National Voices reacts to the 10 Year Plan for the NHS

Jacob Lant, Chief Executive of National Voices, was invited by Government to help shape the vision for the NHS 10 Year Plan. Alongside Professor Bola Owolabi, then Director of the National Healthcare Inequalities Improvement Programme at NHS England, he co-chaired the vision group on how the plan could create a truly fair and inclusive health service. National Voices’ ‘I statements’ were central to the development of the vision group work that underpinned the plans development. 

The plan covers many areas from digital and AI, through to genomics, neighbourhood health services and a patient choice charter. There are significant structural changes such as bringing back the Foundation Trust (FT) model for all Trusts but this time around with a focus on population health outcomes rather than pieces of activity such as hip replacements. Yet the proposed removal of Governors from FTs alongside the closing of Healthwatch creates questions around community accountability. 

The return of national service frameworks, rebadged as Modern Service Frameworks, will be welcome to members as a way to ensure a focus on single-conditions, but there is more work to be done to ensure the value of coproduction, community involvement and VCSEs are harnessed in the plan’s implementation. 

Below are our initial comments on the plan, but our analysis and influencing will continue in the weeks and months ahead. 

Overview 

Jacob Lant, Chief Executive of National Voices, said: “There is a welcome new emphasis in the ten-year plan on improving day-to-day patient experience and outcomes. This focus is essential if the Government’s three shifts are to achieve the aim of boosting public confidence, creating an NHS that is more sustainable, and ensuring that no communities are left behind.  

“But we have seen plans before, and we must now see clear action on how this will deliver practical changes to people in the real world.” 

On patient voice 

 Jacob Lant, Chief Executive of National Voices, said: “Giving patient choice and experience such prominence in the plan is heartening, with a clear message that services must start to organise themselves around how people and communities actually live their lives. But decommissioning the Healthwatch network leaves big shoes to fill in terms of how the system listens to people and communities about what’s working and what’s not.  

“The plan provides the headlines for a new feedback culture in the NHS, one that harnesses the power of new technology like the NHS App and analysis through artificial intelligence. But the real test will come in how the system interprets what it hears, how it involves people in developing solutions, and how this is fed back to those who share their stories. It will also require close working with the VCSE to ensure we mitigate against the risk of already marginalised voices getting further lost in a feedback mechanism designed for the majority.  

“While we are pleased that patient experience and outcomes will play a much more prominent role in judging the success of the NHS, there is still much work to do on how some of these mechanisms will work in practice. The Patient Power Payments for example need to be carefully tested to ensure providers are properly incentivised to listen both to individuals and communities.” 

On Inequalities 

Jacob Lant, Chief Executive of National Voices, said: “Poverty has often been overlooked in recent years as a driver of poor health, both at an individual level and for broader communities, yet we know it drives so much in terms of poorer access to services, experiences of care and outcomes. By finally reviewing funding formulas and shifting resources into the areas of greatest need, the Plan can help to tackle the inverse care law head-on. And given the intersection of economic hardship with a whole range of other social factors like systemic racism and disability discrimination, there is potential to make great strides in creating a fairer and more equitable NHS.  
 
“But shifting resources is only half the battle. We need to see outcomes on health inequalities used as one of the key success measures for NHS leaders as a new culture of accountability is developed through implementation. This will be backed up by the NHS’ plans to publish the demographic data for key performance measures, such as hospital waiting lists. This transparency will make it impossible for leaders to hide or ignore the blatant inequalities faced by minoritised communities any longer.” 

On deliverability of the plan 

Jacob Lant, Chief Executive of National Voices, said: “There was a big risk that this plan, like many NHS plans before it, would make promises about a brave new future which felt completely unrealistic to the vast majority of patients accessing care right now. Yet it is clear the Secretary of State has listened hard to that message about getting the basics of care right. After all, the key to rebuilding public confidence in the NHS will be people feeling the improvements first-hand. They don’t necessarily need to be big changes, but people need to feel that things are getting better This is where fixing everyday challenges – like poor admin processes that are commonplace but are such a day-to-day frustration for people – comes in. Chasing cancelled appointments and delayed test results is especially trying for those with multiple health conditions for whom managing NHS admin can feel like a second job. 

“With so much structural change also happening in the sector, there’s a real risk of leaders and frontline staff becoming distracted. But if we don’t fix these basics in the next few years then the NHS will not win back the public trust in the services it offers, and is likely to face even greater existential challenges in the years ahead.”   

Notes to editors 

1. We recently released polling data in collaboration with Ipsos, exploring the ‘I Statements’ that helped shape the plan. The results show that people living with long-term conditions continue to report poorer experiences with the NHS. 

2. National Voices has previously highlighted how shifting the NHS’s measures of success to focus on the experiences of people with long term conditions could support the success of the 10-Year Plan. 

3. National Voices worked with the King’s Fund and Healthwatch England on a report that examined how “dysfunctional” admin processes were increasing the burden on patients. 

4. Read the 10 Year Plan here.