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Find out what’s in store for service transformation in England over the next decade

The long-awaited NHS Long Term Plan was published on 7 January. 

It sets out a vision for how services in England will be transformed over the next 10 years and outlines how the £20.5 billion annual funding boost for the NHS will be spent.

Its aims are ambitious. It claims it will help save half a million lives by prioritising primary and community care, and by providing pioneering treatments for killer conditions, such as stroke, heart disease, diabetes and cancer. But with more than 100,000 vacancies in the NHS in England and counting, the aims of the plan could remain just that.

The greatest improvements in care won’t come from promises but from the people who help deliver them

Patricia Marquis, Director of RCN England, says: “We all want the NHS to succeed as a provider of cutting-edge treatment free at the point of use. However the greatest improvements in care won’t come from promises but from the people who help deliver them.

“The health service must harness the talents of its staff and empower them to make change happen.

“More importantly, there must be enough staff to deliver the vision for the future. Without investment in growing the workforce, this plan will struggle to get off the ground.”

The health service must harness the talents of its staff and empower them to make change happen

There are currently 41,000 nurse vacancies in the NHS in England and applications to study nursing have fallen by a third since the final year of the bursary in 2016.

Providing solutions

In advance of the plan’s publication, RCN student members launched a campaign to get £1 billion a year invested into nursing higher education in England – almost the same amount removed from health care education when the bursary was scrapped in 2017. 

We also provided solutions to help increase the number of people in nurse education and counteract the catastrophic decline in applicants. 

While the RCN’s warnings have been heard – the plan does reference the “unsustainable number” of shortages in the nursing workforce – responsibility for addressing them has been pushed to yet another plan, promised for later this year. 

“We are committed to improving the working lives of all staff,” the plan says. “As a service, we will now take sustained and concerted action to ensure we have enough people, with the right skills and experience, so that staff have the time they need to care for patients well. 

“We will ensure our people have rewarding jobs…with opportunities to develop their skills…and have support to manage the complex and often stressful nature of delivering health care.”

It sounds positive, but as the leave rate for NHS nurses has been increasing since 2013, you might ask what the Government has been doing until now to address the problem.

Pictured below: Prime Minister Theresa May and Health Secretary Matt Hancock chat to nursing staff at Alder Hey Children's Hospital in Liverpool as they launch the NHS Long Term Plan for England

Developing a workforce plan

It is still unclear how much money will be invested in the workforce – the Health Education England budget has yet to be set as part of the Government’s spending review in early 2019. So all hopes rest on the workforce implementation plan and more money being secured as part of the review. 

The workforce plan will be led by NHS Improvement, but involve a national workforce group, including a new NHS Chief People Officer. 

The group is tasked with showing “how the future challenges can be addressed for the total workforce”.

The contribution of overseas nurses is vital but we must do more to attract, train and retain thousands more home-grown nurses

It’s a tall order, and one that couldn’t come soon enough. “We’ve been stressing the need for national workforce planning for years,” says Patricia. “Our members are at breaking point, often stretched too thin to provide the care they would like. 

“Nursing degree courses are up to a third more time intensive than other degrees, which means student nurses have far less time to take on part-time jobs. This financial stress leads too many to quit courses before they have chance to realise how varied and fulfilling a career in nursing can be.

“The system needs a rethink. The contribution of overseas nurses is vital, and very much valued, but we must do more to attract, train and retain thousands more home-grown nurses.”

Online nursing degrees

The plan presents some concerning solutions to the workforce crisis. A new online nursing degree for the NHS could be launched as soon as next year, and university entry requirements could be lowered so that more applicants are accepted onto nursing degree courses.

“Nursing is a career like no other, and it takes the right values and ambition to succeed,” adds Patricia. “Entry standards to the nursing degree are rigorous because they have to be – it is what safe patient care demands.”

Whatever happens next, the RCN is determined to be part of the group developing the NHS workforce strategy to make sure it delivers what it needs to for members. We won’t rest until nurse numbers are on the rise. 

Join our Fund Our Future campaign to help secure the future of nursing

Words by Kim Scott

The plan at a glance

136 pages, 7 chapters, 70 mentions of nurse or nursing – here's the NHS Long Term Plan at a glance...

Setting out a new service model

  • £4.5bn a year more for primary medical and community services
  • A third of people attending A&E discharged within 24 hours
  • Out-of-hospital emergency care with appointments bookable through NHS 111
  • Social prescribing for 2.5 million more people
  • Digital-first primary care with patients offered phone or online GP appointments
  • Redesigned outpatient services with face-to-face hospital appointments reduced by a third.

Action on prevention and health inequalities

  • All smokers admitted to hospital offered NHS-funded tobacco treatment services
  • £30 million extra to meet the needs of rough sleepers
  • Weight management services for people with type 2 diabetes or hypertension with a BMI of 30+
  • Specialist smoking cessation support for pregnant women
  • Expansion of NHS specialist clinics for people with serious gambling problems.

Progress on care quality and outcomes

  • Increased funding for children and young people’s mental health services
  • Boys vaccinated against HPV-related diseases
  • Three quarters of cancers diagnosed early by 2028 
  • Maternity-related deaths halved by 2025
  • Development of an expert neonatal nursing workforce
  • Children with cancer offered whole genome sequencing 
  • £130 million upgrade of radiotherapy machines 
  • Proton beam facilities in London and Manchester
  • 150,000 heart attacks prevented through improved community first response
  • A modernised stroke workforce 
  • Patients with type 1 diabetes given life changing flash glucose monitors
  • 24/7 community-based mental health crisis response 
  • Mental health nurses in ambulance control rooms 
  • Increased funding to grow planned surgery 
  • One million people to participate in health research 
  • Specific waiting time targets for emergency mental health services
  • Pregnant women to access maternity notes on smart phones.

Supporting NHS staff

  • Five-year NHS job guarantee for every new graduate nurse
  • The nursing vacancy rate reduced to 5% by 2028
  • Funding for clinical placements to increase in line with student nurse numbers 
  • A new online nursing degree linked to guaranteed placements 
  • 4,000 more mental health and learning disability nursing students 
  • 7,500 new nursing associates this year 
  • Body cameras piloted to keep staff safe 
  • Widespread introduction of electronic rosters
  • Development of a new Workforce Disability Equality Standard 
  • £2 million a year to reduce violence, bullying and harassment of NHS staff
  • Two-year fellowship for newly registered nurses entering general practice
  • Expansion of multi-professional credentialing to enable clinicians to develop new capabilities formally recognised in specific areas of competence
  • Two-year fellowship for newly registered nurses entering general practice.

Rolling out digitally-enabled care

  • Patients able to access GPs digitally and opt for “virtual” outpatient appointments
  • Apps developed to support particular conditions
  • Virtual and augmented reality used as part of mental health therapies for young people
  • Staff helped to capture health information digitally at the point of care
  • All community staff to have access to mobile digital devices, including access to care records.

Read the NHS Long Term Plan in full

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