Five Year Forward View

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The Five Year Forward View was produced by NHS England in October 2014 under the leadership of Simon Stevens as a planning document.

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.[1]

No more top-down reorganisation is 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.[2] 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 permitting the development of "Accountable Care Organisations" similar to those in Spain and parts of the USA.[3] 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.[4]

The fact that the word “competition” does not appear once in the document is being hailed by a victory by Labour.

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,[5] but the report does make it clear that more resources, an extra £8bn in Government funding by 2020 would be needed.[6]

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 inentives encourage participation in Weight Watchers-type schemes.[7] 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.[8]

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 Vitality 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.[9]

Vanguard areas

29 areas were selected (from 269 applicants) to pilot new models for localised healthcare in March 2015.[10]

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.

  • Fylde Coast: £4.26m will extend the Extensive Care service for elderly and frail patients with two or more long-term conditions, and establish a single point of contact for all out-of-hospital services.[11]
  • Calderdale
  • Erewash
  • North Birmingham and Sandwell
  • West Wakefield
  • Sunderland
  • Stockport
  • Dudley
  • Whitstable: Whitstable Medical Practice
  • Tower Hamlets
  • Southern Hampshire: Southern Health NHS Foundation Trust
  • West Cheshire
  • Northamptonshire: Lakeside Healthcare
  • Rushcliffe

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.

  • East and North Hertfordshire
  • Nottingham
  • Sutton
  • Airedale
  • Wakefield
  • Gateshead[12]

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. [13]

A further wave of 8 new sites were announced in July 2015:

Future models of acute care

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.[15]

References

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External Links

The NHS Five Year Forward View

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