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Is the NHS long-term plan too short-sighted on community solutions?

Posted on 16 January 2019

The Government has started the new year by publishing its long-awaited NHS Long Term Plan, touted as a 'historic moment' for our most cherished, but most challenged, national institution. 


Most people inside and outside the NHS have welcomed the plan in broad terms, with its increased funding settlement and commitments around key services.  However, there is concern about unanswered questions – particularly where the NHS will find the workforce it needs to meet these commitments – and about a number of significant omissions.

Given the Secretary of State has published his own vision for increasing action on prevention, it seems strange that this is one of the least ambitious areas of the document.  Yes, this is a plan for the NHS and public health and social care are the responsibility of local councils, but given the increased budget for the former and the ongoing fiscal squeeze on the latter, it seems only right that we should expect to see more.

Over the last few years we have developed a comprehensive understanding of the determinants of health and the benefits to be achieved from community-level interventions which create the settings and the self-efficacy required for people to make better lifestyle choices and benefit from the social, environmental and economic infrastructure that keeps us well.

Year of Green Action 

The plan promises over 1,000 trained social prescribing link workers by 2021, helping to build the networks to encourage more GPs and healthcare staff to refer to community schemes.  We know from our experience of managing projects such as Grow Blackpool what a transformative effect this can have on people’s lives.  However, the plan doesn’t offer any help in terms of supporting the development and sustainability of the projects being referred to, many of which are reliant on shrinking pots of local money being fiercely protected by enlightened public health commissioners. 

The fact that the Government has also designated 2019 as a Year of Green Action, to help kick-start public engagement with its long-term plan for the environment, should have presented a clear opportunity to think radically about how the NHS can make the link between a healthy environment and a healthier population, including through the use of its own estate.  This opportunity appears to have been missed.

Delivering social value 

The plan does recognise the potential for the health service to create social value in local communities through its role as an 'anchor institution', something that is long overdue.  The Social Value Act provides tools and opportunities for public sector bodies to amplify their impact on local communities and the local economy but its application by health trusts has been limited to date.  The NHS should be at the forefront of using its commissioning power to contribute to health creation in communities, not lagging behind.  Indeed it has the potential to help shape a new model of local wealth building of the kind being implemented in Preston and explored by councils elsewhere.

So, the NHS plan scores well on intent but fails to grasp the challenge that an institution so central to our lives and so dominant in our public finances – could and should be taking every opportunity to shape the way we live.  An increased emphasis on prevention and addressing health inequalities is welcome but the Government needs to recognise that cuts to local authority public health budgets and neighbourhood services leave communities without the support they need to contribute to these goals.  Community organisations and projects can provide invaluable support networks for those at risk of ill health or living with long-term conditions while creating healthy, inclusive, sustainable neighbourhoods that improve quality of life for everyone.

The NHS needs to become a more obvious champion of the social infrastructure needed to make this happen everywhere.


Words by Graham Duxbury, national CEO of Groundwork

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