{"id":43870,"date":"2019-01-15T12:02:18","date_gmt":"2019-01-15T11:02:18","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=43870"},"modified":"2019-01-21T14:29:39","modified_gmt":"2019-01-21T13:29:39","slug":"the-nhs-long-term-plan-the-road-from-plan-to-improvements-for-patients","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2019\/01\/15\/the-nhs-long-term-plan-the-road-from-plan-to-improvements-for-patients\/","title":{"rendered":"The NHS long term plan: the road from plan to improvements for patients"},"content":{"rendered":"<p><span style=\"font-weight: 400\">The long term plan for the NHS in England is not short of proposals. [<\/span><span style=\"font-weight: 400\">1]<\/span><span style=\"font-weight: 400\"> Its 50,000 words harbour a multiplicity of initiatives to enhance primary and community care, strengthen the role of the NHS in preventing ill health, improve outcomes for major conditions, grow and better support the healthcare workforce, and make more use of digital technologies. <\/span><\/p>\n<p><span style=\"font-weight: 400\">The plan is just that<\/span><span style=\"font-weight: 400\">\u2014<\/span><span style=\"font-weight: 400\">a plan<\/span><span style=\"font-weight: 400\">\u2014<\/span><span style=\"font-weight: 400\">and so is understandably lighter on the detail of implementation, which local health and care systems are now tasked with developing. It makes much of its pragmatism and achievability, noting that almost everything in it is already being implemented successfully somewhere in the NHS. But identifying the solutions is often only half the battle<\/span><span style=\"font-weight: 400\">\u2014<\/span><span style=\"font-weight: 400\">the challenge is to get solutions working well for staff and patients everywhere. The decisions that policymakers and system leaders make in the next few months will be critical in determining how far this will be achieved over coming years.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Translation from plans to patient benefit is a journey fraught with pitfalls, and will require thoughtful approaches to implementation that support clinicians in leading the changes they can see are needed locally. <\/span><\/p>\n<p><span style=\"font-weight: 400\">As <\/span><i><span style=\"font-weight: 400\">The BMJ<\/span><\/i><span style=\"font-weight: 400\"> and Health Foundation\u2019s <\/span><a href=\"https:\/\/www.bmj.com\/quality-improvement\"><span style=\"font-weight: 400\">current series on Quality Improvement in Healthcare<\/span><\/a><span style=\"font-weight: 400\"> is exploring, it is easy to underestimate the difficulty of making change happen in a complex adaptive system such as the NHS. [<\/span><span style=\"font-weight: 400\">2,<\/span><span style=\"font-weight: 400\">3]\u00a0<\/span><span style=\"font-weight: 400\">Patients and healthcare professionals have intrinsic motivation to improve care, though will make decisions on which initiatives to engage with based on their judgements as to how a given idea fits with their aims and ways of seeing the world, and often have considerable power to support, actively resist, or passively let pass solutions suggested from outside. <\/span><\/p>\n<p><span style=\"font-weight: 400\">Furthermore, what has worked once in one place won\u2019t necessarily work the same way, or get the same results in a different context. That means that many of the kinds of changes the plan proposes can\u2019t be directed solely from positions of national or organisational authority, but instead also require clinical professionals to work alongside patients in identifying and understanding problems, designing, testing and adapting solutions, and evolving new ways of working. <\/span><\/p>\n<p><span style=\"font-weight: 400\">As such, it will be important that local plans don\u2019t mandate a \u201ccopy and paste\u201d approach to the solutions outlined in the plan, but ask what conditions and support will enable clinical teams to implement solutions effectively. <\/span><\/p>\n<p><span style=\"font-weight: 400\">These conditions will include the development of organisations and teams with sufficiently aligned aims and objectives, able to harness professional motivation and will, involve patients in the design and delivery of care, access useful information and intelligence, and apply good operational management and quality improvement methods to solve problems. Action to boost workforce supply, morale, and retention will also be critical<\/span><span style=\"font-weight: 400\">\u2014<\/span><span style=\"font-weight: 400\">without sufficient staff, expending precious time and emotional energy on leading service improvement risks being perceived as an unaffordable indulgence in the face of operational delivery pressures. <\/span><\/p>\n<p><span style=\"font-weight: 400\">The plan has many of the right instincts in this area, setting out plans to boost improvement capability, and articulating a \u201creorientation\u201d away from reliance on arms-length regulation and performance management to supporting service improvement \u201cacross systems and within providers.\u201d This shift in ways of thinking could be critical, given evidence that national improvement initiatives can be interpreted by organisations and staff as tools for accountability and blame. [<\/span><span style=\"font-weight: 400\">4]<\/span><\/p>\n<p><span style=\"font-weight: 400\">A new Chief Improvement Officer will set an important tone, and have critical decisions to make, including about the balance between the resources held centrally for improvement and those invested in building improvement capacity and capability in local organisations and teams. <\/span><\/p>\n<p><span style=\"font-weight: 400\">Local capacity and capability will be vital, particularly as the NHS undertakes the challenging work of supporting healthcare professionals working in different organisations to improve care together as part of Integrated Care Systems. In the end, delivery on the promise of the Long Term Plan will not be decided in plans and papers, but will instead rely on translation of its ideas into the thousands of conversations had, decisions taken, and choices made by healthcare professionals and patients every day in meeting rooms, corridors, clinics, theatres, and wards across the NHS. \u00a0\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><em><span style=\"font-weight: 400\"><strong><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2019\/01\/Will_Warburton.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-43871\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2019\/01\/Will_Warburton.jpg\" alt=\"\" width=\"160\" height=\"160\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2019\/01\/Will_Warburton.jpg 160w, https:\/\/blogs.bmj.com\/bmj\/files\/2019\/01\/Will_Warburton-150x150.jpg 150w\" sizes=\"auto, (max-width: 160px) 100vw, 160px\" \/><\/a><\/strong><\/span><\/em><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Will Warburton<\/strong>, Director of Improvement, The Health Foundation.<\/span><\/em><\/p>\n<p><em><strong>Competing interests<\/strong>: None declared.<\/em><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><i><span style=\"font-weight: 400\">The Health Foundation is a partner on a number of strategic initiatives with NHS England and NHS Improvement to support quality improvement in health care in the UK. As an independent charity, the Health Foundation contributes time and financial resources to these initiatives, sometimes on a partially or wholly match-funded basis. \u00a0<\/span><\/i><\/p>\n<p><strong>References:<\/strong><\/p>\n<ol>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">NHS. The NHS long term plan. 2019. <\/span><a href=\"https:\/\/www.longtermplan.nhs.uk\/\"><span style=\"font-weight: 400\">https:\/\/www.longtermplan.nhs.uk\/<\/span><\/a><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">BMJ. Quality Improvement. 2019 <\/span><a href=\"https:\/\/www.bmj.com\/quality-improvement\"><span style=\"font-weight: 400\">https:\/\/www.bmj.com\/quality-improvement<\/span><\/a><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Braithwaite J <\/span><i><span style=\"font-weight: 400\">Changing how we think about healthcare improvement. BMJ 2018;361:k2014<\/span><\/i><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Armstrong N, Brewster L Tarrant C, et al <\/span><i><span style=\"font-weight: 400\">Taking the heat or taking the temperature? A qualitative study of a large-scale exercise in seeking to measure for improvement, not blame<\/span><\/i><span style=\"font-weight: 400\">. Soc Sci Med 2018;198:157\u201364<\/span><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The long term plan for the NHS in England is not short of proposals. [1] Its 50,000 words harbour a multiplicity of initiatives to enhance primary and community care, strengthen [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2019\/01\/15\/the-nhs-long-term-plan-the-road-from-plan-to-improvements-for-patients\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":43853,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[236],"tags":[],"class_list":["post-43870","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-nhs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>The NHS long term plan: the road from plan to improvements for patients - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2019\/01\/15\/the-nhs-long-term-plan-the-road-from-plan-to-improvements-for-patients\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The NHS long term plan: the road from plan to improvements for patients - The BMJ\" \/>\n<meta property=\"og:description\" content=\"The long term plan for the NHS in England is not short of proposals. 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