The NHS long-term plan must be owned locally

The NHS Long Term Plan gives us a promising direction but leaves a number of questions unanswered.

Once it became clear a long-term plan would be forthcoming, the NHS Confederation worked with local NHS trust, CCG and independent provider leaders to pose three questions that the strategy would need to answer:

1. Is the plan affordable and deliverable?

2. Will it enable health and care systems to transform while ensuring sustainability of provision?

3. And will the plan support and enable local system leaders to do their job, as set out in our publication Letting local systems lead.

It is our view that the plan has only partially answered these questions. And while there is much that can – and will – be said in response to the first two questions, it is in the third that the plan is weakest.

This may be in part, of course, because we are talking about behaviour and not what is written down.

Setting local priorities

There is significant space devoted to setting out an architecture for local system leadership but there is less detail about how local leaders will shape service planning at both a local and national level, and be able to set local priorities according to local need.

It is natural for the centre to desire greater standardisation and a spread of what works best across the service, just as it is natural for the Treasury to push for measurable results from a not insignificant investment.

The systemic problems facing the service can only be addressed by local leaders, clinicians and other staff working in close partnership, and through the centre supporting and empowering local systems to tackle the challenges

But we remain concerned that in diluting some of the accountabilities of the 2012 Health and Social Care Act we do not create a command and control system from the centre which alienates everyone at a local level. This could lead to frustration at a local level at oppressive regulation on senior leaders and a disillusioned and disengaged clinical workforce.

What is clear is that the plan needs to be owned locally, otherwise it is our view it will simply not work.

As we made clear in Letting local systems lead, the systemic problems facing the service can only be addressed by local leaders, clinicians and other staff working in close partnership, and through the centre supporting and empowering local systems to tackle the challenges.

There is a particular need for flexibility in workforce development, and we hope the forthcoming workforce strategy will enable local leaders to get the most from their own staff.

Patient choice may not always be a key driver of quality, but the ability to choose the most convenient location for an operation, for example, can significantly enhance the patient experience. We must make sure we do not inadvertently reduce these options to patients when looking at streamlining how services are planned and provided.

And in order for the plan to be fully embraced and owned on the ground, we need to see further detail about how the voices of patients, staff and our partners will be heard.

Although there is much to welcome in the plan, without taking everyone with it, the plan risks becoming a tablet of stone that’s seen as out of touch by the people trusted to bring it to life.