UK: NHS Five Year Plan – Unwavering Commitment To Universal Healthcare But New Approaches To Delivery And More Attention To Prevention

Last Updated: 27 October 2014
Article by Karen Taylor

Most Read Contributor in UK, August 2017

The much anticipated report, the NHS Five Year Forward View1, launched today by Simon Stevens, the Chief Executive of NHS England, developed through consultation with key stakeholders, including patient groups.2

It articulates why change is needed, what that change might look like and how it can be achieved and highlights the need to close the widening health inequalities gap, improve the quality of care and tackle the pervasive funding challenges. It confirms that the vision of "universal healthcare, irrespective of age, health, race, social status or ability to pay" has not changed, but that the world has, and that the NHS needs to change to take advantage of the opportunities that science and technology can bring to help staff, patients and carers.

The Plan provides a five-year plan for evolving the NHS, to create a more equitable care landscape, better able to cope with surging demand on services and, at the same time, tackle the much trumpeted £30 billion funding gap that will develop by 2020-21 if change doesn't happen. The key actions proposed are:

  • a greater emphasis on prevention of ill health, because "the future health of millions of children, the sustainability of the NHS and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health". The report therefore backs comprehensive action on obesity, alcohol and other health risks and supports new workplace incentives and stronger public health powers for local government
  • giving patients more control on their own care, including shared budgets and support for unpaid carers, and developing better partnerships with voluntary organisations and local communities to meet unrelenting demands
  • removing the siloes between primary care and hospitals, physical and mental health and health and social care to provide a more seamless and efficient service. With far more care delivered locally, supporting people with multiple health conditions, not just single diseases, and key services, such as stroke, provided in specialist centres
  • developing and delivering new models of care, including greater alignment between national NHS bodies to provide meaningful local flexibility, and more investment in workforce, technology and innovation.

There is no "one size fit all" solution rather different local health communities will be supported to choose from a small number of radical new care delivery options and supported to implement them. These include:

  • groups of GPs combined with nurses, other community health services, hospital specialists and also mental health and social care to create integrated out-of-hospital care - Multispecialty Community Providers.
  • integrating hospital and primary care providers to form Primary and Acute Care Systems (PACs), similar to other countries' Accountable Care Organisations, with PACs accountable for the whole health needs of a registered list of patients, using a delegated capitated budget
  • urgent and emergency care services redesigned to integrate A&E departments, GP out-of-hours services, urgent care centres, NHS 111, and ambulance services. Alongside new ways of measuring the quality of services, new funding arrangements and new workforce models
  • smaller hospitals provided with options to help them remain viable, including partnerships with other hospitals, including specialist hospitals, underpinned by adjustments to the NHS payment regime and new models of medical staffing and other options aimed at achieving sustainable organisations
  • midwives enabled to take charge of maternity services, in recognition that having a baby is the most common reason for hospital admission yet only a quarter of women want to give birth in a hospital obstetrics unit,
  • a commitment that frail older people living in care homes will get NHS support comprising in-reach support (medical reviews, medication reviews, and rehab services)
  • confirmation that the foundation of NHS care will remain list-based primary care and a commitment to provide a 'new deal' for GPs, investing more in primary care, while stabilising core funding for general practice, nationally, over the next two years.

A combination of approaches to tackle the funding gap are rehearsed including better demand management, efficiency improvements and new funding models. In considering the funding challenge the report notes that the NHS' traditional performance has been efficiencies of 0.8 per cent annually but nearer to 1.5 – 2 per cent in the last five years. It acknowledges that achieving further year on year net efficiency/demand saving across the NHS of two per cent for the rest of the decade requires a strong performance, but believes that by the end of the five year period, three percent net efficiencies could be achieved through the above actions.

The Plan is predicated on flat real terms NHS spending overall, representing a continuation of current budget protection. It presents , however, three scenarios, based on different combinations of efficiency and funding options which result in the £30 billion gap being closed by one third (£21 billion), one half (£16 billion), or all the way.

While the devil as always is in the detail, the Plan sets the agenda for the next Parliament and throws down the gauntlet to political parties to back fundamental changes to health services that could significantly improve care for patients. It is hard to disagree with anything in the Plan and indeed the Government and opposition parties are largely supportive, including agreeing that spending needs to increase, however how this might be achieved is where they differ. Whatever the outcome of the general election, a universal healthcare system is clearly something no one intends to tamper with. I urge you all to read the Plan, or at least the Executive Summary and to identify what part you might play. This could include taking more responsibility for your own, and your family's, health and well-being; or, as part of the day job, by helping commissioners, providers and suppliers to play their part.



2. Produced by NHS England, Public Heath England, Monitor, the NHS Trust Development Authority, Care Quality Commission and Health Education England, with advice from patient groups, clinicians and independent experts, the Five Year Forward View lays out four key areas in which action must be taken to plug the growing health and care divide and address 21st century challenges.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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