BHF comment
What the 10 Year Health Plan means for cardiovascular care
The Government published its 10 Year Health Plan on July 3, setting out a new blueprint for the NHS in England.
The plan builds on last year’s review by Lord Darzi, which provided a sobering diagnosis that the NHS is in ‘critical condition’.
Sadly, this is all too evident in many parts of cardiovascular care. High waiting lists, millions of people living with undetected or unmanaged risk, and an overstretched workforce all signal the need for urgent action. This 10 Year Plan outlines the Government’s strategy to address these challenges.
As a major driver of poor health, widening inequalities and growing economic inactivity, upgrading cardiovascular health is central to the Government’s mission to build an NHS that is fit for the future. Below, we unpick how the commitments in the 10 Year Plan may impact the delivery of cardiovascular care.
Shaping a framework for the future
We are delighted to see the Plan commit to a modern service framework for cardiovascular disease (CVD). This reflects the Government’s commitment to reducing premature deaths from heart disease and stroke in England by 25 per cent over the next decade.
There are reasons to be optimistic. Done right, we are confident that a comprehensive framework for CVD can deliver the change that heart patients need to see. We have seen progress via this approach before: the 2000s National Service Framework for coronary heart disease contributed to improvements in cardiovascular health. These included a 40 per cent decline in premature deaths from CVD, reduced elective waiting lists, and the eradication of long waits for treatment.
Following publication of our consensus statement, we’ll be working with the sector together to build a shared view on how this framework can deliver for patients. We look forward to working with the Government on its development and implementation.
Alongside this promising pledge, there are commitments throughout the Plan which could transform cardiovascular prevention and treatment. To act on Darzi’s diagnosis, the 10 Year Plan posits three shifts in how the NHS works: from sickness to prevention; from hospital to community; and from analogue to digital.
New neighbourhood health centres
These health centres will house multiple services under one roof, including diagnostics, mental health, rehab, and nursing. Bringing these services together will also require an adjacent change in skills and workforce over several years.
The principle of bringing care closer to home has been welcomed by heart patients we have spoken to. In a workshop we hosted earlier this year, participants felt this approach would not only offer greater convenience, but also an opportunity to take a more active role in their health. These centres could also alleviate hospital demand.
We know that diagnostic capacity has been a pinchpoint in the cardiac elective pathway – as the Government’s Elective Reform Plan rightly acknowledges – so expanding delivery into new settings is a sensible step.
NHS app will be upgraded
The NHS app will give patients more information and options related to their care, allowing them to choose their own providers. It will also enable remote monitoring of CVD and integrate data from wearable devices by 2028.
Empowering patients to take a more active role in their health is important, but must be approached with care, and digital tools only used where clinically appropriate. Despite being the app being promoted as a ‘doctor in your pocket’, it is essential that the skills, expertise and dedication of clinicians remain recognised and promoted to patients.
Clinical information should be delivered in a way that is understandable and supported with appropriate signposting. Without this, there is a risk of emotional distress and inadvertent increase in demand. Analogue alternatives should remain available to ensure those with lower digital literacy are not excluded.
Medical research
The Plan commits to focus health research funding on the prevention, detection and treatment of long-term conditions.
This looks promising for cardiovascular research, which has long seen a shortfall compared to the human and financial burden of CVD. The rapid pace of innovation in technologies like AI, predictive genetic testing and synthetic biology is throwing up new opportunities for transformative research into CVD treatment and prevention.
Our partnership with the National Institute for Health and Care Research on the grand challenge of tackling inequalities in cardiovascular disease is one example of where we can accelerate our understanding of interventions to tackle CVD. We support the development of similar initiatives to drive breakthroughs at scale and pace.
Measures to address obesity
Our food system promotes unhealthy food and drink over healthier options, which is driving rising rates of obesity.
The Plan introduces a mandatory ‘healthy food standard’ for large food businesses, a move which could help over three million people reach a healthier weight.
This standard should be robustly developed with experts, swiftly implemented, and built upon with further commitments to create a healthy food environment.
Reducing health inequalities
Reassuringly, the Plan is anchored in a commitment to tackling unfair gaps in health outcomes. This is an approach we strongly support. As we set out in our recent report, Bridging Hearts, CVD is the single biggest contributor to the gap in overall life expectancy between the richest and poorest areas in England.
As such, it is encouraging that the Plan directs investment to areas of greatest need and recognises that the Carr-Hill formula – which allocates funding for general practice but fails to adequately account for increased need in the most deprived areas – is not fit for purpose.
The work starts now
However, most of these ambitions are not new. Previous Governments have tried and largely failed to translate them from paper to reality and unsuccessfully delivered change on the scale that is required to upgrade the country’s cardiovascular health. Determined, full-blooded implementation of this plan is key.
The scale of system change proposed in the plan is hugely ambitious and we agree it cannot all be done at once. The Government will need to sequence change smartly, thinking through the potential unintended effects of changing one part of the system on all others.
Implementation will likely mean changes to funding flows, revision of contracts, upgrades to infrastructure, and a reconfigured workforce.
Financing these ambitions will pose a challenge. This Plan lands soon after the Chancellor set out the NHS’ settlement for the next three years.
Although a decent sum in the context of a tight fiscal environment, the capital budget – in particular – was considered by many in the system to be largely insufficient. This settlement will of course not be enough to deliver on all the promises in the Plan, at least not immediately, so future spending reviews will be critical to ensuring the Plan’s success. 
Simultaneously, integrated care boards have been asked to make cuts of 50 per cent. The next NHS operational planning guidance will need to advise local systems how they should prioritise.
Having the right people is also vital. The composition of the workforce will need to change vastly, so we look to autumn’s 10 Year Workforce Plan to set out a strong pipeline to recruit and retain specialty talent and skills.
In a time of structural reorganisation and financial cuts, maintenance of clinical leadership and expertise is more vital than ever.
Cardiac networks are a valuable forum that convenes clinicians, operational staff and patients to align care pathways, reduce variation and prioritise prevention. It is essential that funding for these is protected.
There is much to celebrate in this Plan. We look forward to working together – with the sector and Government – to translate these promises into lasting change that can help more people live with healthier hearts for longer.