NHS Long Term Plan: “Advances in technology mean outpatients appointment are not the fastest or most accurate way to provide specialist advice”

NHS  | January 2019 | NHS Long Term Plan

The NHS’ 10 year plan outlines how a third or outpatients appointments may be reduced as the current model is “outdated and unsustainable”.


Outpatients traditionally serve at least three purposes, and in each case there are
opportunities for redesign. An outpatient appointment can provide: advice and diagnosis for a patient and their GP; follow-up review after a hospital procedure; and ongoing specialist input into a long-term condition. Technology means an outpatient appointment is often no longer the fastest or most accurate way of providing specialist advice on diagnosis or ongoing patient care. 

The plan describes  the traditional model of outpatient care as being “outdated  and unsustainable”.  It outlines its intention to  redesign services so that over the next five years patients will be able to avoid up to a third of face-to-face outpatient visits, removing the need for up to 30 million outpatient visits a year.

The document also includes a case study of Tower Hamlets  Chronic Kidney Disease e-Clinics where a single pathway from primary to secondary care with rapid
access to specialist advice provided by consultant led e-clinics have transformed the way the way this care is delivered.

Four reasons are cited as enabling these technology-driven shifts:


  1. They are already happening
    in parts of the NHS, so this is clearly ‘the art of the possible’.
  2. There is strong patient ‘pull’ for these new ways of accessing services, freeing-up staff time for those people who can’t or
    prefer not to.
  3. The hardware to support ‘mobile health’ is already in most people’s pockets –
    in the form of their smart phone – and the connection software is increasingly available for the NHS to credential from third party providers.
  4. The Long Term Plan provides dedicated funding to capitalise on these opportunities

Read the NHS Long Term Plan at the NHS Long Term Plan website  (Source: NHS Long Term Plan)

See also:

OnMedica | Number of outpatients appointments to be cut

Can a Strong Economic Case Be Made for Investing in the NHS? 25th Annual Lecture Publication

Office of Health Economics | January 2019 | Can a Strong Economic Case Be Made for Investing in the NHS? 25th Annual Lecture Publication

The Office of Health Economics has just published Can a Strong Economic Case Be Made for Investing in the NHS? 25th Annual Lecture Publication, which is a transcript of a lecture given last autumn by Professor Peter Smith. 

eco case for health
Image source: ohe.org

In his lecture Professor Smith argued that an economic case can be made for investment in the NHS. But it is not straightforward and will involve changes in the way the NHS thinks about itself. The NHS must show how it can promote the government’s macroeconomic objectives, including sustainable public finances; a stable economy and financial system; and structural reforms to increase employment, productivity, growth, and international competitiveness; and supporting societal wellbeing.

Read and download the transcript here 

Letting Local Systems Lead: How the NHS Long Term Plan can deliver a Sustainable NHS

NHS Confederation | November 2018 | Letting Local Systems Lead

In Letting Local Systems Lead,  NHS Confederation are calling for action to remove the barriers to effective local system working.

systems lead
Image source: nhsconfed.org

The publication of Letting Local Systems Lead follows a survey of NHS Confederation members which found that:

  • Six in ten leaders (61%) agree that sustainability and transformation partnerships (STPs) and integrated care systems (ICSs) represent the right approach for partnership working between the NHS and local government.
  • But the vast majority of respondents considered that only moderate progress (44%) or a little progress (42%) had been made in implementing the system working approach set out in the NHS Five Year Forward View
  • When asked what would make a difference, local leaders identified better local partnership working, improved engagement with staff, patients and communities, more effective local governance and a more supportive oversight regime (Source: NHS Confederation)

Full details at NHS Confederation 

Download  Letting Local Systems Lead 

Health and care integration

Interface between health and social care | Public Accounts Committee

This report highlights the widespread consensus that integration and joint working is the right way forward for the health and social care system to deliver the best and most effective outcomes for people and their families.

Financial pressures and an ageing population have both increased the need for joined-up working, with local authorities reducing real-terms spending on adult social care by 5.3% between 2010-11 and 2016-17, while the number of people in England aged 85 and over rose by 28% between 2006 and 2016.

However, the report finds that the government lacks an effective overall strategy or plan to achieve its aim of integrating the health and social care sectors. It recommends the government should set out a costed 10-year plan for social care to go with its 10-year plan for the NHS.

Employee engagement in the NHS

Employee Engagement in the NHS: A secondary data analysis of the NHS Healthy Workforce and Britain’s Healthiest Workplace surveys | RAND Corporation

This study examined the factors associated with engagement among NHS employees as part of a project with the Health Foundation.

Key Findings

  • Comparing the NHS to other sectors in the UK, the findings suggest that employee engagement in the NHS is lower than in some UK sectors, such as media and telecommunications and professional services, but better than in others, such as financial services and logistics.
  • The report suggests that a number of demographic factors are associated with levels of engagement, including gender and age.
  • Employees working in different NHS occupations report different levels of engagement. For instance, among employees in social care, admin and general management levels of engagement tend to be lower on average. In contrast, employees in medical and dental occupations, and nursing and healthcare assistants tend to report higher levels of engagement.


  • Approaches aimed at improving staff engagement will need to be targeted at specific groups.
  • It is important to keep making the business case for improved staff engagement to key policy makers and decision-makers in the service starting possibly with finance directors and chief executives.

Full document: Employee Engagement in the NHS

Image source: http://www.rand.org

70 years of the NHS in Wales: the changing role of the NHS finance function

HFMA  | October 2018 | 70 years of the NHS in Wales: the changing role of the NHS finance function

HFMA has released a briefing, which reflects on what has changed for the NHS in Wales since its inception 70 years ago; it reviews some of the advancements and challenges faced; and explores how this might inform the direction of travel for the NHS policy framework in Wales and the role of NHS finance.


Read the full briefing at HFMA

Healthcare in 2088 how will research and innovation transform the NHS in the next 70 years?

NIHR| August 2018 | Healthcare in 2088 – how will research and innovation transform the NHS in the next 70 years?

In a new post on the NIHR blog Professor Mike Trenell, Director at NIHR Innovation Observatory, envisages how the NHS might look in 70 years’ time. Acknowledging the difficulty in making predictions about the future of the NHS even in a decade’s time, he writes that it is much more problematic to prepare further ahead.  Instead, Professor Trenell and his colleagues at the NIHR Innovation Observatory keep an eye on what the future holds. Helping the NHS and healthcare leaders to understand future medicines, devices and diagnostics helps to shape policy, regulation and approvals and stimulate research activity.

They identify three areas that will influence the future of healthcare

  1. Digital Healthcare:
    In the future, whether you access a GP through a video call, artificial intelligence is used to interpret your MRI scan, or your phone lets you know what dose of a drug to take – digital healthcare holds the potential to fundamentally change how we access and provide care.
  2. Changing Genes: The ability to alter genetic coding was established in 2012, a technology called Clustered Regularly Interspaced Short Palindromic Repeats – CRISPR. But scientists and care teams have translated this into ways to tailor immune therapies to attack cancers or cut out mutations that cause disease.Research taking place in this area right now provides a glimpse of how gene editing might affect future care. For example, researchers funded by the NIHR’s Efficacy and Mechanism Evaluation (EME) Programme are conducting a clinical trial looking at using gene therapy to replace the faulty gene that causes the incurable eye disease choroideremia with a healthy one.

    The ability to modify genes will have deep implications for the management and prevention of some diseases, but it will also have deep societal and ethical implications.

  3. Looking after ourselves This area is not an innovation by definition, but it will have important implications for us all. Today the NHS has developed into a world leading health care provision service, but is being challenged by the pressures being put upon it. Obesity rates continue to rise and physical activity levels falling. Although the NHS is keeping us alive longer, it comes at a very real financial and individual cost (are the extra years actually of a quality we would like?).We are moving from an era of biomedical enlightenment into a realisation of its limitations. The future will involve a greater balance of disease prevention and public health as well as disease management – we need to revisit the original remit of the NHS and create a “wellbeing culture”. (Source: NIHR)

    The full unabridged blog post is available from NIHR