Welcome to our latest series of short articles on the world of the NHS and medical devices.
As part of ongoing NHS reform, the Five Year Forward View (5YFV) attempts the most radical approach yet. Here, we give an overview of its main themes and initiatives.
What’s your experience so far of the 5YFV?
Next year, the NHS celebrates its 70th birthday. Since its inception in 1948 it’s seen plenty of changes and many challenges, and yet – complicated though it may be – has never lost sight of providing free, effective healthcare at the point of use.
Our NHS continues to do a great job, and does so amid an ever-challenging environment: an ageing population (and total population of more than 54 million), an increase in preventable illness, varying quality of care, social inequality, complex organisational structure, cost pressures, and staffing and resourcing issues.
In short, patients’ needs have been changing, new treatment options have been emerging, and service pressures have been building.
NHS Five Year Forward View (5YFV)
To address these scenarios, The NHS Five-Year Forward View (5YFV) was proposed by the partner organisations that deliver and oversee health and care services – and, in 2015, implemented a wide-ranging strategy setting out a new direction and new ideas for the way the NHS delivers its services and how it manages its funding.
Some of what’s needed was to come from the NHS itself, whereas other initiatives relied on new partnerships with local communities, local authorities and employers.
5YFV – Key Themes and Initiatives
Now that it’s well under way, here we take an overview of its key themes and initiatives…
- Prevention is better than cure
A big drive is on maintaining public health by helping people live healthier lives and, in turn, facilitate the health of future generations. Workplace support initiatives have also been proposed to help improve employees’ health and reduce sickness-related unemployment.
There is particular focus on smoking cessation, obesity and alcoholism reduction (and other major health risks), and specific disease areas (e.g. dementia and diabetes) in order to reduce the incidence of treatments arising from these. Reducing treatment demand in these ‘preventable’ areas would enable resources to be more effectively directed elsewhere.
Additionally, the reform advocates for stronger public health-related powers for local government and elected mayors so that, when people do need to access health services, patients will gain far greater control of their own care – including the option of shared money to join health and social care.
- New models of care are based on collaboration and integration
New models of care have been introduced to break down the traditional, artificial divides in how care is provided between primary, secondary, and community care, and mental health and social care.
They’re designed to integrate these sectors (e.g. by integrating primary and acute care systems) and trial new and innovative ways of delivering care more locally across whole communities – with some services still in specialist centres, organised to support people with multiple health conditions, and not just single pathologies.
- Sustainability and Transformation Plans (STPs) and Place-Based Planning provide the structure
New planning arrangements – sustainability and transformation plans –oversee this, requiring commissioners, providers and others to produce five year plans that set out clear proposals for how integration is to be achieved. It involves place-based planning and systems of care to take into account local needs and populations.
- Vanguard sites test the models of care
‘Vanguard’ sites are being used to test these different care models so that they can be rolled out efficiently within the 5-year plan and beyond. Designed to be coordinated in three waves of implementation (with acute care collaboration sites included in wave three), this scale of change will vary from area to area. However, it is estimated that 50% of the population will be covered by vanguard sites by 2020/21.
- £100 billion buys a lot but it needs to be spent wisely…
As with any other industry, the NHS needs to use its budget as efficiently as possible. In 2015/16, the NHS’ total budget was £116.4 billion, with £100 billion spent on commissioning. (That would buy 86% of Apple, or buy outright either Google, Microsoft, Facebook and Coca-Cola – and still leave plenty of change).
Since 5YFV’s introduction in 2015, the NHS has put more money into primary care, and will keep the amount of money the same to fund general practice nationally in the first two years. Even so, NHS England and independent analysts have suggested that there will be a shortfall of nearly £30 billion between resources and patient needs by 2020/21.
The 5YFV has proposed some ways to reduce that deficit by then, including GP-led Clinical Commissioning Groups having the option of more control over the wider NHS budget, and NHS Trusts publishing monthly receipts for the top 100 items bought (such as bandages, needles and rubber gloves – supported by a ‘model hospital’ demonstrating what good looks like).
If something is to grow, it has to change. Not even our National Health Service is immune from this.
The NHS Five Year Forward View is seen as a viable opportunity for meaningful change through strengthening primary care, empowering patients and communities, and making further efficiencies within the health service.
What’s your experience…?