Five Year Forward View
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.
- Wirral
- Mid Nottinghamshire
- Northumbria
- Yeovil
- Salford: Salford Royal NHS Foundation Trust
- Lancashire North and Cumbria
- North East Hampshire and Farnham
- Harrogate
- Isle of Wight
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:
- South Nottingham System Resilience Group, which includes Nottingham University Hospitals NHS Trust, South Nottingham and Erewash Clinical commissioning groups, Nottingham City and County councils, and East Midlands Ambulance Service.
- Cambridgeshire and Peterborough Clinical commissioning group.
- North East Urgent Care Network is bringing both pharmacists and paramedics into primary care settings.
- Barking and Dagenham, Havering and Redbridge System Resilience Group is developing shared patient records.
- West Yorkshire Urgent Emergency Care Network.
- Leicester, Leicestershire and Rutland System Resilience Group.
- Solihull Together for Better Lives, which includes Heart of England NHS Foundation Trust, Birmingham and Solihull Mental Health NHS Foundation Trust, Solihull Metropolitan Borough Council, and Solihull Clinical commissioning group, is creating multidisciplinary teams to deliver services in patients homes.
- South Devon and Torbay System Resilience Group – led by South Devon and Torbay Clinical commissioning groups, South Devon Healthcare NHS Foundation Trust, and Torbay and Southern Devon Health and Care NHS Trust plans to open two new urgent care centres.[14]
Future models of acute care
Multi-hospital chains
- Salford Royal NHS Foundation Trust and Wrightington, Wigan and Leigh foundation group
- Northumbria Healthcare foundation group
- Royal Free London NHS Foundation Trust
Multi-site specialty franchises
- Dartford and Gravesham and Guy’s and St Thomas’ foundation group
- Moorfields Eye Hospital NHS Foundation Trust
- National Orthopaedic Alliance: Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Royal National Orthopaedic Hospital NHS Trust and Royal Orthopaedic Hospital NHS Foundation Trust
- Neuro Network: Walton Centre NHS Foundation Trust, Warrington and Halton Hospitals NHS Foundation Trust, Liverpool and Warrington Clinical Commissioning Groups and NHS England Specialised Services Commissioning Team (North).
Accountable clinical networks
- MERIT – Mental health accountable clinical network: Birmingham and Solihull Mental Health NHS Foundation Trust, Black Country Partnership NHS Foundation Trust, Dudley and Walsall Mental Health Partnership NHS Trust and Coventry and Warwickshire Partnership NHS Trust
- Cheshire and Merseyside maternity and paediatrics accountable clinical network
- Royal Marsden NHS Foundation Trust, The Christie Hospital NHS Foundation Trust and University College London Hospitals NHS Foundation Trust
- East Midlands Radiology Consortium
- Multispecialty Dorset accountable clinical network: Dorset County Hospital NHS Foundation Trust, Poole Hospital NHS Foundation Trust, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust
- Multispecialty Yorkshire and Derbyshire accountable clinical network
References
- ↑ "Forward view: Unprecedented call for NHS funding growth". Health Service Journal. 23 October 2014. Retrieved 16 November 2014.
- ↑ "The future begins in Stevenstown". Local Government Chronicle. 24 October 2014. Retrieved 16 November 2014.
- ↑ Pym, Hugh (23 October 2014). "NHS five-year plan document 'packs a punch'". BBC News. Retrieved 16 November 2014.
- ↑ "Stevens: New care vanguard must bring in GP lists". Health Service Journal. 10 February 2015. Retrieved 22 February 2015.
- ↑ Cram, Colin (27 October 2014). "NHS Five Year Forward View: bold promise of £22bn savings will fall short". Guardian. Retrieved 16 November 2014.
- ↑ "One in three NHS hospitals needed Government bailout funds last year". Independent. 7 November 2014. Retrieved 16 November 2014.
- ↑ "Firms to receive NHS cash to reward staff for losing weight in 'radical model' for health care". Independent. 23 October 2014. Retrieved 17 November 2014.
- ↑ "Giving night shift staff healthy food choices is a priority, says NHS chief". Nursing Standard. 27 October 2014. Retrieved 16 November 2014.
- ↑ Vickers, Robin (3 December 2014). "Building future NHS organisations starts with citizens". Health Service Journal. Retrieved 23 December 2014.
- ↑ Pym, Hugh (10 March 2015). "NHS revamp - rhetoric into reality?". BBC News. Retrieved 10 March 2015.
- ↑ "Huge cash injection help Blackpool’s struggling hospital". Blackpool Gazette. 23 October 2015. Retrieved 23 October 2015.
- ↑ "NHS chief unveils 29 ‘vanguard’ areas in his new reforms". Independent. 10 March 2015. Retrieved 11 March 2015.
- ↑ "Vanguards reveal transformation plans and barriers to change". Health Service Journal. 8 September 2015. Retrieved 22 October 2015.
- ↑ "First eight urgent and emergency care vanguards revealed". Health Service Journal. 24 July 2015. Retrieved 24 September 2015.
External Links
The NHS Five Year Forward View