Horizon scanning: The NHS Long Term Plan Sharing Learning: VCSE Partnerships April 2019

1. Horizon scanning: • The NHS Long Term Plan • Sharing Learning: VCSE Partnerships • April 2019

2. Context - June 2018 • 3.4% funding increase over 5 years • £20.5bn by 2023 • The Prime Minister set out five priorities in her speech: • Putting the patient at the heart of how we organise care • A workforce empowered to deliver the NHS of the future • Harnessing the power of innovation • A focus on prevention, not just cure • True parity of care between mental and physical health

3. Despite growing pressures, the NHS is efficient and equitable, and continues to improve • The system operates under considerable pressure • Helps over 20 million mental health service usersa year1 • Conducts 5 million GP consultations per week2 • Serves over 1 million patients3, delivers 1,900 babies4, admits 64,000 people to A&E1, completes 28,000 operations a day1 • We continue to improve in specific areas • Waiting times are lower than a decade ago (although slowly rising)7 • Annual cancer survival rates are improving8 • Heart attack and stroke deaths have tumbled (total CVD mortality is down 68% since 1980)7 • The NHS is more efficient that the rest of the economy • In 2016-17 healthcare productivity grew by 3.0%, more than treble the rate achieved across the wider UK economy

4. However, international comparisons suggest areas for improvement exist • Source: Nuffield Trust Report – How Good is the NHS? (2018) Above average performance Below average performance, but improving Below average performance

5. We engaged with a wide range of stakeholders across 17 workstreams • 17 • Workstreams focused on life course, clinical priorities and enablers • 200 • Distinct engagement events • 3.5 million • Individuals or organisational members represented through submissions • 2,000+ • Submissions via the online forum 5,427 Readers of blogs about the Long Term Plan • 500 • Direct submissions by letter or email • 21,788 • Views of the online discussion guide

6. The NHS Long Term Plan sets out how we will invest the funding commitment from government Do things differently, through a new service model Take more action on prevention and health inequalities 1 Improve carequality and outcomes for major conditions 2 Ensure that NHS staff get the backing that they need 3 Make better use of data and digitaltechnology 4 Ensure we get the most out of taxpayers’ investment in the NHS 5 6

7. 1. A new service model for the 21st century • Five major, practical changes • Boosting ‘out-of-hospital’ care and finally dissolving the divide between primary and community health services • Redesigning and reducing pressure on emergency hospital services • Enabling more personalised care • Making digitally-enabled primary and outpatient care mainstream • Focusing on population health and partnerships with local authority-funded services, through new Integrated Care Systems everywhere Backed by additional investment of at least £4.5 billion in primary and community care by 2023/24

8. Enabling more personalised care • 1.39. We will roll out the NHS Personalised Care model across the country, reaching 2.5 million people by 2023/24 and then aiming to double that again within a decade. • 1.40. As part of this work, through social prescribing the range of support available to people will widen, diversify and become accessible across the country. Link workers within primary care networks will work with people to develop tailored plans and connect them to local groups and support services. Over 1,000 trained social prescribing link workers will be in place by the end of 2020/21 rising further by 2023/24, with the aim that over 900,000 people are able to be referred to social prescribing schemes by then.

9. Key elements of social prescribing in primary care networks

10. How can local partners maximise this funding opportunity? CCGs will be encouraged to bring local partners together to develop a shared local plan for social prescribing (by June 2019), incl. local authorities, primary care networks, VCSE leaders, existing social prescribing connector schemes and other partners. Plans should include: • how partners will build on existing local social prescribing connector schemes to avoid duplication and maximise impact • how social prescribing link workers will be embedded in all primary care networks across the local area • how additional link workers will be recruited locally • shared commitment to support for the VCSE sector and community groups to receive social prescribing referrals, through funding and development support. Templates are available from NHS England: england.socialprescribing@nhs.net

11. 2. More NHS action on prevention and health in equalities Action on health inequalities • Improving upstream prevention • Targeting a higher share of funding towards geographies with high health inequalities • An enhanced and targeted continuity of carer model in maternity care • Delivering physical health checks to 110,000 more people with SMI per year • Ensuring people with a learning disability and/or autism get better support • Investing up to £30 million extra to meet the need of rough sleepers • Better support for carers, particularly those from vulnerable communities • Expanding NHS specialist clinics to help more people with serious gambling problems • Smoking cessation services for all NHS inpatients who smoke, expectant mothers and their partners and long-term users of specialist MH services based on the Ottawa Model • Weight management services in primary care for people with type 2 diabetes or hypertension with a BMI of 30+ • Double the NHS Diabetes Prevention Programme over next 5 years, and testing of very low calorie diets • Alcohol Care Teams in hospitals • Lower air pollution from all sources

12. 7. Possible legislative change • Following the request from the Health and Social Care Committee and the Prime Minister, the Long Term Plan sets out potential legislative changes for Parliament’s consideration. • These proposals would: • Give CCGs and NHS providers shared new duties • Remove specific impediments to ‘place-based’ NHS commissioning • Support the more effective running of ICSs • Support the creation of NHS integrated care trusts • Remove the counterproductive effect that general competition rules and powers can have on the integration of NHS care • Cut delays and costs of the NHS procurement processes • Increase flexibility in the NHS pricing regime • Facilitate NHS England and NHS Improvement working more closely together Consultation closes 25 April

13. Appendix: Support for wider social goals

14. Long Term Plan: key Implementation dates for 2019 Early 2019 Spring ‘19 Summer ‘19 Autumn ‘19 • 1 • 2 • 4 • 5 5-year local planning with local engagement LTP national implementation framework published NHS Assembly established Detailed LTP implementation plan published • 3 • 6 Workforce interim report published Workforce implementation plan published

15. NHS England publications and resources • Summary Guide to Social Prescribing • Universal Personalised Care • NHS Long Term Plan • Five Year Framework for GP Contract Reform • Fortnightly Future Health and Care bulletin • sent to over 6,000 subscribers • sign-up via this link. https://www.england.nhs.uk/email-bulletins/future-health-and-care-update/

16. What do the priorities of the Long Term Plan mean for you? • Impact of social prescribing commitments? • What is awareness and understanding with grass roots VCSE #smallbutvital • How as a sector can you use the social prescribing investment to strengthen VCSE? • How can you best influence 5-year local planning between now and the autumn? • How do you want to engage at system, place and neighbourhood level? • noting ICS Partnership Board commitment • Can you help clinicians and other NHS system leaders to navigate the VCSE and better understand your contribution and impact? • Importance of a clear narrative around ‘reducing pressure on the system’ • What is the role of social enterprise and community foundation colleagues in your system?

17. Appendix – further details on the NHS Long Term Plan

18. Role of link workers in primary care networks Social prescribing link workers will be embedded within PCN multi-disciplinary teams to; • provide personalised support to individuals, their families and carers to take control of their wellbeing, live independently, and improve their health outcomes • develop trusting relationships by giving people time and focusing on ‘what matters to them’ • take a holistic approach, based on the person’s priorities, and the wider determinants of health • co-produce a simple personalised care and support plan to improve health and wellbeing • introduce or reconnect people to community groups and services • evaluate the individual impact of a person’s wellness progress • record referrals within GP clinical systems using the national SNOMED social prescribing codes • support the delivery of the comprehensive model of personalised care • draw on and increase the strengths and capacities of local communities, enabling local VCSE organisations and community groups to receive social prescribing referrals.

19. Chapter 3: Further progress on care quality and outcomes for children and young people Maternal and child health • 50% reduction in stillbirth, maternal mortality, neonatal mortality and serious brain injury by 2025 • Continuity of carer for most women through and beyond their pregnancy, targeted towards those who will benefit most • Expanded perinatal mental health support Children and Young People’s services • Whole genome sequencing for all children with cancer • Increased funding for children and young people’s mental health services • Mental health support for children and young people embedded in schools and colleges and a new approach to young adult mental health services for people aged 18-25 Learning disability & autism • Action to tackle the causes of morbidity and preventable deaths in people with a learning disability and autistic people • Reduced waiting times for specialist services • Increased investment in intensive, crisis and forensic community support

20. Chapter 3: Better care for major health conditions Cancer • Increasing the proportion of cancers diagnosed at stages 1 and 2 from around half now to three-quarters of cancer patients by 2028 • A new faster diagnosis standard for cancer will begin to be introduced so that patients receive a definite diagnosis or ruling out of cancer within 28 days CVD and respiratory • Preventing 150,000 heart attacks, strokes and dementia cases • Investing in spotting and treating lung conditions early to prevent 80,000 stays in hospital • Working with partners to improve community first response and building defibrillator networks to improve survival from out of hospital cardiac arrest Mental health • Spending at least £2.3bn more a year on mental health care • Expanding access to IAPT services for adults and older adult with common mental health problems, with a focus on those with long-term conditions • Ambulance staff will be trained and equipped to respond effectively to people in a crisis

21. Chapter 4: NHS staff will get the backing that they need A new workforce implementation plan Expanding the number of nurses, midwives, AHPs and other staff Growing the medical workforce International recruitment Supporting current NHS staff Enabling productive working Nurturing the next generation of leaders Supporting successful volunteering programmes

22. Chapter 5: Digitally-enabled care will go mainstream across the NHS • An NHS where digital access to services is widespread • Where patients and their carers can better manage their health and condition • Where clinicians can access and interact with patient records and care plans wherever they are, with ready access to decision support and AI • Where predictive techniques support local Integrated Care Systems to plan and optimise care for their populations • Where secure linked clinical, genomic and other data support new medical breakthroughsand consistent quality of care

23. Chapter 6: Taxpayers’ investment will be used to maximum effect • The Long Term Plan sets out five tests for restoring a sustainable financial path for the NHS to: Return to financial balance Achieve cash-releasing productivity growth of at least 1.1% a year, with all savings reinvested in frontline care Reduce the growth in demand for care through better integration and prevention Reduce variation across the health system, improving providers’ financial and operational performance Make better use of capital investment and its existing assets to drive transformation