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

The NHS has actually been marking its 70th anniversary, and the nationwide dispute this has let loose has centred on 3 big truths. 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 also been optimism - about the possibilities for continuing medical advance and better results of care.

In expecting the Health Service's 80th birthday, this NHS Long Term Plan takes all 3 of these realities as its beginning point. So to be successful, we should keep all that's great about our health service and its place in our national life. But we must take on head-on the pressures our staff face, while making our additional funding go as far as possible. And as we do so, we need to speed up the redesign of client care to future-proof the NHS for the decade ahead. This Plan sets out how we will do that. We are now able to because:

- first, we now have a secure and improved funding path for the NHS, averaging 3.4% a year over the next 5 years, compared to 2% over the past 5 years;
- second, because there is broad consensus about the modifications now needed. This has been validated by clients' groups, professional bodies and frontline NHS leaders who because July have all assisted form this plan - through over 200 different events, over 2,500 different reactions, through insights used by 85,000 members of the public and from organisations representing over 3.5 million people;
- and 3rd, due to the fact that work that kicked-off after the NHS Five Year Forward View is now beginning to bear fruit, supplying useful experience of how to produce 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 throughout the NHS, here are the huge modifications it will bring:

Chapter One sets out how the NHS will move to a new service design in which clients get more alternatives, much better support, and appropriately joined-up care at the correct time in the ideal care setting. GP practices and health center outpatients presently supply around 400 million in person visits each year. Over the next five years, every patient will can online 'digital' GP consultations, and revamped hospital assistance will have the ability to prevent up to a third of outpatient consultations - conserving clients 30 million trips to healthcare facility, and saving the NHS over ₤ 1 billion a year in brand-new expenditure avoided. GP practices - usually covering 30-50,000 people - will be funded to collaborate to handle pressures in main care and extend the series of hassle-free local services, developing truly integrated teams of GPs, community health and social care personnel. New health groups will be needed under brand-new national requirements to supply fast support to individuals in their own homes as an option to hospitalisation, and to ramp up NHS support for people living in care homes. Within 5 years over 2.5 million more individuals will take advantage of 'social prescribing', a personal health budget, and new assistance for handling 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 five years, investment in primary medical and community services will grow faster than the general NHS budget plan. This commitment - an NHS 'first' - produces a ringfenced local fund worth a minimum of an additional ₤ 4.5 billion a year in genuine terms by 2023/24.

We have an emergency care system under real pressure, but likewise one in the middle of extensive change. The Long Term Plan sets out action to guarantee clients get the care they need, quickly, and to alleviate pressure on A&E s. New service channels such as urgent treatment centres are now growing far faster than hospital A&E attendances, and UTCs are being designated throughout England. For those that do need healthcare facility care, emergency situation 'admissions' are significantly being treated through 'very same day emergency situation care' without requirement for an overnight stay. This model will be presented across all severe health centers, increasing the percentage of intense admissions generally discharged on day of attendance from a 5th to a third. Building on medical facilities' success in improving outcomes for major injury, stroke and other important illnesses conditions, brand-new medical requirements will guarantee patients with the most serious emergency situations get the finest possible care. And structure on current gains, in collaboration with local councils further action to cut postponed healthcare facility discharges will assist free up pressure on medical facility beds.

Chapter Two sets out brand-new, funded, action the NHS will require to reinforce its contribution to avoidance and health inequalities. Wider action on avoidance will help people stay healthy and likewise moderate demand on the NHS. Action by the NHS is a complement to - not a replacement for - the important function of people, neighborhoods, federal government, and businesses in shaping the health of the country. Nevertheless, every 24 hours the NHS enters into contact with more than a million individuals at minutes in their lives that bring home the personal effect of ill health. The Long Term Plan therefore funds particular new evidence-based NHS avoidance programs, including to cut smoking; to lower 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 deal with health inequalities, NHS England will base its five year funding allowances to areas on more accurate evaluation of health inequalities and unmet requirement. As a condition of getting Long Term Plan funding, all significant nationwide programmes and every local area throughout England will be required to set out specific measurable goals and mechanisms by which they will add to narrowing health inequalities over the next five and 10 years. The Plan also sets out particular action, for instance to: cut smoking in pregnancy, and by individuals with long term mental illness; make sure people with learning disability and/or autism improve assistance; supply outreach services to individuals experiencing homelessness; assist people with severe mental disorder discover and keep a job; and enhance uptake of screening and early cancer medical diagnosis for people who presently miss out on out.

Chapter Three sets the NHS's concerns for care quality and results improvement for the years ahead. For all major conditions, results for clients are now measurably better than a decade ago. Childbirth is the best it has actually ever been, cancer survival is at an all-time high, deaths from cardiovascular disease have actually cut in half considering that 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, inexplicable local variation, and undoubted chances for more medical advance. These truths, together with patients' and the general public's views on concerns, suggest that the Plan goes further on the NHS Five Year Forward View's focus on cancer, psychological health, diabetes, multimorbidity and healthy ageing consisting of dementia. But it likewise extends its focus to kids's health, cardiovascular and respiratory conditions, and discovering impairment and autism, amongst others.

Some enhancements in these areas are always framed as ten years objectives, offered the timelines needed to broaden capacity and grow the workforce. So by 2028 the Plan devotes to drastically improving cancer survival, partly by increasing the proportion of cancers identified early, from a half to 3 quarters. Other gains can take place earlier, such as halving maternity-related deaths by 2025. The Plan also allocates adequate funds on a phased basis over the next five years to increase the variety of prepared operations and cut long waits. It makes a renewed dedication that mental health services will grow faster than the general NHS budget, developing a new ringfenced local 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 particularly kids and young individuals. The Plan likewise identifies the vital significance of research study and innovation to drive future medical advance, with the NHS devoting to play its complete part in the advantages these bring both to patients and the UK economy.

To make it possible for these changes to the service model, to avoidance, and to major medical enhancements, the Long Term Plan sets out how they will be backed by action on labor force, innovation, innovation and efficiency, in addition to the NHS' total 'system architecture'.

Chapter Four sets out how existing workforce pressures will be dealt with, and personnel supported. The NHS is the greatest employer in Europe, and the world's biggest company of extremely skilled specialists. But our personnel are feeling the pressure. That's partially since over the previous years workforce development has not stayed up to date with the increasing needs on the NHS. And it's partly because the NHS hasn't been an adequately versatile and responsive company, especially in the light of changing staff expectations for their working lives and professions.

However there are practical chances to put this right. University places for entry into nursing and medication are oversubscribed, education and training locations are being broadened, and much of those leaving the NHS would stay if companies can lower work pressures and use improved versatility and expert advancement. This Long Term Plan for that reason sets out a number of specific workforce actions which will be overseen by NHS Improvement that can have a favorable effect now. It also sets out larger reforms which will be settled in 2019 when the workforce education and training budget plan for HEE is set by government. These will be consisted of in the detailed NHS labor force implementation strategy released later on this year, overseen by the brand-new cross-sector national labor force group, and underpinned by a brand-new compact 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 places, ensuring that well-qualified prospects are not turned away as happens now. Funding is being guaranteed for an expansion of scientific placements of up to 25% from 2019/20 and approximately 50% from 2020/21. New routes into nursing and other disciplines, including apprenticeships, nursing partners, online certification, and 'make and discover' assistance, are all being backed, together with a new post-qualification work guarantee. International recruitment will be considerably broadened over the next three years, and the workforce implementation strategy will also set out brand-new rewards for scarcity specializeds and hard-to-recruit to geographies.

To support current staff, more flexible rostering will become mandatory throughout all trusts, funding for continuing professional advancement will increase each year, and action will be required to support diversity and a culture of regard and reasonable treatment. New roles and inter-disciplinary credentialing programmes will allow more workforce versatility throughout a person's NHS profession and between private personnel groups. The new medical care networks will supply flexible options for GPs and broader primary care teams. Staff and patients alike will take advantage of a doubling of the variety of volunteers also assisting throughout the NHS.

Chapter Five sets out a wide-ranging and financed programme to upgrade technology and digitally enabled care throughout the NHS. These investments allow many of the wider service modifications set out in this Long Term Plan. Over the next 10 years they will result in an NHS where digital access to services is widespread. Where clients and their carers can better manage their health and condition. Where clinicians can gain access to and connect with patient records and care plans anywhere they are, with ready access to decision assistance and AI, and without the administrative inconvenience these days. Where predictive strategies support regional Integrated Care Systems to prepare and optimise take care of their populations. And where safe and secure linked medical, genomic and other data support brand-new medical advancements and consistent quality of care. Chapter Five determines costed structure blocks and turning points for these developments.

Chapter Six sets out how the 3.4% five year NHS financing settlement will help put the NHS back onto a sustainable monetary course. In ensuring the price of the phased dedications in this Long Term Plan we have taken account of the existing financial pressures throughout the NHS, which are a first call on additional funds. We have also been practical about inevitable continuing demand development from our growing and aging population, increasing concern about locations of longstanding unmet requirement, and the expanding frontiers of medical science and innovation. 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 main care will necessarily reduce the requirement for medical facility beds. Instead, taking a sensible method, we have provided for hospital funding as if patterns over the previous 3 years continue. But in practice we expect that if areas carry out the Long Term Plan successfully, they will gain from a monetary and medical facility capability 'dividend'.

In order to deliver for taxpayers, the NHS will continue to drive efficiencies - all of which are then readily available to cities to reinvest in frontline care. The Plan sets out significant reforms to the NHS' financial architecture, payment systems and incentives. It develops a brand-new Financial Recovery Fund and 'turn-around' process, so that on a phased basis over the next 5 years not just the NHS as an entire, but also the trust sector, regional systems and individual organisations progressively go back to financial balance. And it reveals how we will conserve taxpayers an additional ₤ 700 million in minimized administrative costs across suppliers and commissioners both nationally and in your area.

Chapter Seven describes next actions in executing the Long Term Plan. We will develop on the open and consultative process used to develop this Plan and strengthen the ability of clients, professionals and the public to contribute by developing the new NHS Assembly in early 2019. 2019/20 will be a transitional year, as the regional NHS and its partners have the chance to shape local implementation for their populations, appraising the Clinical Standards Review and the national application framework being published in the spring, as well as their differential local beginning points in securing the significant national improvements set out in this Long Term Plan. These will be united in a comprehensive nationwide application program by the autumn so that we can likewise effectively appraise Government Spending Review choices on workforce education and training spending plans, 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 changed to much better support delivery of the concurred changes set out in this LTP. This Plan does not require modifications to the law in order to be implemented. But our view is that modification to the main legislation would substantially accelerate progress on service integration, on administrative effectiveness, and on public responsibility. We suggest modifications to: create publicly-accountable integrated care locally; to improve the nationwide administrative structures of the NHS; and eliminate the excessively stiff competition and procurement regime used to the NHS.

In the meantime, within the current legal structure, the NHS and our partners will be relocating to develop Integrated Care Systems everywhere by April 2021, building on the development currently made. ICSs unite regional organisations in a pragmatic and practical method to provide the 'triple combination' of main and specialist care, physical and mental health services, and health with social care. They will have a key role in working with Local Authorities at 'place' level, and through ICSs, commissioners will make shared decisions with providers on population health, service redesign and Long Term Plan execution.