NHS Five Year Forward View

The NHS Five Year Forward View was published on 23rd Oct 2014. It sets out a vision for the future of the NHS. It was developed by the partner organisations that deliver and oversee health and care services including NHS England, Public Health England, Monitor, Health Education England, the Care Quality Commission and the NHS Trust Development Authority.

The purpose of the Five Year Forward View is to articulate why change is needed, what that change might look like and how we can achieve it. This was the first time the NHS as a whole had set out its vision to government rather than vice versa

Why change is needed?

The NHS had achieved considerable success in delivering efficiencies whilst maintaining services over recent years but this approach (e.g. pay restraint) could not be sustained indefinitely. Some of the fundamental challenges facing us:

  • Increasing Elderly population: we live longer, with complex health issues
  • Modern advances in treatments and technologies- transforming our ability to predict, diagnose and treat disease.
  • Increasing budget pressures due to the global recession.

NHS England have previously predicted that if we continue with the current model of care and expected funding levels, we could have a funding gap of £30bn a year by 2020/21 which will continue to grow and grow quickly if action isn’t taken.

The funding gap of £30bn supposes

•             Uncontrolled rising demand

•             No efficiency savings

•             No additional funding

Therefore the three strands of a sustainable solution proposed in the 5 year forward plan are:-

• Considerably greater emphasis on reducing demand through effective measures to prevent ill health (e.g. alcohol, obesity etc.) This will produce medium/longer terms benefits.

• Major changes in the models of care recognising the need for a path between a single centrally determined model and “letting a thousand flowers bloom” i.e. a limited menu of solutions to suit local needs.

•Additional funding from Government of £8bn a year

 

Key themes in the NHS Five year forward view are:

Prevention

Radical upgrade in prevention and public health:

One in five adults still smoke. A third of us drink too much alcohol. A third of men and half of women don’t get enough exercise. Just under two thirds of us are overweight or obese. The NHS will therefore now back hard-hitting national action on obesity, smoking, alcohol and other major health risks. We will help develop and support new workplace incentives to promote employee health and cut sickness-related unemployment. And we will advocate for stronger public health-related powers for local government and elected mayors.

New care models: Out of hospital care to be larger part of what the NHS does

  1. Patients will gain far greater control of their own care – including the option of shared budgets combining health and social care.
  2. NHS will take decisive steps to break down the barriers in how care is provided between family doctors and hospitals, between physical and mental health, between health and social care. The future will see far more care delivered locally but with some services in specialist centres, organised to support people with multiple health conditions, not just single diseases.
  3. England is too diverse for a ‘one size fits all’ care model to apply everywhere. But nor is the answer simply to let ‘a thousand flowers bloom’. One new option will permit groups of GPs to combine with nurses, other community health services, hospital specialists and perhaps mental health and social care to create integrated out-of-hospital care – the Multispecialty Community Provider. A further new option will be the integrated hospital and primary care provider – Primary and Acute Care Systems – combining for the first time general practice and hospital services.
  4. Across the NHS, urgent and emergency care services will be redesigned to integrate between A&E departments, GP out-of-hours services, urgent care centres, NHS 111, and ambulance services. Smaller hospitals will have new options to help them remain viable, including forming partnerships with other hospitals further afield, and partnering with specialist hospitals to provide more local services. Midwives will have new options to take charge of the maternity services they offer. The NHS will provide more support for frail older people living in care homes.
  5. The foundation of NHS care will remain list-based primary care. Given the pressures they are under, we need a ‘new deal’ for GPs. Over the next five years the NHS will invest more in primary care, while stabilising core funding for general practice nationally over the next two years. GP-led Clinical Commissioning Groups will have the option of more control over the wider NHS budget, enabling a shift in investment from acute to primary and community services. The number of GPs in training needs to be increased as fast as possible, with new options to encourage retention.

The five year plan argues that there is nothing in their analysis that suggests that continuing with a comprehensive tax funded NHS is intrinsically un-doable. The five year plan argues that delivering on the transformational changes set out in the plan and the resulting annual efficiencies could – if matched by staged funding increases as the economy allows – could close the £30 billion gap by 2020/21.

Ref: http://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf

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