– ‘this is a major step forward’ –  ‘Despite the now released Fit for the future: 10 Year Health Plan, England has nothing equivalent’ – ‘England would do well to draw inspiration from its neighbour’.

By stewartb

A respected think tank focusing on health and care in England, the King’s Fund published (July 14) a blog post with the headline: ‘What can English health policy learn from Scotland? A coherent policy approach to population health.’

Source: https://www.kingsfund.org.uk/insight-and-analysis/blogs/scotland-coherent-policy-approach-population-health

It describes the King’s Fund’s longstanding advocacy of a stronger focus in England on population health through promoting the ‘integration for health, as opposed to just integration of care and services’. It argues for the importance of ‘coherence in policy and practice across the four key pillars of a population’s health: effort on the wider determinants (such as housing and inclusive economic growth); health behaviours; integration of care; and the role of communities themselves. In principle, this is straightforward; in practice, it isn’t.’ (my emphasis)

The think tank has been arguing that policies for effective change need to be linked to three factors:

• ‘having a clear vision, supported by a framework that everyone can see themselves in and that can be used as a guiding light through complexity’;
• ‘a shift of effort and resources towards those areas and interventions that will really improve health’; and
• ‘leadership that coheres contributions between and across the pillars of population health as much as within any single pillar’. (my emphasis)

It is in this context that the King’s Fund expresses its positive view: ‘so welcome to see the publication of the Scottish government and the Convention of Scottish Local Authorities (COSLA) framework for population health. It sets out a clear national vision and framework over the next 10 years that will drive action and change.‘

The article acknowledges that the policy framework is based on evidence of what actually drives population health: ‘Scotland’s framework condenses down to a concerted focus on and across social and economic factors, places and communities, enabling healthy living, equitable health and care, and an overall system based on prevention.’

Adding: ‘There is much detail in the 38 pages (contrast this with England’s 10 Year Health Plan that comes in at a whopping 168 pages), and surrounding documentation (including an extensive evidence review), including significant areas on primary prevention, such as developing new approaches to resource allocation across health and other public service, improving whole-system accountability, and more commitment to health in all policies.’

The King’s Fund’s article acknowledges: ‘So, yes, more to do but Scotland does now have a population framework to help cohere the national approach to population health – this is a major step forward.’ And states: ‘Despite the now released Fit for the future: 10 Year Health Plan, England has nothing equivalent.’ 

Regarding the substance of the recently published 10 Year Health Plan from the Westminster Labour government:‘..  there is nothing that people can look to that provides coherence at national level to support the delivery of the government’s stated goal, reiterated in Fit for the future, of halving the gap in healthy life expectancy between the richest and poorest regions. England would do well to draw inspiration from its neighbour.’

Media coverage?

Scotland’s new Population Health Framework, the one praised by the King’s Fund, was published on June 17 – see https://www.gov.scot/publications/scotlands-population-health-framework/. Spot mainstream media coverage of this Scottish Government/COSLA co-created plan anyone? Too positive a story for those ever so ‘alert’ health correspondents with BBC Scotland, The Herald etc.?

I checked my impression of an absence of media coverage with ChatGPT: ‘Mainstream media coverage of Scotland’s new Population Health Framework – particularly from outlets like BBC Scotland, The Scotsman, or The Herald—has been meagre to virtually non-existent, especially when compared to the attention that health and social care issues typically attract.‘

‘Despite the Framework’s significance—a national strategy jointly issued by the Scottish Government and COSLA with clear implications for prevention, inequality, and the NHS’s future—the media footprint is minimal. The most active and engaged responses have come from: third sector organisations, public health bodies, think tanks.’ 

Reactions to Labour’s much vaunted 10 Year Health Plan for England

As we get closer to the 2026 Holyrood election, expect to see the British Labour Party and its media allies ramp up campaigning rhetoric on health and care in Scotland. Expect relentless negativity to continue, coupled now with pushing a ‘change’ agenda linked to claims of the reforming zeal and the exemplary plan – supposedly – of the Westminster Labour government. In this context, it’s worth taking the pulse of responses from credible commentators on Labour’s plan for England.

King’s Fund

On July 3, the think tank published this: ‘The King’s Fund comments on the publication of ‘Fit for the Future: 10 Year Health Plan for England’. Its CEO is quoted “There are more than 150 pages of a vision of how things could be different in the NHS by 2035, but nowhere near enough detail about how it will be implemented. Without this detail it is hard to judge how the ambitions written on the page will make a difference to the reality of the care we receive over the next few years.”

Nuffield Trust

When another of England’s high profile health think tanks, the Nuffield Trust commented on Labour’s Health Plan for England, tellingly it opened with this quote from Alan Milburn, Labour’s Secretary of State for Health from 1999 to 2003: “My advice to a new secretary of state is really simple. Buy time. The best political trick I ever pulled off was to publish a 10-year plan.”

Source: Nuffield Trust (July 3) ‘Will the scale of ambition scupper delivery of the 10 Year Plan? – With the NHS 10 Year Plan now published, Becks Fisher says the plan is rightly ambitious and contains much to like. But plans should be judged on their delivery, and this one’s undoing could be whether there’s enough funding to meet the scale of its ambitions.’ (https://www.nuffieldtrust.org.uk/news-item/will-the-scale-of-ambition-scupper-delivery-of-the-10-year-plan )

(A UK government press release dated November 9, 2024 had this news: ‘Former Health Secretary to help government fix health and care – Alan Milburn joins the Department of Health and Social Care’s board to support the government’s ambitious plans for reform.’)

Health Foundation

For completeness, the CEO of the third of England’s key health think tanks had this to say on July 7 about the Westminster government’s 10 year plan: “The plan is chock-full of initiatives – several to a page – almost everything its architects could think of and threaded together with a distinct ‘do it or else’ narrative undertone. On getting to the end, it is easier to sink back in exhaustion than stand up and clap.”

Source: https://www.health.org.uk/features-and-opinion/blogs/10-year-plan-for-change-or-plus-a-change

Adding: “Taken as a whole, the broad direction of travel is familiar, not just relative to the Secretary of State’s oft-stated three shifts but to at least 30 years of previous policymaking and ‘big moment’ Plans (capital P) in health – more tech, a shift to care in the community and prevention. The broad direction is right and many of the initiatives look sensible, disregarding some oddities that always creep into plans like this …”.

However, the Health Foundation then repeatedly displays scepticism:

• “the more you look at the plan the more curious it seems”

• “The first and most obvious curiosity is that in the scramble to produce a plan with government defining vision, realism about delivery appears to have been forgotten”

• “In the current world of 2.8% real-terms growth per year to 2028, the real priorities in the 10-year plan are not set out, nor are their timing, trade-offs or implications for resources (money and staff). We are left with a breezy ‘everything, everywhere, all at once’ impression”

• “And this alongside the self-inflicted cost, distraction and motivation-sapping reorganisation of the Department of Health and Social Care (DHSC), NHS England and integrated care boards, plus significant financial deficits that can’t be menaced away. Setting out a vision for the NHS that is unachievable, prefaced by a ‘reform or die’ threat, risks creating problems (if only political) further down the track.”

• “The second curiosity, given that neighbourhood care is the centrepiece, is the lack of reference to previous serious attempts to shift care from hospital into the community.”

• “The third curiosity is the lack of a coherent thread and underlying engine that will power ‘system reform’, aka progress across NHS organisations. Old hands like me look for this first in plans like this. Why? Because you need to build a coherent architecture across the system to support the change.” – recall the King’s Fund specifically concluded: ‘Scotland does now have a population framework to help cohere the national approach to population health – this is a major step forward.’

• And finally, “No inkling of assessing impact” ….. “Given the (rightful) emphasis on tech, a proper assessment of impact is vital, especially given current levels of techno-ecstasy in society, which are not unlinked to the potential for private profit. And, judging by a marked increase in media-grabby overclaims in the past few months on the impact of certain initiatives, independent assessment (without fear or favour) is needed more than ever. But there is no inkling of this in the plan.”

Source: https://www.health.org.uk/features-and-opinion/blogs/10-year-plan-for-change-or-plus-a-change

British Medical Association

And finally, a view on the 10 Year Health Plan for England from the BMA (see https://www.bmj.com/content/390/bmj.r1396 )

‘More hope than substance: New technology offers hope—for instance, in reducing administration for clinicians—and government is right to try to harness it. But the plan borders on techno-optimism.’

‘Standing back, the guiding ideas behind the plan are muddy. A mix of measures rely on competition and choice to stimulate improvements – for instance, by encouraging a “plurality” of providers and asking patients to shop around between them. Yet large integrated providers will become the “norm.” And some measures look destined for perverse effects. For example, a scheme where patients will be asked to rate their care and decide whether the provider gets reimbursed in full is likely to result in already struggling NHS hospitals being penalised for issues beyond their control, such as crumbling buildings.’

‘What is clear is that the plan means more NHS restructuring. Government had already announced plans to abolish NHS England and cut spending in NHS integrated care systems. But now these systems will be reorganised too—merged across larger areas, with changes in their role and governance. This is not radical: it is part of the constant cycle of “redisorganisation” that characterises NHS policy making. Evidence suggests it won’t help. Taken together, these changes signal a shift back to a sharper purchaser-provider split in the NHS, away from the more collaborative approach envisaged for integrated care systems just a few years ago.’

End note

Praise for Scottish Government/COSLA co-created 10 year health and care plan – but little or no mainstream media coverage of this in Scotland. Consequence: Scotland’s electorate left ill-formed on this positive whilst continually subjected to negatively framed news of health and care in Scotland.  Favourable result for opponents of the Scottish Government!

Widespread scepticism regarding Labour’s 10 year plan for England – but little or no mainstream media coverage of this in Scotland. Consequence: Labour able to feed Scotland’s electorate with the party’s proposals for NHS reform here relatively unchallenged by a compliant media! Favourable result for opponents of the Scottish Government and especially the British Labour Party in Scotland!

Returning to engagement with ChatGPT: ‘Scottish media typically fails to include UK or international context, reinforcing negative framing. This pattern falls short of BBC guidelines and does raise concerns about bias by omission. The root causes seem to be a mix of structural reporting incentives, political pressures, and possibly editorial habits, rather than overt partisan bias.’

‘Omission in this context can distort public understanding, making health policy seem perpetually dysfunctional rather than complex, evolving, or mixed in performance.’