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NHS Long Term Plan Clinical Priorities – An Overview

10th September 2019

The NHS Long Term Plan makes some striking commitments to several areas of clinical care. They have been selected as the areas that have the greatest impact as ‘killers and disablers’ of the population while having patient outcomes that are behind other advanced health systems around the world.

Chapter 3 of the plan is titled Further Progress on Care Quality and Outcomes and it outlines that in key areas the population’s health is doing better than it ever has before. There is room for improvement however as the plan also identifies emerging health needs that have not been adequately met so far, such as the young person’s mental health services.

Patient outcomes and the quality of care provided are at the forefront of the new vision for the NHS over the next 10 years – more money from the government is on the table, £20bn extra over the next 7 years, so the ambitions of the NHS Long Term Plan are achievable.

Here, we take a quick look at which clinical areas have been deemed priorities. The criteria for selection has taken the views of patients and the public along with evidential data from the Global Burden of Disease (GBD) study for England.

Cancer

The survival rate for cancer is currently at the highest it has ever been and the factor identified as being key to further increases is early diagnosis. The best long-term survival rates are found in patients diagnosed in stage 1 & 2 (of 4 stages) and by the year 2028, it is the Long Term Plan’s ambition to increase early diagnosis in stages 1 & 2 from its current position of ~50% to nearer 75%.

There is a commitment to give patients a clear yes or no cancer diagnosis within 28 days from screening or GP referral. This is planned to start rolling out from 2020.

Mental health

The plan cites an alarming statistic in relation to mental health and children; “between the ages of 5-15, one in every nine children has a mental disorder.” This comes from a 2017 study by the NHS.

A renewed commitment to increasing investment in mental health is outlined and will result in exceeding the previous pledges of 10% of total budget. The increases mean that NHS England is the only major western healthcare system to have made and kept promises to spend over the 10% point in this clinical area.

Existing services are growing and new services and initiatives are being rolled out. Programmes like Improving Access to Psychological Therapies (IAPT) are considered world-leading in the treating of common conditions and 9 out of 10 adults with mental health issues are supported in primary care schemes like the IAPT.

The conditions deemed ‘common’ such as stress, depression and anxiety have a cost to the nation’s economy that far exceeds the portion of the NHS budget allocated for mental health. Increased investment in mental health is not only a smart choice from the point of view of the population’s health, it is a sound financial decision too.

Children’s health

A very broad area to list as a priority and there are not many details contained within the section as to how this area is to receive a focus. The importance of children’s health cannot be overstated, they make up a third of our population and represent our future, but the practicalities of how we care for them when they’re sick will be covered by the other clinical specialties such as Cancer and Mental Health.

Cardiovascular Disease

A quarter of all deaths in the UK are caused by CVD (Cardiovascular disease) and it is the biggest cause of premature death in deprived areas. The NHS have identified this as the area they can save most lives in over the next decade. CVD is preventable as it is linked directly to lifestyle and dietary factors.

Not only can lives be saved with effective prevention, but the financial burden of dealing with CVD can be reduced significantly – The plan outlines one strategy of getting people to reduce their salt intake by only 1 gram per day. This, it is projected, will result in 1,500 fewer deaths per year and a saving of £140million to the NHS budget.

Maternity and neonatal health

Sustained reductions year on year in stillbirths and neonatal deaths has been mirrored by substantial increases in women’s positive experience of maternity care. The Long Term Plan has identified areas of further improvement and seeks to implement changes in partnership with government initiatives and education programmes for expectant parents.

The commitment to Maternity and Neonatal health is summed up in this quote from The Long Term Plan document :  “The NHS will accelerate action to achieve 50% reductions in stillbirth, maternal mortality, neonatal mortality and serious brain injury by 2025.”

Stroke

Another preventable disease, Stroke is the 4th biggest killer in the UK and the biggest cause of complex disability. Steady progress since 1999 in stroke care has seen mortality half, however it still occupies the 4th spot on the list of top killers and according to the government website, 1 in 6 of us will have a stroke in our lifetime. Stroke currently claims 32,000 lives a year in the UK.

Hyper-acute stroke care (HASC) has undergone some changes recently and improvements have been yielded as a result. The counter-intuitive measure of reducing the number of HASC units and centralising them has actually increased the number of patients being treated successfully. This appears to be an example of the benefits of focusing specialised staff and resources to deliver the highest possible levels of care.

The NHS Long-Term Plan’s strategy when it comes to stroke care is clearly stated as “…the NHS having the best performance in Europe for people with stroke.”

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