reiterate the intention to recruit 50,000 more nurses, 6,000 more GP's and build 40 new hospitals. This article will be the first in our series to be published throughout January following the progress of the NHS Long Term Plan (LTP) one year on from its release.
The story so far
The LTP was published on 7 January 2019 and, soon after, NHS England and Improvement (NHSE&I) put forward their proposals for new legislation to put the LTP’s ambitious aims into action. On 24 June, the House of Commons Health and Social Care Committee report into legislative proposals for the NHS set out recommendations as to the next steps. NHSE&I then published a recommendations document, which endorses an NHS Bill to be laid before parliament in its next session. On 14 October, the Queen's Speech 2019 also suggested measures (and new laws) be brought forward to support the NHS. Following their election win, the Conservatives have made clear that the NHS remains a top priority for their now large majority government.
Given the commitments made in the LTP, the Conservatives' significant parliamentary majority and political imperative to focus on the NHS, it appears likely that topics such as better maternity and elderly care and advancing digital transformation in the NHS will be high on the agenda post-Brexit. Both the health secretary Matt Hancock and Pharmacy minister Jo Churchill have been re-elected and retained their positions within the new cabinet arrangement, which may suggest the aims of the LTP will remain unchanged.
Other NHS focussed goals from the Conservative Party's manifesto include the seven new Health Data Research Hubs which were announced in September and widely welcomed, including by the new national information and technology partner to the health and social care system, NHSX. The Health Data Research Hubs focus on improving the lives of those with specific diseases such as cancer, asthma and Chron's.
In addition, digital goals include the ambitious plan for delivering 50 million more GP appointments per year, through digital booking and online consultations. This links to the plans for NHS digitisation within the LTP, which we will review in more detail in an upcoming article focusing on what technology the NHS has implemented since the LTP publication.
Capital spending and infrastructure
In July, the Financial Times reported that lack of capital spending on infrastructure in the NHS had "reached a crisis point", however with thoughts beginning to turn away from Brexit, the government pledged billions of pounds of capital investment into the NHS at the Conservative Party conference, as part of the Health Infrastructure Plan (HIP). This came after (and in addition to) the 2019 Spending Round, where an additional £854 million funding was earmarked for the NHS. During the General Election 2019 the conservatives reiterated their commitment to further capital funding for the NHS.
The HIP set out a 5-year programme of investment in health infrastructure, including a new hospital building programme. Whilst the HIP was criticised for failing address years of backlog maintenance issues (the King's Fund has noted a number of Trusts with significant maintenance backlogs have missed out on funding) and being deliberately vague, it does represent significant post-austerity investment in the NHS and is likely to be implemented post-General Election.
Both the Secretary of State for Health and Social Care, Matt Hancock, and the CEO of NHSE, Simon Stevens, have been critical of the current processes for approving healthcare infrastructure funding, and it is proposed that more assistance be offered to NHS providers in developing business cases for access to capital funding as well as streamlining the application process.
Given the Conservatives' parliamentary majority, it is likely that they will have little trouble gaining parliamentary support for new healthcare legislation. For example, the LTP envisages:
- removal of the NHS from competition law constraints;
- changes to procurement rules, lifting the NHS from the remit of the Public Contracts Regulations 2015; and
- a new NHS Trust being created where it is difficult to find a provider capable of holding an Integrated Care Provider (ICP) Contract.
The implementation of the ICP Contract, paired with any other legislation necessary to push forward the LTP agenda is likely to be a key focus following Brexit.
The Queen's Speech also confirmed healthcare-related legislation, with the government planning to enshrine in law a commitment to increase the health service's funding by £33.9bn per year by 2023. The speech also pledged to seek cross-party consensus for the long-term reform of the social care system, with continuing reform of the Mental Health Act. We will be following any legislative changes that may link to the aims of the LTP closely and set out potential legislative changes in an upcoming article on the proposed NHS Bill.
As we discussed previously in a pre-election article, regardless of the winner of the December election, the NHS would benefit from additional expenditure. In addition, the Conservatives' resounding election victory now gives them a remit and the political power to implement legislative changes to the Health and Social Care Act 2012 that has been discussed for some time. The trend of digitisation remains key with health outcomes and focus on research in relation to specific illnesses likely to be at the forefront of developments.