Ahead of the long term plan, what are the lessons from history from the 6 national strategic plans produced by the NHS over the last 20 years? Our collection of essays out today tries to answer this and here are some things I think are especially important. THREAD
1. Beware of optimism bias. The NHS has long been prone to unreasonable expectations about how quickly the system can deliver complex change at once. Does anyone remember the Better Care Fund promising to make emergency admissions fall 3.5% in just one year? (they rose)
2. Get the right mix of top down and bottom up – problem here is we have underinvested in local planning capability. £100ms spent on management consultants suggests we didn't have the people or expertise. There seems to have been limited knowledge transfer when they do the work
3. Plans should generally set out what to do, not how to do it. The right answer will vary locally. Rolling out the same thing nationally, like 'Darzi centres' means many areas will be lumbered with a solution that doesn't work for them.
4. There does need to be a plausible "theory of change" - ie. Methods and mechanisms that will cause the plan to actually happen. This is often lacking or too reliant on top down managerialism, penalties or clever (& often ineffective) incentives.
5. Don't use simple solutions for complex problems or where local context is important. E.g. fining Councils for delayed transfers of care generally failed because the causes were too complex for a single intervention and it disrupted local relationships.
6. The plan needs to have a compelling narrative to engage and energise front line staff. Policy speak won't make people change what they do on a day to day basis.
7. Flows of money must be aligned with the stated aims of the plan. We had decades of rhetoric about shifting care out of hospital while investment has fallen in community services and primary care.
8. Engage the public and don't pretend you will if you won't! STPs were badly damaged by toxic mistrust after poor and misleading communication.
9. No strategy will work if it doesn't have a well-developed workforce plan to produce the staff it needs. We really can't afford to forget this yet again. So far the signs are not encouraging.
10. Structural reorganisation may sometimes be necessary but history has proved that it costs more than anticipated and has less impact than expected, except to distract from change. I really don't have to point to examples for this one!
Bonus lesson: This isn't in our collection of essays out today because it's been said better by @Paul_Corrigan You can't reduce inequalities without working across sectors with councils, charities and other services. The NHS can't do it alone. blog.pauldcorrigan.com/2018/06/26/yes…
Read our collection on lessons from previous plans here nuffieldtrust.org.uk/comment-series…
