Implementing the NHS Long Term Plan - Are there lessons from abroad?

04 July 2019


by Mike Farrar PwC NHS NEDs programme chair

Email +44 (0)20 7804 4019

‘Adding value to every pound we spend’ was the tag-line for the NHS Long Term Plan even though there was an increase in resources available from 2020/21 for the following five years.

We are not alone across the world in dealing with the situation of increasing demand outstripping new resources - it is a shared global problem. There are, however, different approaches to managing the situation. In this blog we examine some of those approaches and compare and contrast the Long Term Plan Implementation Framework against them.

Here are the eight strategies we see being used with some success globally:

  1. Focusing on prevention with particular emphasis on using citizens as assets.
  2. Investing in primary care at scale and using primary care based on technology and digital access.
  3. Taking a whole Systems approach with place based capitation financing.
  4. Managing unwarranted clinical variation and standardising processes.
  5. Using lean type approaches to taking cost out of business processes and pathways.
  6. Introducing new digital technologies to support population health management (using big data to predict and target need); transfer services from a physical to a virtual offer; using data to inform health and well being directly by citizens.
  7. Introducing new developments in life sciences in the pharmaceutical and medtech sectors - such as genomics or robotic surgery.
  8. Adapting delivery and purchasing systems to create aligning incentives and structures to capitalise on the first seven strategies.

Looking at this list we can see strong synergy with the UK - there will be a government green paper on prevention and primary care networks are emerging, albeit less technologically enabled than in other countries. We are taking more of a whole system approach, which is reflected in our commitment towards integrated care, and Getting It Right First Time (GIRFT) and Right Care are clearly targeting clinical variability. Western Sussex, amongst others, are following the Virginia Mason Lean example and NHSX is attempting to implement a digital revolution whilst the Academic Health Science Networks (AHSNs) and the Accelerated Access Collaborative are leading developments with the life sciences industry.

But the key question for the UK is the alignment of structures and incentives to deliver all of this. Capable management, with wide creative and collaborative mindsets, is needed. Yet we are still waiting on this critical element with the workforce strategy delayed. This, on top of the fact, that we are taking another 20% out of management costs. Additionally, the development of integrated place based care is proving more difficult to deliver than hoped and new legislation is required to provide some of the necessary regulatory and structural changes.

We are currently working with many of the aspiring or established Integrated Care Systems (ICS) and their regional office teams. Our global reach means we have experience of how systems across the world have made progress on some of the key issues. Our experience tells us that, if the NHS can learn quickly, leverage effective partnerships and deploy all its talent, the Long Term Plan can, and will, be implemented.

by Mike Farrar PwC NHS NEDs programme chair

Email +44 (0)20 7804 4019