I’ve not been close to work with the NHS for some years, and I’ve been away from England rather longer; but I think I know what a plan looks like, and the NHS Long Term Plan isn’t it. The supposed plan is a long, rambling shopping list, lacking in structure, priorities or the means of achieving any aspirations people might have. It’s all very well to say that the service will “dissolve the divide between primary and community health services”, or that people will have “more personalised health care when they need it”, but we need to know why, how, and how we will know if it’s happened.
One of the implications of the lack of structure is that there will be no way to tell whether or not this document has made any difference. Being told, in bold lettering, that “The health service will continue to support implementation and delivery of the government’s new five-year action plan on Antimicrobial Resistance” or that “every trust in England with a maternity and neonatal service will be part of the National Maternal and Neonatal Health Safety Collaborative” tells us nothing at all – and if those objectives aren’t achieved, the gaps will be covered up by the rubble from hundreds of other equivalent objectives which might be achieved on the whole, or in part, or not at all. The problem with long lists of policies, Aaron Wildavsky wrote in Speaking truth to power, is that they become a way of burying the things that don’t get achieved – “mechanisms for avoiding rather than making choices”. The NHS Long Term Plan doesn’t identify problems, aims, methods, process, outcomes, or how to get value for money. That doesn’t inspire confidence for the future.