The NHS plan: an economic perspective

The NHS Plan, published in July 2000, presented an ambitious blueprint for the transformation of the way the NHS delivers health care. The backdrop to the Plan is the substantial increase in resources for the NHS promised for the next 5 years. At the heart of the Plan is the aim of ensuring these resources are used effectively to provide a health service “designed around the patient”. After reviewing the perceived flaws in the current system and dismissing the notion of alternative systems of health care funding, the main part of the Plan outlines the strategy for tackling the shortcomings. The discussion is wide-ranging and includes not only those areas we would expect to see covered, such as the interface between health and social care and the performance management system, but also issues such as investment in infrastructure, the relationships between the NHS and the private sector and key personnel issues such as the supply of health care professionals and their contractual arrangements. This discussion paper summarises the main elements of the Plan before focusing more closely on seven key themes on which economic analysis has a distinctive insight to offer – investment, information, labour markets, the independent sector, waiting times, performance management, and patient and carer responses. Some of the preconditions for success of the Plan are outlined and gaps in the available evidence to support various aspects of the Plan are highlighted. Our conclusions suggest that there is reason to be optimistic that the Plan will deliver many of its lofty aspirations if two key conditions are met. First, that front-line staff are on board and have the resources and the will to help implement the Plan; and second, that political expediency and the desire to achieve short-term goals does not drive out the commitment to the long-term aims for the NHS.