NHS England Long Term Plan

The NHS England Long Term Plan was published in January 2019. Respiratory disease is a priority area in the plan; the first time that lung disease has been a clinical priority area for the NHS in England.

Download the full plan and its executive summary

The main topics mentioned in the respiratory section of the plan are:

• Early and accurate diagnosis: with a particular emphasis on spirometry testing in the community via primary care networks, and extending the Liverpool and Manchester lung health check pilots to offer breath tests and discussion to assess lung cancer risk in mobile units, with any patient at risk to have an immediate low-dose CT scan.
• Pulmonary rehabilitation: expanding services and increasing the number of patients with respiratory disease who are referred to pulmonary rehabilitation, where appropriate. This will look at different ways in which pulmonary rehabilitation can be delivered at a local level. The plan commits to expanding pulmonary rehabilitation services over 10 years, preventing 500,000 exacerbations and avoiding 80,000 new admissions.
• Correct medication: with a particular focus on medication reviews for patients with asthma and the possibility of switching to inhalers with a lower carbon impact and smart inhalers where clinically appropriate.
• Pneumonia: recognising the huge burden placed on the NHS by pneumonia, particularly during winter, the plan emphasises the importance of consistent use of risk scoring to reduce avoidable admissions as well as nurse-led supported discharge services to support safe out of hospital care.
• Flexible learning: a ‘first contact’ package will be developed to support those diagnosed with COPD and asthma, and form part of the treatment plan. This will include face to face and digital options to enable patients to self-manage their condition.
• Breathlessness: the plan highlights breathlessness as a common symptom shared across cardiac and lung conditions and commits to producing an evidence base for joint cardiac and pulmonary rehabilitation models, which can then be rolled out across the NHS.

There are also several priorities which are highly relevant to the respiratory specialty throughout the plan, including:

• Prevention:
  • Smoking cessation: the plan proposes a new smoke-free pathway for mothers and partners, a new universal smoking cessation offer as part of mental health services and that by 2023/24 all admitted to hospital be offered tobacco treatment services.
  • Air pollution: there is recognition of the damage to health caused by air pollution and a target of cutting business mileages and fleet air pollutants by 20% by 2023/24.
• Health inequalities: the Long Term Plan will see funding targeted to areas with high inequalities and local systems required to set out how they will reduce inequalities by 2023/24 and 2028/29 with measurable targets to be set.
• Workforce: the plan trails a comprehensive new workforce implementation plan including expanding numbers of nurses, midwives, associated healthcare professionals and other staff, growing the medical workforce, internal recruitment, supporting current staff, enabling productive working, leadership and talent management, volunteers.
• Integrated care systems: all areas are expected to move to become integrated care systems with the aim of triple integration: between primary and specialist, physical and mental health, and health and social care.
• Digital: an ambition is set for digitally-enabled care to be mainstream across the NHS within the next 10 years. This is to include straightforward digital access to NHS services, integrated patient records, decision support and AI to help clinicians apply best practice, and ensure data security.

To support the Long Term Plan, several other documents have been published during 2019:

• Interim NHS People Plan
• Long Term Plan Implementation Framework
• Mental Health Implementation Plan 2019/20 - 2023/24

All STPs and ICSs have also been requested to write new five year plans setting out how they will meet the commitments of the Long Term Plan. A summary of these five year plans will be published in Dec 2019 or early 2020.

Implementation

The Long Term Plan is being implemented via a series of programme boards, delivery boards and working groups. Within respiratory the structure is as follows:

There are also a number of cross cutting work streams, the main ones which relate to respiratory are:

• Workforce
• Self-management and rehabilitation