John Lister looks more closely at some of the key proposals and ideas in the Ten Year Plan
Foundation Trusts
When these bodies were first launched back in 2004 FT status was only open to the top-rated ‘3-star trusts’ – already the wealthiest and best-performing. They are now to be to reinvigorated and reinvented, with a promise to add back in Alan Milburn’s original plan for FTs to be given freedom to borrow money. This was firmly squashed last time around by Gordon Brown as Chancellor, and it appears the Treasury is still not convinced that this should be allowed.
The new Plan also discards the flimsy pretence of local or democratic accountability in FTs, by allowing them to decide who sits on their own boards and cutting out their need for them to have boards of governors.
Streeting and chums also seem happy for FTs to retain the additional freedom to make up to half their income from private patients, which was controversially pushed through in the 2012 Health and Social Care Act by David Cameron’s government with LibDem help, against Labour opposition.
But have FTs ever been the success the Plan claims? Research published in 2011 by York University academics, found NO evidence of any substantial positive “FT effect”:
“the issue perhaps is … whether the extra costs involved in setting up and regulating FTs are justified. […] although there are … examples of FTs introducing novel treatment paths and service arrangements, … it is difficult to know whether the Trusts would have been able to make such changes anyway.”
In 2015, the Health Foundation came to a similar conclusion, emphasising how similar was the performance of NHS trusts and foundations:
“… across a number of quality measures, Foundation Trusts and NHS trusts perform similarly. For the proportion of patients receiving harm free care NHS trusts seem to outperform FTs.”
And a King’s Fund blog in 2016 noted the continued dependence of FTs on government and NHS support, and argued the FTs were: “independent corporations on paper, yet entirely dependent on the state in reality – for funding, capital investment and bailouts when things went wrong.”
Back to a market in health care
Also brought back into play in the Plan is the New Labour attempt to create a costly and chaotic competitive market system, re-sharpen the division between commissioners (Integrated Care Boards) and providers, and once again emphasise “patient choice” rather than any rational planning and allocation of resources.
Integrated Care Boards (ICBs), acting now purely as commissioners are called upon to create and shape local markets in health care –open to the private sector as well as NHS providers – just as Primary Care Trusts were obliged to do from 2005.
There seems to be a literal echo of 2005-6 in the summary on page 79:
“As well as commissioning, which will often involve ‘market making’, ICBs will need to actively cultivate strong providers. To support that, ICBs will be empowered to commission neighbourhood health services from a diverse range of providers, both within and beyond the NHS, drawing on different models of provision to develop effective contractual arrangements.”
NHCs = Polyclinics
The proposal for a network of Neighbourhood Health Centres is very similar to Lord Darzi’s 2007 plan for Polyclinics. But the accompanying Technical Paper to that plan revealed that each polyclinic would employ an average of around 90 medical and nursing staff (including 35 GPs and 3-4 consultants), be located in rented accommodation (it was widely assumed they would be rented from the private sector), and run on a budget of around £21m a year. So the proposed 150 polyclinics in the capital would have needed to enlist a total of over 5,200 GPs – slightly more than the number of GPs in London – and cost a total of £3.1 billion per year.
Darzi seriously underestimated the numbers of non-clinical staff that would be needed to ensure that the new polyclinics could work as they should. His projected total “administrative overhead” would have left just £326,000 for IT services, admin and clerical staff and management to run a £20m a year operation, equivalent to just 13 clerical staff on £25,000 a year – nowhere near the level of managerial and support staff that would have been needed.
The plan was rejected by the public (a massive £5m London-wide consultation yielded just 1,900 responses in support of polyclinics, just scraping 51% of responses, while the BMA swiftly gathered 1.2 million signatures against the plans.) By June 2008 even the King’s Fund was warning that polyclinics may be more expensive, less efficient and less accessible than the traditional family doctor service. Only a few, partial efforts at Polyclinics ever opened, and none of these lasted long.
In a Plan lacking any real details for implementation we don’t yet have any costings or details of NHCs (catchment population, scope of services, staffing etc) to estimate if they might prove less unsuccessful. However Streeting has said that the long term aim is a network of just 250-300 NHCs in England, suggesting a much larger catchment area of 190,000-228,000 – equivalent to the lists of 84-100 GPs.
This scale of catchment is much bigger than a neighbourhood – it’s larger than many small towns. Given the extent to which GPs rejected the smaller-scale polyclinic proposals it seems most unlikely Wes will find today’s already over-stretched and under-funded GPs leaping to embrace the plan for NHCs: nor is there compelling evidence that it would necessarily deliver all the magical results the Plan seems to expect.
Private Finance Initiative – this time as PPP
After ministers were effectively told last month by the Treasury that they should discard any thought of replicating the Blair/Brown era extravagance of the Private Finance Initiative for building public sector infrastructure, the Plan includes a commitment to bring back the very similar Public Private Partnerships (PPPs) as the way to finance new Neighbourhood Health Centres (NHCs).
The Treasury guidance did say the only NHS arena where the government might explore the feasibility of using PPP models for taxpayer-funded projects was “In certain types of primary and community health infrastructure.” This has now opened the door for PPPs to be used to fund the new centres.
However this ignores the evidence the most proportionately expensive (and poor value) PFI contracts were for building relatively low-cost project (like NHCs) – where payments over 25 or 30 years offered long term, guaranteed profits to the private sector investors. 20 NHS PFI schemes for buildings valued at less than £100 million are delivering in excess of ten times the initial cost, compared with the average total cost of 6.6 times.
AI – warnings ignored
The new Plan goes hell for leather for Artificial Intelligence as a means to cut staff numbers and increase efficiency, but shows no awareness of warnings on the limitations and potential weaknesses of using AI in general, and especially in health care.
Nowhere in the Plan is there any assessment of the cost of the AI applications themselves, or of the widespread need to upgrade and update NHS IT systems to enable it to be fully used.
Nor is there any reference to protecting confidentiality of patient data, especially given the strong possibility that the contract for handling centralised patient records would go to the US corporation Palantir, whose boss Peter Thiel has expressed contempt for the NHS, while the company works hand in glove with the Trump administration and Netanyahu’s war machine.
A bonfire of accountabilities
The Plan and recent changes will make Integrated Care Boards even less democratically accountable, by forcing mergers that will leave many of them covering much larger populations, and stripping away the involvement of local councils and replacing this with mayors of strategic authorities.
Local accountability will be undermined even more by the Plan’s proposal to “create a new opportunity for the ‘very best’ FTs to hold the whole health budget for a defined local population as an integrated health organisation (IHO).”
These new bodies would have no accountability to anyone in the area they cover. And IHOs would be given the security of “longer-term, capitation-based” contracts – while other trusts and FTs would no longer be paid through block contracts, and instead be paid “only … for effective care which has been commissioned by an integrated care board (ICB),” with payment withheld for “poor quality care” and/or a “bonus for high quality care.”
Meanwhile the last remnants of local statutory bodies with a responsibility to speak up for patients and the local public (first established in Community Health Councils (CHCs) in 1974) are to be swept away with the abolition of the largely toothless Healthwatch England and its 150 largely dormant local Healthwatch bodies.
The best CHCs were fiercely independent of local health chiefs and waged high profile campaigns on standards of care and in defence of threatened services: that’s why they were abolished in Alan Milburn’s Bill establishing Foundation Trusts. By contrast Healthwatch was set up as token bodies with a much more limited brief as part of Andrew Lansley’s Health and Social Care Act.
But the loss of Healthwatch comes at the same time as the axing of the Freedom to Speak Up Guardian along with the network of local Guardians – effectively gagging potential staff whistleblowers and cutting another line of accountability.
These imperfect mechanisms at least gave some opportunity for the public and staff to raise and share concerns: it is even more concerning to see that the new arrangements emerging in the Plan will also leave local government with less voice than ever on local health services, even as the social care services they run come under greater pressure.
Nor is there any obvious voice within the ever-less local NHS for primary care, community health or mental health, despite the central role the Plan seems to give to NHCs. An organisation the size of the NHS that offers no avenue for legitimate concerns and suggestions to be raised by such key players is setting itself up to fail.
Half hearted commitments on training
The Plan makes a reference to the appalling bottlenecks and systems failure in the training of resident doctors (p101) and promises to:
“• work across government to prioritise UK medical graduates for foundation training, and to prioritise UK medical graduates and other doctors who have worked in the NHS for a significant period, for specialty training
- over the next 3 years, create 1,000 new specialty training posts with a focus on specialties where there is greatest need.”
While the reduction in reliance on overseas doctors is welcome, the expansion of places falls way short, given that this year alone, 20,000 applicants are expected to miss out on speciality training – which means they can’t train to eventually become consultants or GPs.
Elsewhere the Plan promises to “end the 8am scramble” for a GP appointment by training new GPs, ignoring the fact qualified GPs are being left unemployed because local practices cannot afford to pay them, while patients face long waits to see a doctor.
There is also talk about increasing the numbers of nurses and midwives trained, while we know thousands of them qualifying this year, along with newly-trained physiotherapists and other health professionals are struggling to find jobs, with cash-strapped trusts seeking to cut numbers overall and only employ experienced staff.
These gaps between the picture presented in the Plan and the reality on the ground in the NHS in 2025 question how viable many of its proposals will prove in practice.
Baseless assumptions
The question marks over the Plan are underlined by a series of assumptions which again clash with the reality in the NHS.
1) That “rigorous financial discipline” can be “restored” in a single year. (p 133) None of this section of the document makes any great sense. We are told that:
“The NHS has developed an addiction to deficits. Where once they were an exception that indicated genuinely poor financial management, today they have become a widespread and accepted feature of health service management.”
This completely ignores the extent and impact of the austerity squeeze on NHS funding from 2010, which brought an abrupt halt to ten years of real terms growth in budgets, and forced trusts into deficits. By the spring of 2020 borrowing to cover these deficits had reached such a level that Matt Hancock as Health Secretary effectively wrote off £13.4 billion of debt.
In April last year, while Labour was insisting England’s NHS could be fixed without any extra spending, the IFS warned that it was facing the biggest actual cut in spending since the 1970s.
The deficits have been a symptom not of “poor financial management,” but of trusts lacking the resources they need to cope with demand for emergency and elective care.
Wes Streeting has said NHS England’s £2.2 billion deficit funding to prop up flagging trust finances will halt at once, and the Plan states: “From financial year 2026 to 2027, we expect all NHS organisations to deliver operational plans that are fully compliant with the NHS planning guidance. There will be no exceptions.”
But on the day the Plan was published NHS England CEO Sir Jim Mackey told the Health Service Journal deficit funding would only begin to be withdrawn next year, and it would not be removed immediately, not least because several systems with high deprivation – such as Lancashire, Greater Manchester, Cheshire and Merseyside, and South East London – are big recipients.
The Health Foundation has pointed out that the attempt to move to a community and neighbourhood based system has been made before: and the lack of sufficient extra funding in the Spending Review makes it no easier this time:
“Future funding will be below historic growth, the plan’s commitment to increasing the share of funding going to primary and community services is weak, and the political priority placed on waiting lists will keep hospitals in the spotlight.”
The Plan not only assumes a near instant (and apparently painless) transition to balanced budgets, but also assumes all organisations will be able to set aside an additional 3% of their budgets to invest in “service transformation.” (p134)
In fact we know that one of the ways ICBs have been seeking to save money and reduce deficits is to slow down the treatment of elective patients, which of course makes it even less likely that the government can deliver its one remaining electoral promise on the NHS – to restore the 18 week maximum wait for elective care for 92% of patients by 2029.
2) In addition to assuming all trusts can somehow swiftly eradicate deficits that have built up over 15 years, the Plan assumes most can then deliver a surplus: “Every organisation will be required to continue to refresh their plans, aiming for most organisations to be in a sustainable surplus position.” Exactly how that can be delivered, alongside “patient choice” and without most commissioners being in deficit is of course not explained.
3) The third assumption is that the NHS will suddenly be able to do a whole series of things it has always failed at before, and that it can and should take on tasks that are better done by other bodies, not least the assertion that “It will be a service equipped to narrow health inequalities.” (p 9)
4) The fourth assumption is that toxic management culture that exists in too many trusts can somehow be wished away or magically eradicated and that a cohort of high quality managers will miraculously emerge and survive all of the job cuts taking place at every level in the NHS and emerge in sufficient numbers to rescue failing trusts.
Missing links
In addition to the baseless assumptions there are of course three vital missing links that would be necessary to transform Fit for the Future from a wish list into a workable plan:
- No workforce plan (although the current plan, produced just 2 years ago, is rejected as impractical and unaffordable)
- No finance plan, needed to correspond to the 30 or so commitments that carry increased costs or require up-front investment to secure savings.
- No implementation plan, setting out what to do in each part of England’s NHS beginning this month, this year, and working forwards.
Dear Reader,
If you like our content please support our campaigning journalism to protect health care for all.
Our goal is to inform people, hold our politicians to account and help to build change through evidence based ideas.
Everyone should have access to comprehensive healthcare, but our NHS needs support. You can help us to continue to counter bad policy, battle neglect of the NHS and correct dangerous mis-infomation.
Supporters of the NHS are crucial in sustaining our health service and with your help we will be able to engage more people in securing its future.
Please donate to help support our campaigning NHS research and journalism.
John Lister looks more closely at some of the key proposals and ideas in the Ten Year Plan
Foundation Trusts
When these bodies were first launched back in 2004 FT status was only open to the top-rated ‘3-star trusts’ – already the wealthiest and best-performing. They are now to be to reinvigorated and reinvented, with a promise to add back in Alan Milburn’s original plan for FTs to be given freedom to borrow money. This was firmly squashed last time around by Gordon Brown as Chancellor, and it appears the Treasury is still not convinced that this should be allowed.
The new Plan also discards the flimsy pretence of local or democratic accountability in FTs, by allowing them to decide who sits on their own boards and cutting out their need for them to have boards of governors.
Streeting and chums also seem happy for FTs to retain the additional freedom to make up to half their income from private patients, which was controversially pushed through in the 2012 Health and Social Care Act by David Cameron’s government with LibDem help, against Labour opposition.
But have FTs ever been the success the Plan claims? Research published in 2011 by York University academics, found NO evidence of any substantial positive “FT effect”:
“the issue perhaps is … whether the extra costs involved in setting up and regulating FTs are justified. […] although there are … examples of FTs introducing novel treatment paths and service arrangements, … it is difficult to know whether the Trusts would have been able to make such changes anyway.”
In 2015, the Health Foundation came to a similar conclusion, emphasising how similar was the performance of NHS trusts and foundations:
“… across a number of quality measures, Foundation Trusts and NHS trusts perform similarly. For the proportion of patients receiving harm free care NHS trusts seem to outperform FTs.”
And a King’s Fund blog in 2016 noted the continued dependence of FTs on government and NHS support, and argued the FTs were: “independent corporations on paper, yet entirely dependent on the state in reality – for funding, capital investment and bailouts when things went wrong.”
Back to a market in health care
Also brought back into play in the Plan is the New Labour attempt to create a costly and chaotic competitive market system, re-sharpen the division between commissioners (Integrated Care Boards) and providers, and once again emphasise “patient choice” rather than any rational planning and allocation of resources.
Integrated Care Boards (ICBs), acting now purely as commissioners are called upon to create and shape local markets in health care –open to the private sector as well as NHS providers – just as Primary Care Trusts were obliged to do from 2005.
There seems to be a literal echo of 2005-6 in the summary on page 79:
“As well as commissioning, which will often involve ‘market making’, ICBs will need to actively cultivate strong providers. To support that, ICBs will be empowered to commission neighbourhood health services from a diverse range of providers, both within and beyond the NHS, drawing on different models of provision to develop effective contractual arrangements.”
NHCs = Polyclinics
The proposal for a network of Neighbourhood Health Centres is very similar to Lord Darzi’s 2007 plan for Polyclinics. But the accompanying Technical Paper to that plan revealed that each polyclinic would employ an average of around 90 medical and nursing staff (including 35 GPs and 3-4 consultants), be located in rented accommodation (it was widely assumed they would be rented from the private sector), and run on a budget of around £21m a year. So the proposed 150 polyclinics in the capital would have needed to enlist a total of over 5,200 GPs – slightly more than the number of GPs in London – and cost a total of £3.1 billion per year.
Darzi seriously underestimated the numbers of non-clinical staff that would be needed to ensure that the new polyclinics could work as they should. His projected total “administrative overhead” would have left just £326,000 for IT services, admin and clerical staff and management to run a £20m a year operation, equivalent to just 13 clerical staff on £25,000 a year – nowhere near the level of managerial and support staff that would have been needed.
The plan was rejected by the public (a massive £5m London-wide consultation yielded just 1,900 responses in support of polyclinics, just scraping 51% of responses, while the BMA swiftly gathered 1.2 million signatures against the plans.) By June 2008 even the King’s Fund was warning that polyclinics may be more expensive, less efficient and less accessible than the traditional family doctor service. Only a few, partial efforts at Polyclinics ever opened, and none of these lasted long.
In a Plan lacking any real details for implementation we don’t yet have any costings or details of NHCs (catchment population, scope of services, staffing etc) to estimate if they might prove less unsuccessful. However Streeting has said that the long term aim is a network of just 250-300 NHCs in England, suggesting a much larger catchment area of 190,000-228,000 – equivalent to the lists of 84-100 GPs.
This scale of catchment is much bigger than a neighbourhood – it’s larger than many small towns. Given the extent to which GPs rejected the smaller-scale polyclinic proposals it seems most unlikely Wes will find today’s already over-stretched and under-funded GPs leaping to embrace the plan for NHCs: nor is there compelling evidence that it would necessarily deliver all the magical results the Plan seems to expect.
Private Finance Initiative – this time as PPP
After ministers were effectively told last month by the Treasury that they should discard any thought of replicating the Blair/Brown era extravagance of the Private Finance Initiative for building public sector infrastructure, the Plan includes a commitment to bring back the very similar Public Private Partnerships (PPPs) as the way to finance new Neighbourhood Health Centres (NHCs).
The Treasury guidance did say the only NHS arena where the government might explore the feasibility of using PPP models for taxpayer-funded projects was “In certain types of primary and community health infrastructure.” This has now opened the door for PPPs to be used to fund the new centres.
However this ignores the evidence the most proportionately expensive (and poor value) PFI contracts were for building relatively low-cost project (like NHCs) – where payments over 25 or 30 years offered long term, guaranteed profits to the private sector investors. 20 NHS PFI schemes for buildings valued at less than £100 million are delivering in excess of ten times the initial cost, compared with the average total cost of 6.6 times.
AI – warnings ignored
The new Plan goes hell for leather for Artificial Intelligence as a means to cut staff numbers and increase efficiency, but shows no awareness of warnings on the limitations and potential weaknesses of using AI in general, and especially in health care.
Nowhere in the Plan is there any assessment of the cost of the AI applications themselves, or of the widespread need to upgrade and update NHS IT systems to enable it to be fully used.
Nor is there any reference to protecting confidentiality of patient data, especially given the strong possibility that the contract for handling centralised patient records would go to the US corporation Palantir, whose boss Peter Thiel has expressed contempt for the NHS, while the company works hand in glove with the Trump administration and Netanyahu’s war machine.
A bonfire of accountabilities
The Plan and recent changes will make Integrated Care Boards even less democratically accountable, by forcing mergers that will leave many of them covering much larger populations, and stripping away the involvement of local councils and replacing this with mayors of strategic authorities.
Local accountability will be undermined even more by the Plan’s proposal to “create a new opportunity for the ‘very best’ FTs to hold the whole health budget for a defined local population as an integrated health organisation (IHO).”
These new bodies would have no accountability to anyone in the area they cover. And IHOs would be given the security of “longer-term, capitation-based” contracts – while other trusts and FTs would no longer be paid through block contracts, and instead be paid “only … for effective care which has been commissioned by an integrated care board (ICB),” with payment withheld for “poor quality care” and/or a “bonus for high quality care.”
Meanwhile the last remnants of local statutory bodies with a responsibility to speak up for patients and the local public (first established in Community Health Councils (CHCs) in 1974) are to be swept away with the abolition of the largely toothless Healthwatch England and its 150 largely dormant local Healthwatch bodies.
The best CHCs were fiercely independent of local health chiefs and waged high profile campaigns on standards of care and in defence of threatened services: that’s why they were abolished in Alan Milburn’s Bill establishing Foundation Trusts. By contrast Healthwatch was set up as token bodies with a much more limited brief as part of Andrew Lansley’s Health and Social Care Act.
But the loss of Healthwatch comes at the same time as the axing of the Freedom to Speak Up Guardian along with the network of local Guardians – effectively gagging potential staff whistleblowers and cutting another line of accountability.
These imperfect mechanisms at least gave some opportunity for the public and staff to raise and share concerns: it is even more concerning to see that the new arrangements emerging in the Plan will also leave local government with less voice than ever on local health services, even as the social care services they run come under greater pressure.
Nor is there any obvious voice within the ever-less local NHS for primary care, community health or mental health, despite the central role the Plan seems to give to NHCs. An organisation the size of the NHS that offers no avenue for legitimate concerns and suggestions to be raised by such key players is setting itself up to fail.
Half hearted commitments on training
The Plan makes a reference to the appalling bottlenecks and systems failure in the training of resident doctors (p101) and promises to:
“• work across government to prioritise UK medical graduates for foundation training, and to prioritise UK medical graduates and other doctors who have worked in the NHS for a significant period, for specialty training
While the reduction in reliance on overseas doctors is welcome, the expansion of places falls way short, given that this year alone, 20,000 applicants are expected to miss out on speciality training – which means they can’t train to eventually become consultants or GPs.
Elsewhere the Plan promises to “end the 8am scramble” for a GP appointment by training new GPs, ignoring the fact qualified GPs are being left unemployed because local practices cannot afford to pay them, while patients face long waits to see a doctor.
There is also talk about increasing the numbers of nurses and midwives trained, while we know thousands of them qualifying this year, along with newly-trained physiotherapists and other health professionals are struggling to find jobs, with cash-strapped trusts seeking to cut numbers overall and only employ experienced staff.
These gaps between the picture presented in the Plan and the reality on the ground in the NHS in 2025 question how viable many of its proposals will prove in practice.
Baseless assumptions
The question marks over the Plan are underlined by a series of assumptions which again clash with the reality in the NHS.
1) That “rigorous financial discipline” can be “restored” in a single year. (p 133) None of this section of the document makes any great sense. We are told that:
“The NHS has developed an addiction to deficits. Where once they were an exception that indicated genuinely poor financial management, today they have become a widespread and accepted feature of health service management.”
This completely ignores the extent and impact of the austerity squeeze on NHS funding from 2010, which brought an abrupt halt to ten years of real terms growth in budgets, and forced trusts into deficits. By the spring of 2020 borrowing to cover these deficits had reached such a level that Matt Hancock as Health Secretary effectively wrote off £13.4 billion of debt.
In April last year, while Labour was insisting England’s NHS could be fixed without any extra spending, the IFS warned that it was facing the biggest actual cut in spending since the 1970s.
The deficits have been a symptom not of “poor financial management,” but of trusts lacking the resources they need to cope with demand for emergency and elective care.
Wes Streeting has said NHS England’s £2.2 billion deficit funding to prop up flagging trust finances will halt at once, and the Plan states: “From financial year 2026 to 2027, we expect all NHS organisations to deliver operational plans that are fully compliant with the NHS planning guidance. There will be no exceptions.”
But on the day the Plan was published NHS England CEO Sir Jim Mackey told the Health Service Journal deficit funding would only begin to be withdrawn next year, and it would not be removed immediately, not least because several systems with high deprivation – such as Lancashire, Greater Manchester, Cheshire and Merseyside, and South East London – are big recipients.
The Health Foundation has pointed out that the attempt to move to a community and neighbourhood based system has been made before: and the lack of sufficient extra funding in the Spending Review makes it no easier this time:
“Future funding will be below historic growth, the plan’s commitment to increasing the share of funding going to primary and community services is weak, and the political priority placed on waiting lists will keep hospitals in the spotlight.”
The Plan not only assumes a near instant (and apparently painless) transition to balanced budgets, but also assumes all organisations will be able to set aside an additional 3% of their budgets to invest in “service transformation.” (p134)
In fact we know that one of the ways ICBs have been seeking to save money and reduce deficits is to slow down the treatment of elective patients, which of course makes it even less likely that the government can deliver its one remaining electoral promise on the NHS – to restore the 18 week maximum wait for elective care for 92% of patients by 2029.
2) In addition to assuming all trusts can somehow swiftly eradicate deficits that have built up over 15 years, the Plan assumes most can then deliver a surplus: “Every organisation will be required to continue to refresh their plans, aiming for most organisations to be in a sustainable surplus position.” Exactly how that can be delivered, alongside “patient choice” and without most commissioners being in deficit is of course not explained.
3) The third assumption is that the NHS will suddenly be able to do a whole series of things it has always failed at before, and that it can and should take on tasks that are better done by other bodies, not least the assertion that “It will be a service equipped to narrow health inequalities.” (p 9)
4) The fourth assumption is that toxic management culture that exists in too many trusts can somehow be wished away or magically eradicated and that a cohort of high quality managers will miraculously emerge and survive all of the job cuts taking place at every level in the NHS and emerge in sufficient numbers to rescue failing trusts.
Missing links
In addition to the baseless assumptions there are of course three vital missing links that would be necessary to transform Fit for the Future from a wish list into a workable plan:
Dear Reader,
If you like our content please support our campaigning journalism to protect health care for all.
Our goal is to inform people, hold our politicians to account and help to build change through evidence based ideas.
Everyone should have access to comprehensive healthcare, but our NHS needs support. You can help us to continue to counter bad policy, battle neglect of the NHS and correct dangerous mis-infomation.
Supporters of the NHS are crucial in sustaining our health service and with your help we will be able to engage more people in securing its future.
Please donate to help support our campaigning NHS research and journalism.
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