A vision for the NHS

On the 23 October 2014, NHS England published its Five Year Forward View, a vision document for the future of the NHS.

The timing, and the timeline, is very deliberate: this is NHS England’s chief executive, Simon Stevens, setting his stall for next year’s general election.

Whichever party (or parties) form/s the next government will have to decide whether they take this vision on. And whether they are willing to pay for it.

This is a crucial point because Stevens has addressed the enduring taboo of money. Politicians are largely in a state of denial about the funding crisis facing the NHS, forecasted to be short by about £30 billion by 2020/21.

That’s just under a third of the annual budget of the NHS. Stevens is clear: if you want the NHS to continue providing a universal health care service, free at the point of delivery, you cannot escape the fact that more money will need to be found.

For a pre-election period, where more spending, even on the NHS, is avoided like the plague by political parties, this is the very definition of throwing down the gauntlet.

So what does the vision say?

It doesn’t mince its words in support of the NHS and its principles of universal free health care, the opening line being no less than “[t]he NHS may be the proudest achievement of our modern society”.

In a concise 40 pages it then describes what an NHS in 2020 should look like. Not so much a roadmap but more a holiday brochure.

Which is not to belittle what it says. It is unflinching about the public health challenges that could jeopardise the long-term sustainability of the NHS and the ultimately the health and wellbeing of the nation.

It makes a welcome reference to Derek Wanless’ report, now over a decade old, that highlighted the need to have a population more “engaged” with their health, making healthy decisions and self-managing long term conditions.

Stevens challenges the old way of working, a health infrastructure locked into collections of hospitals remote from primary care (GPs), largely unchanged since recommendations made in 1962 (and arguably since the NHS was founded).

This is where things actually get very interesting. “Multi-specialty Community Providers” – in simple terms teams of health professionals with a range of skills working together across traditional boundaries – are proposed.

Where, for example, an older person living with multiple conditions will currently have their health needs managed almost independently of each other, this approach would formally join-up their care.

“Primary and Acute Care” systems are also mooted, a way of bringing hospitals and primary care more closely together, even suggesting that a local hospital could hold a contract to provide GP services for a local area.

The innovation is not necessarily in what’s being proposed but in the scope. These will not be the discrete programmes that are scattered across the country, each delivering small benefits to often small groups of people, as many already are.

These will need to be the new norm in a future NHS.

On paper, this approach is good news for older people. We have long raised the issues of the lack of joined-up care and little systematic focus on prevention.

For a person at risk of falling with multiple long-term conditions and frailty, an approach that starts with preventing ill health, moves to care that is close to home, and in all cases works in a joined-up way should be very welcome.

Stevens is not being prescriptive. He’s not naïve enough to believe you can impose new approaches from the centre. But he is certainly expecting progress.

Making this case to the public, on the whole very satisfied with the NHS, is the next task and the most important one. No one is going to march for Multi-specialty Community providers, regardless of the potential benefits.

Moving this vision on will not only mean translation but also involvement. The public rightfully have a voice on the NHS and making change will mean taking full advantage of their views, as partners, and not turning them away.

Standing still is not an option for the NHS.

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