• 목록
• 답변
• 글쓰기
• 게시판 리스트 옵션
  • 수정
  • 삭제

The NHS has been marking its 70th anniversary, and the nationwide dispute this has actually released has actually centred on three big facts. There's been pride in our Health Service's long-lasting success, and in the shared social dedication it represents. There's been issue - about financing, staffing, increasing inequalities and pressures from a growing and ageing population. But there's likewise been optimism - about the possibilities for continuing medical advance and much better outcomes of care.

In looking ahead to the Health Service's 80th birthday, this NHS Long Term Plan takes all three of these realities as its beginning point. So to be successful, we need to keep all that's good about our health service and its location in our nationwide life. But we need to take on head-on the pressures our personnel face, while making our extra funding go as far as possible. And as we do so, we need to accelerate the redesign of client care to future-proof the NHS for the years ahead. This out how we will do that. We are now able to because:

- initially, we now have a protected and improved funding path for the NHS, averaging 3.4% a year over the next five years, compared to 2% over the past five years;
- 2nd, because there is wide agreement about the modifications now needed. This has actually been confirmed by clients' groups, expert bodies and frontline NHS leaders who because July have all helped shape this plan - through over 200 separate events, over 2,500 separate responses, through insights used by 85,000 members of the general public and from organisations representing over 3.5 million individuals;
- and 3rd, due to the fact that work that kicked-off after the NHS Five Year Forward View is now starting to bear fruit, supplying practical experience of how to bring about the modifications set out in this Plan. Almost everything in this Plan is already being executed successfully somewhere in the NHS. Now as this Plan is carried out right across the NHS, here are the big changes it will bring:

Chapter One sets out how the NHS will move to a brand-new service model in which clients get more choices, better assistance, and properly joined-up care at the best time in the optimum care setting. GP practices and healthcare facility outpatients presently provide around 400 million face-to-face visits each year. Over the next 5 years, every patient will can online 'digital' GP consultations, and redesigned medical facility support will have the ability to avoid as much as a 3rd of outpatient appointments - conserving clients 30 million trips to medical facility, and saving the NHS over ₤ 1 billion a year in brand-new expenditure avoided. GP practices - generally covering 30-50,000 people - will be funded to work together to deal with pressures in medical care and extend the range of hassle-free local services, creating truly incorporated teams of GPs, neighborhood health and social care personnel. New broadened community health groups will be required under new national standards to provide fast assistance to people in their own homes as an alternative to hospitalisation, and to ramp up NHS assistance for individuals living in care homes. Within 5 years over 2.5 million more individuals will take advantage of 'social prescribing', an individual health budget plan, and brand-new assistance for managing their own health in collaboration with clients' groups and the voluntary sector.

These reforms will be backed by a brand-new guarantee that over the next 5 years, investment in main medical and social work will grow faster than the general NHS spending plan. This commitment - an NHS 'initially' - produces a ringfenced regional fund worth at least an additional ₤ 4.5 billion a year in genuine terms by 2023/24.

We have an emergency care system under genuine pressure, but also one in the middle of profound modification. The Long Term Plan sets out action to guarantee clients get the care they need, quick, and to eliminate pressure on A&E s. New service channels such as urgent treatment centres are now growing far much faster than medical facility A&E presences, and UTCs are being designated throughout England. For those that do need medical facility care, emergency situation 'admissions' are significantly being dealt with through 'very same day emergency care' without need for an overnight stay. This model will be rolled out throughout all severe health centers, increasing the percentage of acute admissions usually released on day of participation from a 5th to a 3rd. Building on medical facilities' success in improving outcomes for significant trauma, stroke and other vital illnesses conditions, new scientific requirements will ensure clients with the most severe emergency situations get the best possible care. And building on recent gains, in partnership with local councils further action to cut postponed medical facility discharges will assist release up pressure on medical facility beds.

Chapter Two sets out new, funded, action the NHS will require to enhance its contribution to prevention and health inequalities. Wider action on prevention will help people stay healthy and also moderate demand on the NHS. Action by the NHS is an enhance to - not an alternative to - the important role of individuals, neighborhoods, government, and services in forming the health of the nation. Nevertheless, every 24 hours the NHS comes into contact with more than a million people at minutes in their lives that bring home the individual effect of ill health. The Long Term Plan therefore funds particular new evidence-based NHS prevention programs, including to cut smoking cigarettes; to minimize weight problems, partly by doubling enrolment in the successful Type 2 NHS Diabetes Prevention Programme; to limit alcohol-related A&E admissions; and to lower air contamination.

To assist tackle health inequalities, NHS England will base its 5 year funding allotments to areas on more accurate assessment of health inequalities and unmet requirement. As a condition of getting Long Term Plan funding, all significant nationwide programmes and every local location throughout England will be required to set out specific measurable goals and systems by which they will add to narrowing health inequalities over the next 5 and 10 years. The Plan likewise sets out specific action, for instance to: cut smoking in pregnancy, and by people with long term psychological illness; ensure individuals with learning disability and/or autism get better support; provide outreach services to individuals experiencing homelessness; assist people with serious mental health problem discover and keep a job; and enhance uptake of screening and early cancer medical diagnosis for individuals who presently miss out.

Chapter Three sets the NHS's top priorities for care quality and results improvement for the years ahead. For all significant conditions, results for clients are now measurably better than a years back. Childbirth is the most safe it has ever been, cancer survival is at an all-time high, deaths from cardiovascular illness have actually halved because 1990, and male suicide is at a 31-year low. But for the biggest killers and disablers of our population, we still have unmet need, unusual regional variation, and undoubted chances for additional medical advance. These truths, together with clients' and the public's views on top priorities, imply that the Plan goes further on the NHS Five Year Forward View's focus on cancer, mental health, diabetes, multimorbidity and healthy aging consisting of dementia. But it likewise extends its focus to kids's health, cardiovascular and respiratory conditions, and finding out disability and autism, amongst others.

Some enhancements in these areas are necessarily framed as ten years objectives, provided the timelines needed to expand capacity and grow the workforce. So by 2028 the Plan dedicates to drastically improving cancer survival, partly by increasing the percentage of cancers detected early, from a half to 3 quarters. Other gains can occur earlier, such as cutting in half maternity-related deaths by 2025. The Plan likewise assigns sufficient funds on a phased basis over the next 5 years to increase the number of prepared operations and cut long waits. It makes a renewed commitment that psychological health services will grow faster than the general NHS budget, producing a brand-new ringfenced regional mutual fund worth a minimum of ₤ 2.3 billion a year by 2023/24. This will enable additional service expansion and faster access to community and crisis psychological health services for both grownups and especially kids and young people. The Plan likewise identifies the crucial importance of research study and innovation to drive future medical advance, with the NHS committing to play its full part in the benefits these bring both to patients and the UK economy.

To allow these modifications to the service model, to prevention, and to major medical enhancements, the Long Term Plan sets out how they will be backed by action on labor force, technology, development and effectiveness, as well as the NHS' overall 'system architecture'.

Chapter Four sets out how existing labor force pressures will be dealt with, and personnel supported. The NHS is the greatest employer in Europe, and the world's biggest employer of highly experienced professionals. But our personnel are feeling the strain. That's partly since over the past years workforce growth has not kept up with the increasing needs on the NHS. And it's partly because the NHS hasn't been a sufficiently flexible and responsive employer, particularly in the light of altering personnel expectations for their working lives and careers.

However there are practical opportunities to put this right. University locations for entry into nursing and medication are oversubscribed, education and training places are being expanded, and a lot of those leaving the NHS would stay if employers can decrease work pressures and provide enhanced flexibility and expert advancement. This Long Term Plan for that reason sets out a number of particular labor force actions which will be overseen by NHS Improvement that can have a positive impact now. It likewise sets out larger reforms which will be finalised in 2019 when the workforce education and training budget for HEE is set by government. These will be included in the comprehensive NHS labor force application plan published later this year, managed by the new cross-sector national labor force group, and underpinned by a brand-new compact in between frontline NHS leaders and the national NHS leadership bodies.

In the meantime the Long Term Plan sets out action to broaden the number of nursing and other undergraduate locations, guaranteeing that well-qualified candidates are not turned away as occurs now. Funding is being ensured for a growth of medical positionings of as much as 25% from 2019/20 and up to 50% from 2020/21. New routes into nursing and other disciplines, consisting of apprenticeships, nursing partners, online qualification, and 'make and find out' assistance, are all being backed, together with a new post-qualification work warranty. International recruitment will be substantially broadened over the next 3 years, and the labor force execution strategy will also set out brand-new rewards for lack specialties and hard-to-recruit to geographies.

To support present staff, more versatile rostering will end up being compulsory across all trusts, funding for continuing professional development will increase each year, and action will be taken to support diversity and a culture of respect and fair treatment. New functions and inter-disciplinary credentialing programmes will allow more workforce versatility across an individual's NHS profession and in between individual staff groups. The brand-new primary care networks will supply flexible choices for GPs and broader primary care groups. Staff and clients alike will take advantage of a doubling of the variety of volunteers also assisting across the NHS.

Chapter Five sets out a comprehensive and funded programme to update innovation and digitally made it possible for care across the NHS. These investments enable a number of the broader service modifications set out in this Long Term Plan. Over the next 10 years they will lead to an NHS where digital access to services is widespread. Where clients and their carers can much better manage their health and condition. Where clinicians can gain access to and communicate with client records and care strategies anywhere they are, with ready access to decision assistance and AI, and without the administrative hassle these days. Where predictive techniques support local Integrated Care Systems to plan and optimise look after their populations. And where protected connected scientific, genomic and other data support new medical developments and constant quality of care. Chapter Five recognizes costed building blocks and turning points for these advancements.

Chapter Six sets out how the 3.4% five year NHS financing settlement will help put the NHS back onto a sustainable monetary path. In making sure the cost of the phased dedications in this Long Term Plan we have actually appraised the existing financial pressures throughout the NHS, which are a very first get in touch with additional funds. We have actually also been practical about inevitable continuing demand development from our growing and aging population, increasing concern about areas of longstanding unmet requirement, and the expanding frontiers of medical science and development. In the modelling foundation this Long Term Plan we have for that reason not locked-in an assumption that its increased financial investment in community and medical care will necessarily decrease the need for healthcare facility beds. Instead, taking a sensible method, we have actually offered healthcare facility financing as if trends over the past three years continue. But in practice we expect that if areas carry out the Long Term Plan successfully, they will gain from a financial and health center capacity 'dividend'.

In order to deliver for taxpayers, the NHS will continue to drive effectiveness - all of which are then available to regional locations to reinvest in frontline care. The Plan sets out significant reforms to the NHS' financial architecture, payment systems and rewards. It develops a new Financial Recovery Fund and 'turn-around' procedure, so that on a phased basis over the next five years not only the NHS as a whole, but likewise the trust sector, local systems and individual organisations gradually return to financial balance. And it reveals how we will conserve taxpayers a further ₤ 700 million in decreased administrative costs across companies and commissioners both nationally and locally.

Chapter Seven discusses next steps in carrying out the Long Term Plan. We will develop on the open and consultative procedure utilized to develop this Plan and reinforce the ability of patients, experts and the general public to contribute by establishing the brand-new NHS Assembly in early 2019. 2019/20 will be a transitional year, as the local NHS and its partners have the opportunity to shape local application for their populations, taking account of the Clinical Standards Review and the national implementation structure being published in the spring, in addition to their differential local starting points in protecting the significant national enhancements set out in this Long Term Plan. These will be united in a detailed nationwide application programme by the autumn so that we can likewise properly take account of Government Spending Review choices on labor force education and training budgets, social care, councils' public health services and NHS capital expense.

Parliament and the Government have both asked the NHS to make consensus propositions for how primary legislation may be adapted to better assistance delivery of the agreed changes set out in this LTP. This Plan does not require changes to the law in order to be carried out. But our view is that amendment to the main legislation would significantly speed up progress on service integration, on administrative effectiveness, and on public accountability. We suggest modifications to: produce publicly-accountable integrated care locally; to streamline the nationwide administrative structures of the NHS; and eliminate the overly stiff competition and procurement regime used to the NHS.

In the meantime, within the existing legal structure, the NHS and our partners will be transferring to create Integrated Care Systems all over by April 2021, constructing on the development already made. ICSs combine local organisations in a pragmatic and practical way to deliver the 'triple combination' of main and specialist care, physical and mental health services, and health with social care. They will have an essential role in working with Local Authorities at 'place' level, and through ICSs, commissioners will make shared decisions with suppliers on population health, service redesign and Long Term Plan implementation.