On 23rd October 2014, NHS England published its Five Year Forward View, which began with the statement (1,2):
‘the NHS is at a crossroads and needs to change and improve as it moves forward.’
The NHS Five Year Forward View was developed by several organisations that oversee and deliver health care (2). These organisations include NHS England, Public Health England, Health Education England, Monitor, the NHS Trust Development Authority, and the Care Quality Commission, with input from patient groups, clinicians and independent experts (1,3,4,5,6,7). This collective document, the Five Year Forward View, was developed as a five-year plan of how the NHS should change if it is to close the widening gaps in the funding and quality of care of the NHS (2). It includes a description of various local and national models of care required to support healthcare delivery, disease prevention, new models of service delivery, and integration of services (2).
The NHS Five Year Forward View had three main recommendations (2):
- Firstly, that we all take our health more seriously, to reduce the health burden due to alcohol, smoking and obesity.
- Second, that changes should be made in the way that health services are provided, including by combining health and social care.
- Third, that the government provides financial support to allow the delivery of high-quality NHS services. In the latter case, staged funding increases were proposed to close the £30-billion gap by 2020/21.
The NHS Five Year Forward View detailed the following new models for future health care provision (2):
- GP practices to be allowed to combine into single organisations providing a wider range of services.
- New organisations to be created that provide both GP and hospital services together with mental health, community and social care.
- Creation of seven-day-a-week networks to patients needing urgent care.
- Sustaining local hospitals, if clinically justified and supported by local commissioners.
- Concentrating some services into specialist centres.
- Allowing groups of midwives to set up NHS-funded midwifery services to give women the choice of having home births.
- Provision of more health and rehabilitation health services in care homes and thus improving the quality of life and reduce hospital bed use.
- Provision of more support for carers and encouraging volunteering.
On 3rd June 2015, the NHS Confederation held its annual conference in Liverpool (8,9). The conference was attended by more than 3,000 health-sector leaders. NHS England’s CEO, Simon Stevens delivered the keynote speech on the opening day and set out his plans for how the NHS could deliver the Five Year Forward View(2). The priorities include redesigning NHS emergency care, tackling poor performance and harnessing the health service’s purchasing power. Simon Stevens told the NHS Confederation conference audience (9):
“We, the National Health Service, have set out our stall before the British people and come together to charter our own destiny.”
Simon Stevens did acknowledge that previous strategies for improving NHS performance have not only failed but have been ‘tested to destruction.’ He added that he saw no likelihood of the NHS receiving additional cash this year but announced several specific improvement measures during his keynote speech (9).
Recommended Improvement Measures for the NHS, June 2015:
1) Poorly Performing NHS Regions
New measures are recommended to tackle poor performance in three regions: Essex, North Cumbria, and North-West Devon. These measures will include a ‘success regime’ for regulators working with NHS England in these regions (9).
2) Re-design of Emergency Care
The urgent redesign of emergency care in the NHS will be an attempt to address a current system that is confusing for patients who have conditions that could be treated by their GP or even pharmacist (9).
3) NHS Purchasing
The importance of harnessing the ‘purchasing power’ of the NHS is highlighted by recommendations that the NHS should review some of its biggest areas of spending. The high-cost areas that are targeted include the use of employment agencies, for medical and nursing staffing. Temporary staffing costs are the single largest cause of hospital deficits (9).
4) Learning Disability Care
New models for learning disability care are recommended, including a closure programme for some long-stay institutions, following a programme of transition (9).
5) Public Health
At the NHS Confederation conference, Simon Stevens reiterated some of the points about public health previously made by the Health Secretary, Jeremy Hunt (9). The public health issues that will take priority include smoking, lack of exercise, obesity and alcohol, all of which create health consequences that place an increasing burden on NHS resources (9).
It can sometimes be difficult to appreciate how much healthcare in the UK is improving and just how resilient the NHS has been during the financial storms of recent years. Protected NHS funding and dedicated NHS staff have been the key reasons for these improvements and resilience. Seventy years after its creation, despite its problems, it is important to find hope in the fact that millions of people are working for the same thing, to maintain and improve the National Health Service.
If you would like to comment on any of the issues raised by this article, particularly from your own experience or insight, Healthcare-Arena would welcome your views.
(1) NHS England website: http://www.england.nhs.uk Accessed June 24, 2015
(2) NHS England. Five Year Forward View. Published October 23, 2014. http://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf Accessed June 24, 2015
(3) Public Health England website: https://www.gov.uk/government/organisations/public-health-england Accessed June 24, 2015
(4) Health Education England website: https://hee.nhs.uk Accessed June 24, 2015
(5) Monitor website. https://www.gov.uk/government/organisations/monitor Accessed June 24, 2015
(6) NHS Trust Development Authority website: http://www.ntda.nhs.uk Accessed June 24, 2015
(7) Care Quality Commission website: http://www.cqc.org.uk Accessed June 24, 2015
(8) The NHS Confederation website: http://www.nhsconfed.org Accessed June 24, 2015
(9) NHS Confederation Conference, 2015. Stevens issues clarion call to NHS leaders to redesign care for patients. June 3, 2015. https://www.england.nhs.uk/2015/06/03/redesign-care/ Accessed June 24, 2015