The Five Year Forward View was produced by NHS England in October 2014 under the leadership of Simon Stevens as a planning document.
Contents
Publication and reception
It received praise for brevity, being only 39 pages, and lacking the illustrations which had graced its predecessors. Like the NHS Plan 2000 with which Stevens was also associated it was supported by the great and good of the NHS, but in this case it was regulators - Monitor, the Care Quality Commission and the like, rather than the Royal Colleges and Trades Unions of the earlier plan. This new national leadership of the NHS issues an unprecedented warning to politicians, none of whom are included in the endorsements, that it cannot continue at current funding levels, and additional resources worth more than 1.5 per cent a year in real terms will be required.
No more top-down reorganisation was proposed, but instead the development of new models to suit local needs, something quite radical for the NHS, which is accustomed to the imposition of uniformity regardless of local conditions. It seeks to break away from Enoch Powell’s 1962 Hospital Plan for England and Wales which established the district general hospital as the central pillar of British healthcare. Even more radical is the proposal to erode the distinction between hospital consultants and General practitioners, encouraging hospitals to employ GPs - a distinction which has lasted in the UK for more than a century - and permit the development of "Accountable Care Organisations" similar to those in Spain and parts of the USA. There is much stress on the fact that 70% of the NHS budget is spent on the management of the 15 million people with long term conditions. Two new models of care – multispecialty community providers, and primary and acute care systems – involve integrating primary care and hospital care in a single provider organisation.
The fact that the word “competition” does not appear once in the document was hailed by a victory by Labour.
Stevens said that the health service would have to break out of its “narrow confines” and promote healthy lifestyles. Employers are key to promoting better health in the population and there should be incentives to encourage participation in Weight Watchers-type schemes. The plan includes a focus on the health of NHS staff, saying that three quarters of hospitals fail to make available nutritious food for nurses and other workers on night shifts. Stevens said NHS staff should set an example by leading healthier lifestyles as part of a drive to improve the health of the nation. He pledged to get junk food out of hospital canteens.
The plan also pays far more attention to the potential for technological innovation using the internet and mobile phone and apps than any previous NHS document. Technology, it envisages, will enable self-management, integration and patient centred care. This has already been done by the Modality Partnership which is given a favourable mention in the document. It already conducts 75 per cent of consultations remotely using phone or Skype. Patients have an electronic care plan they can manage themselves, and digital access to consultant advice.
Finance
Its claims that the NHS could deliver £22bn of annual savings in 5 years’ time, is the latest of a long line of reports to assert that there is scope for the NHS to make major savings, but the report does make it clear that more resources, an extra £8bn in Government funding by 2020 would be needed. It claimed that there would be a "radical upgrade in prevention and public health", but as Dr Sarah Wollaston pointed out in October 2016 there were reductions in other areas of health spending outside NHS England’s budget, in particular public health. Without improvements in social care she said the NHS could not be expected to deliver the Five Year Forward View.
NHS efficiency savings of 2% to 3% a year from 2015 to 2021 were supposed to save £22 billion a year. Between 2004 and 2014 NHS output increased considerably. Hospital admissions increased by 32%, outpatient attendances by 17%, primary care consultations by 25% and community care activity by 14%. Hospital death rates reduced, especially in stroke. At the same time there was an increase in wages of 24% and an increase of 10% in the number of staff and increases in the use of equipment and supplies. As a whole NHS output increased by 47% and inputs by 31%, an increase in productivity of 12.86% during the period, or 1.37% per year, considerably less than envisaged in the Five Year Forward View.
Vanguard areas
29 areas were selected (from 269 applicants) to pilot new models for localised healthcare in March 2015. When insufficient transformation funding was allocated in September 2016 the plans were scaled down.
Primary and acute care systems
Integrated primary and acute care systems will bring together GPs, hospital, community and mental health services. Money will be directed from a joint budget to wherever patients are judged to need it most.
Multispecialty community providers
Multispecialty community providers will bring specialist services, like chemotherapy and dialysis, out of the hospital and closer to people’s homes. NHS England announced three potential routes for MCP contracts in July 2016:
Approved proposals:
Enhanced health in social care
Models of enhanced health in care homes will enable the NHS and councils to work together to provide more healthcare in care homes, and to provide better preventive services there.
Urgent and emergency care
Development of the NHS 111 is a central issue for most of these projects. It's intended that it should meet all urgent clinical needs rather than just be a signposting service so that appointments could be made directly with GPs or rapid access mental health services.
A further wave of 8 new sites were announced in July 2015:
Multi-hospital chains
Multi-site specialty franchises
Accountable clinical networks
Sustainability and transformation plans
In February 2016 NHS organisations in England, both Clinical Commissioning Groups and NHS trusts, were grouped into 44 footprints which were each required to produce joint plans with their local authorities for health and health service transformation for the period up to 2020. Each had a leader, some from the NHS and some from local authorities.
See Sustainability and transformation plan.