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Key points

  • In 2019, the NHS Long Term Plan set out a 10-year strategy for improving and reforming the NHS in England. No part of the plan has been unaffected by COVID-19.
  • Some long term plan commitments have been accelerated by the COVID-19 response, such as improving access to remote consultations in primary care and outpatients. These changes will need careful monitoring and evaluation.
  • However, the overall picture is of one of major delay, disruption and increased demands on services. Previous national targets – such as for expanding access to mental health services – will need to be revised to account for greater need.
  • COVID-19 has exposed and widened existing inequalities in health and care in England. While new partnership structures have been developed to help local agencies improve care, the pandemic has held back the broader process of redesigning care to improve health and reduce inequalities. A more detailed framework for NHS agencies on tackling inequalities is now needed.
  • The Health and Care Bill 2021–22 will introduce changes to NHS structures in England – including formalising local partnerships. But the health system needs an updated strategy for delivering the long term plan, which addresses the backlog in elective care without compromising interventions to prevent disease and reduce inequalities. 
  • Significant additional investment in the NHS is promised, but major unknowns around the future course of the pandemic mean there is considerable uncertainty over whether this will be enough. Before the pandemic, government failed to provide the long-term investment needed to expand the NHS workforce and improve infrastructure. Without enough staff and adequate buildings and equipment, the NHS will not be able to recover services after the pandemic.
  • The NHS cannot prevent disease and reduce inequalities on its own. Increased investment in the NHS must go alongside investment in public health, adult social care reform and a broader range of policy interventions to give more people the opportunity to live a healthy life.

This analysis looks at progress on the main pledges in the NHS Long Term Plan and the impact of COVID-19 on their delivery. 

The NHS Long Term Plan remains the blueprint for the NHS’s evolution, but the pandemic has dealt a huge blow to both the NHS and social care. In this report, we provide a narrative of what was achieved before the pandemic, assemble the evidence of how the pandemic has affected progress against the plan’s major commitments, and identify implications for the future as the NHS and government plans its recovery from the pandemic. 

Our analysis finds that the core principles set out in the long term plan remain as relevant now as they were before COVID-19, but their implementation has been derailed. The NHS now faces major delay, disruption and increased demands on services. Waiting lists for hospital care are the worst on record, at over 5.45 million at the end of June 2021. Significant additional investment has been promised, but major unknowns around the future course of the pandemic mean there is considerable uncertainty over whether this will be enough. 

Alongside the recent funding increase for the NHS, government must now work with the NHS to develop an updated strategy for delivering the NHS Long Term Plan. And while the government’s focus on reducing the NHS backlog is welcome it should not come at the expense of addressing health inequalities already widened by COVID-19. 

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