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

The NHS has been marking its 70th anniversary, and the national argument this has actually released has centred on 3 huge realities. There's been pride in our Health Service's enduring 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 three of these truths as its beginning point. So to be successful, we must keep all that's great about our health service and its location in our nationwide life. But we need to deal with head-on the pressures our personnel face, while making our additional funding go as far as possible. And as we do so, we need to speed up the redesign of patient care to future-proof the NHS for the years ahead. This Plan sets out how we will do that. We are now able to because:

- initially, we now have a safe and improved financing path for the NHS, averaging 3.4% a year over the next five years, compared to 2% over the previous five years;
- second, because there is large agreement about the changes now needed. This has actually been confirmed by patients' groups, professional bodies and frontline NHS leaders who since July have all helped shape this strategy - through over 200 different events, over 2,500 different reactions, through insights offered by 85,000 members of the public and from organisations representing over 3.5 million individuals;
- and third, because work that kicked-off after the NHS Five Year Forward View is now starting to bear fruit, providing useful experience of how to cause the modifications set out in this Plan. Almost whatever in this Plan is currently being implemented successfully somewhere in the NHS. Now as this Plan is executed right throughout the NHS, here are the huge changes it will bring:

Chapter One sets out how the NHS will relocate to a new service design in which clients get more alternatives, better assistance, and appropriately joined-up care at the correct time in the optimal care setting. GP practices and medical facility outpatients presently provide around 400 million face-to-face visits each year. Over the next five years, every patient will deserve to online 'digital' GP assessments, and redesigned health center assistance will be able to avoid as much as a 3rd of outpatient appointments - saving patients 30 million journeys to hospital, and conserving the NHS over ₤ 1 billion a year in new expenditure averted. GP practices - normally covering 30-50,000 individuals - will be funded to interact to handle pressures in medical care and extend the series of practical regional services, creating really integrated groups of GPs, community health and social care personnel. New expanded neighborhood health groups will be required under new nationwide standards to offer quick support to individuals in their own homes as an option to hospitalisation, and to increase NHS assistance for people living in care homes. Within 5 years over 2.5 million more people will gain from 'social prescribing', a personal health spending plan, and new assistance for handling their own health in collaboration with patients' groups and the voluntary sector.

These reforms will be backed by a new guarantee that over the next five years, investment in main medical and neighborhood services will grow faster than the overall NHS spending plan. This commitment - an NHS 'initially' - produces a ringfenced regional 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 genuine pressure, however also one in the midst of profound change. The Long Term Plan sets out action to ensure clients get the care they need, fast, and to ease pressure on A&E s. New service channels such as urgent treatment centres are now growing far much faster than hospital A&E presences, and UTCs are being designated across England. For those that do need health center care, emergency situation 'admissions' are increasingly being treated through 'exact same day emergency care' without requirement for an overnight stay. This design will be presented across all acute health centers, increasing the proportion of severe admissions normally released on day of presence from a 5th to a 3rd. Building on medical facilities' success in improving outcomes for major trauma, stroke and other crucial diseases conditions, new clinical requirements will guarantee clients with the most major emergencies get the finest possible care. And structure on recent gains, in partnership with local councils additional action to cut delayed health center discharges will assist release up pressure on medical facility beds.

Chapter Two sets out brand-new, financed, action the NHS will take to reinforce its contribution to prevention and health inequalities. Wider action on avoidance will assist people stay healthy and also moderate need on the NHS. Action by the NHS is a complement to - not an alternative to - the essential function of individuals, communities, government, and organizations in shaping the health of the country. Nevertheless, every 24 hr the NHS enters contact with more than a million people at minutes in their lives that bring home the individual impact of illness. The Long Term Plan for that reason funds specific new evidence-based NHS prevention programmes, consisting of to cut smoking cigarettes; to lower weight problems, partially by doubling enrolment in the successful Type 2 NHS Diabetes Prevention Programme; to limit alcohol-related A&E admissions; and to lower air pollution.

To assist tackle health inequalities, NHS England will base its five year funding allowances to cities on more accurate evaluation of health inequalities and unmet need. As a condition of getting Long Term Plan financing, all major nationwide programs and every city across England will be needed to set out particular quantifiable objectives and systems by which they will contribute to narrowing health inequalities over the next five and 10 years. The Plan likewise sets out specific action, for instance to: cut smoking in pregnancy, and by people with long term psychological health problems; make sure individuals with finding out impairment and/or autism get better support; offer outreach services to people experiencing homelessness; help people with severe mental illness find and keep a job; and enhance uptake of screening and early cancer medical diagnosis for individuals who presently lose out.

Chapter Three sets the NHS's top priorities for care quality and results improvement for the years ahead. For all major conditions, results for patients are now measurably much better than a years ago. Childbirth is the safest it has ever been, cancer survival is at an all-time high, deaths from cardiovascular disease have halved considering that 1990, and male suicide is at a 31-year low. But for the most significant killers and disablers of our population, we still have unmet need, inexplicable regional variation, and undoubted chances for additional medical advance. These facts, together with patients' and the public's views on top priorities, indicate that the Plan goes further on the NHS Five Year Forward View's concentrate 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 learning special needs and autism, amongst others.

Some enhancements in these areas are necessarily framed as ten years objectives, offered the timelines needed to broaden capability and grow the labor force. So by 2028 the Plan devotes to dramatically improving cancer survival, partially by increasing the percentage of cancers diagnosed early, from a half to 3 quarters. Other gains can happen earlier, such as halving maternity-related deaths by 2025. The Plan likewise allocates sufficient funds on a phased basis over the next five years to increase the number of prepared operations and cut long waits. It makes a restored dedication that psychological health services will grow faster than the general NHS budget, creating a new ringfenced regional mutual fund worth a minimum of ₤ 2.3 billion a year by 2023/24. This will allow further service growth and faster access to community and crisis mental health services for both grownups and especially children and young people. The Plan also identifies the crucial importance of research study and innovation to drive future medical advance, with the NHS devoting to play its full part in the benefits these bring both to clients and the UK economy.

To make it possible for these modifications to the service design, to prevention, and to major scientific enhancements, the Long Term Plan sets out how they will be backed by action on workforce, innovation, development and efficiency, in addition to the NHS' general 'system architecture'.

Chapter Four sets out how existing labor force pressures will be taken on, and staff supported. The NHS is the biggest company in Europe, and the world's biggest employer of extremely competent professionals. But our staff are feeling the pressure. That's partially since over the past years workforce development has actually not kept up with the increasing needs on the NHS. And it's partially since the NHS hasn't been a sufficiently versatile and responsive employer, specifically in the light of altering personnel expectations for their working lives and careers.

However there are practical opportunities to put this right. University places for entry into nursing and medication are oversubscribed, education and training locations are being expanded, and much of those leaving the NHS would remain if companies can reduce work pressures and use improved versatility and professional development. This Long Term Plan for that reason sets out a number of specific labor force actions which will be supervised by NHS Improvement that can have a positive effect now. It also sets out larger reforms which will be finalised in 2019 when the workforce education and training spending plan for HEE is set by government. These will be consisted of in the comprehensive NHS workforce execution plan released later on this year, overseen by the new cross-sector national workforce group, and underpinned by a new compact in between frontline NHS leaders and the national NHS management bodies.

In the meantime the Long Term Plan sets out action to expand the number of nursing and other undergraduate places, guaranteeing that well-qualified candidates are not turned away as happens now. Funding is being guaranteed for an expansion of medical positionings of as much as 25% from 2019/20 and approximately 50% from 2020/21. New routes into nursing and other disciplines, including apprenticeships, nursing partners, online qualification, and 'earn and learn' support, are all being backed, together with a new post-qualification employment warranty. International recruitment will be significantly broadened over the next three years, and the labor force application strategy will likewise set out brand-new incentives for scarcity specializeds and hard-to-recruit to geographies.

To support existing personnel, more flexible rostering will end up being obligatory throughout all trusts, moneying for continuing professional development will increase each year, and action will be required to support diversity and a culture of respect and reasonable treatment. New functions and inter-disciplinary credentialing programs will enable more workforce flexibility throughout a person's NHS career and in between private staff groups. The new main care networks will offer versatile choices for GPs and wider primary care teams. Staff and patients alike will gain from a doubling of the variety of volunteers likewise assisting across the NHS.

Chapter Five sets out an extensive and financed programme to upgrade technology and digitally enabled care throughout the NHS. These financial investments allow a number of the larger service changes 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 patients and their carers can much better handle their health and condition. Where clinicians can gain access to and communicate with client records and care strategies any place they are, with ready access to decision support and AI, and without the administrative hassle these days. Where predictive methods support regional Integrated Care Systems to plan and optimise look after their populations. And where secure linked clinical, genomic and other information support brand-new medical developments and constant quality of care. Chapter Five identifies costed foundation and milestones for these advancements.

Chapter Six sets out how the 3.4% five year NHS financing settlement will assist put the NHS back onto a sustainable financial course. In ensuring the price of the phased dedications in this Long Term Plan we have actually taken account of the present monetary pressures across the NHS, which are a first get in touch with extra funds. We have also been sensible about inevitable continuing need growth from our growing and aging population, increasing concern about locations of longstanding unmet need, and the broadening frontiers of medical science and innovation. In the modelling foundation this Long Term Plan we have for that reason not locked-in a presumption that its increased financial investment in neighborhood and primary care will always lower the need for hospital beds. Instead, taking a prudent method, we have actually provided for medical facility funding as if trends over the previous 3 years continue. But in practice we expect that if local locations execute the Long Term Plan efficiently, they will take advantage of a monetary and capability 'dividend'.

In order to deliver for taxpayers, the NHS will continue to drive performances - all of which are then readily available to regional areas to reinvest in frontline care. The Plan lays out major reforms to the NHS' financial architecture, payment systems and rewards. It establishes a brand-new Financial Recovery Fund and 'turn-around' procedure, so that on a phased basis over the next 5 years not only the NHS as an entire, however also the trust sector, local systems and specific organisations gradually return to monetary balance. And it reveals how we will save taxpayers a more ₤ 700 million in decreased administrative expenses across service providers and commissioners both nationally and locally.

Chapter Seven discusses next steps in implementing the Long Term Plan. We will develop on the open and consultative procedure used to establish this Plan and strengthen the capability of patients, experts and the public to contribute by establishing the brand-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 application for their populations, taking account of the Clinical Standards Review and the national execution framework being released in the spring, along with their differential local beginning points in securing the major nationwide enhancements set out in this Long Term Plan. These will be united in an in-depth national execution programme by the fall so that we can also properly appraise Government Spending Review decisions 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 agreement propositions for how primary legislation might be gotten used to much better support delivery of the concurred changes set out in this LTP. This Plan does not need changes to the law in order to be executed. But our view is that change to the primary legislation would significantly speed up development on service combination, on administrative effectiveness, and on public responsibility. We suggest modifications to: produce publicly-accountable integrated care in your area; to simplify the nationwide administrative structures of the NHS; and get rid of the extremely rigid competition and procurement routine used to the NHS.

In the meantime, within the existing legal structure, the NHS and our partners will be moving to produce Integrated Care Systems everywhere by April 2021, constructing on the progress already made. ICSs unite local organisations in a practical and practical way to provide the 'triple combination' of main and specialist care, physical and psychological health services, and health with social care. They will have an essential role in dealing with Local Authorities at 'location' level, and through ICSs, commissioners will make shared choices with service providers on population health, service redesign and Long Term Plan implementation.