The NHS Five Year Forward View: A step change in thinking

The NHS Five Year Forward View, the blueprint for NHS services, is ‘the most important document I have seen come out of the department in the last five to ten years’ Professor Kieran Walsh, Professor of Health Policy and Management at Manchester Business School said at Open Forum Events’ The NHS Five Year Plan: Policy in Practice conference.

Professor Walsh explained that the common thread across the new models of care were integration and collaboration. Although the seven models are clearly set out in the document the 5YFV does not articulate how these new models of care will work. Walsh said that thinking about how it will work in practice is an important step that tends to be neglected in a rush to implementation. To implement the five year plan effectively much more detailed upfront work on service design, mechanism and intended outcomes is needed.

Equally important in the 5YFV is how the NHS has done restructures in the past and it was stressed that organisational change was not the answer. The Health and Social Care Act had been an ‘object lesson in how not to do health reform’ with ￡3bn and five years wasted. “We have ended up with a structure not too dissimilar to the one we had before,” Walsh said, “it’s a bit more complex, a bit more fragmented and frankly not as fit for purpose.” Walsh went on to stress that something needs to change as King’s Fund figures demonstrate that the health service is not sustainable if the status quo continues.

“If we want to see improvements in quality and productivity in the future then they are going to come from us aligning technologies and treatments with arrangements for service delivery.”

Walsh raised concerns about the organisational capacity in the NHS to innovate and implement the 5YFV and that scope for financial savings is also limited. Although some cost savings will be found through reduced duplication and substitution of services there is evidence of some cost increases through uncovering and meeting previously unmet demand and improving access to services. Walsh concluded by saying that the pace of change set out in the document was ambitious and a bit concerning it was an important opportunity for service redesign and reconfiguration at scale, with the resources to match.

NHS England’s Director for Patient and Public Voice and Information, Giles Wilmore, told delegates that the challenges, in part, can be addressed through better prevention; in particular with how services work with individuals and communities as active participants in their health. He said that there is a huge asset of knowledge and support in community groups that statutory services do not make the best use of. Wilmore highlighted a new programme of work, Realising the Value, that will strengthen the case for change and build the evidence for approaches that support individual and community engagement. Wilmore reinforced that the 5YFV was not a politically inspired process but had come from the leadership within the national NHS bodies.

“We’re very mindful that a vision like the 5YFV is necessary but not sufficient. It is a start on a journey.”

Brian Murray , Head of Sales at TotalMobile followed this by looking at how new technology solutions were helping to transform services and work in the community. A nursing case study in Bristol demonstrated how, by transforming patient engagement and reducing administration burdens, greater efficiencies and increased face-to-face time with patients could be achieved. Murray stressed that for transformation to be successful, especially when implementing new technologies, it was vital that the workforce was supported.

Doctors.net’s James Quekett had opened the conference by referencing a recent GP survey that showed predominately primary care services were not engaged with a lot of the changes outlined in the 5YFV. “If you are going to restructure how services are organised you need the workforce on board,” he said. Quekett told the audience that the lack of integration of care services, particularly for the frail and elderly, is causing significant issues in terms of patient experience and in terms of the cost of care.

Duncan Stephenson, Director of External Affairs at Royal Society of Public Health, informed delegates that it costs ￡60bn a year to treat preventable lifestyle diseases. Stephenson called on the wider public health workforce and allied health professionals to help reduce conditions such as obesity, diabetes, smoking and alcohol-related diseases. “Given the scale of the challenges we face we need to have a more strategic and radical approach to public health.” The Health on the High Street paper was launched on the day of the conference and Stephenson outlined the drive to incentivise more businesses to promote good health and give enhanced powers to local authorities in terms of licencing and planning permission.

“We do not think it is fair or right that people who live in deprived areas should have to make do with unhealthy choices and businesses.”

Devo Manc was the hot topic of the midmorning panel debate and Wigan Council Chief Executive Donna Hall welcomed the additional ￡1.5bn of funding that was being dissolved to Greater Manchester but cautioned that it was not about money. “I think it is a fantastic opportunity for us to shape our destiny and deliver a fundamental redesign across the health and social care system.” Hall revealed that Wigan Council had completed risk stratification work and wrapped care packages around need which had resulted in a 30% reduction in unplanned admissions. Colin Cram, Chief Executive at Open Forum Events, echoed Hall’s concerns on responsibility warning that devolution was a double-edged sword – warning if care did not improve in Greater Manchester it will be the fault of Greater Manchester. Professor Kieran Walshe said that on the other hand it was an exciting idea and there was enormous potential to bring together health and social care, housing, education, transport and economic development. Dr Mohammed Jiva MBE, GP and Medical Secretary Rochdale & Bury Local Medical Committee, questioned why there was no GP representation to discuss viable new models of care. Jiva stressed that healthcare services should be located at places that are convenient for the public first and foremost.

Nick Hex, Associate Director, York Health Economics Consortium addressed the estimated ￡30bn shortfall in funding. He stressing it was the NHS successes in care, delivering increased life expectancy and also increased years of ill health, that was driving up costs and demand. With seventy percent of savings in 2012-13 attributed to pay freezes and reductions in tariffs Hex thought it would be difficult to see those levels of savings in the next five years.

“The NHS Five Year Forward View is really a business case to government to say we need productive investment to support new models of care and in order to make productivity gains.”

Hex urged the audience to think about local areas of need and how some of the techniques and models of care outlined in the 5YV could help deliver savings.

One of the vanguard projects for Multispecialty Community Providers (MCPs) gave an insight in how some of the policies were being implemented in practice. Sarb Basi, Managing Director of The Vitality Partnership explained how some of the future demands and unsustainable workloads were drivers for change, ‘the status quo,’

he said, ‘is not going to be a solution.’ New digital communications, clinical contact centres and telephone access channels had been launched and changing the customer experience across the organisation. Basi and Robin Vickers, Executive Director at Digital Life Sciences, described how the digital operating model had delivered better access and reduced A&E admission by 10-15% with 65% of patients consistently being dealt with remotely without coming into a practice.

“We want to move from a reactive medical business to a proactive population management business that will have a sustainable impact on the health system.”

Another new model of care was covered by Geoff Harris, Assistant County Fire Officer, Greater Manchester Fire and Rescue Service who discussed Community Risk Intervention Teams. GMFRS have fundamentally changed their approach to safety in the home and wider role in the community. The multi-agency, multi-disciplinary

prevention and response teams are delivering are range of care services, such as risk assessments and referrals for falls to ensure support is provided.

“600,000 homes have their thresholds crossed nationally by Fire and Rescue Teams, that’s 600,000 opportunities to do things differently.”

The event concluded with Alison Davis, Clinical Director of Outpatient and diagnostic services at Moorfields Eye Hospital. Davies described how Moorfields Eye

Hospital is providing specialist and holistic care so that patients flow naturally through the system. District hubs are well connected networks and care is provided closely to where they live and work as well as through virtual care. Davies stressed that maintaining quality standards was a key principle.

“If you become too diverse maintaining quality and safety becomes very difficult.”

Article by Daniel Rankine

To view details of the next The NHS Five Year Plan: Managing the Demand event please follow the link. Held in central London on 30th June the next event in the series will explore why the NHS needs to change and the key elements within the 5YFV that aim to deliver transformation and sustainability. A line up of expert speakers will explain the theory whilst examples of the new models of working will described how the theory applies in practice.