Full coverage and reaction to the NHS five year forward view, plus the rest of today’s news and comment
The NHS Five Year Forward View has gathered a large number of responses as well as analysis.
Here are some key points from the plan:
- This is an unprecedented call for funding. The plan says the health service cannot make enough efficiency savings to bridge its projected £30bn funding gap by 2021 if its real terms funding remains flat over the next five years.
- Both Conservatives and Labour say the plan fits with their vision for the NHS. Hunt says it “recognises the real challenges” faced by the service but is “essentially optimistic”. Burnham says that no mention of competition proves that it “fragments” the service.
- The majority of NHS organisations and health think tanks are in agreement that the plan sets out important goals that can only be realised by a funding increase
- ‘New care models’ could cover half of England, including hospitals running GP practices and groups of GPs taking over hospitals
- Small hospitals could be paid more under forward view plans
4.40pm Jeremy Hunt has said clinical commissioning groups should be responsible for all care in their populations, including co-commissioning public health.
Speaking at the Best Practice general practice conference in Birmingham today, the health secretary said:
“Integrated out of hospital care is a really, really important priority and clinical commissioning has made a big difference in unlocking it.
“There is some really extraordinary innovation going on [in CCGs] across the country and I would like to see that go much further.
“I would like to see CCGs becoming accountable care organisations responsible for all the care of the populations they look after, not just commissioning secondary care, but with the better care fund co-commissioning social care, with NHS England co-commissioning primary care and with local authorities to co-commission public health.”
“We have to think about healthcare much more holistically than we certainly did in the past,” he added.
Referring to plans for the NHS to become an “activist agent” of social change in a “radical upgrade” of prevention and public health, under plans announced today in the NHS five year forward view, Mr Hunt said: “we really need to link up public health campaigns done by local and national government with the work done by GPs.
“I think that CCGs can… be the spider at the centre of the web working closely with lots of other people, and the better care fund I think is a fantastic example of that.”
4.39pm The Care Act regulations and guidance for local authorities have now been finalised.
In a statement the Department of Health said: “The government response explains how the regulations and guidance, which come into effect from April 2015, have been revised as a result of the suggestions we received during the consultation.
“We have made changes that include clarifying the guidance on adult safeguarding and revising the eligibility criteria to focus on outcomes and better address social isolation.
“In addition to the revised regulations and guidance for local authorities there will be more materials to help those implementing the Care Act on the Local Government Association’s website.. The Care Act factsheets have also been updated.
The Care Act aims to make the social care system fairer and help people get better care.
4.34pm The College of Emergency Medicine has welcomed the Five Year Forward View published today.
Within the document are a number of mentions of plans concerning the development of A&E departments and the pressures they are under are also noted.
The absence of any comment on the pressing need to maintain a focus on recruiting and retaining the necessary skilled workforce in A&E departments is an unwelcome omission.
The College president, Dr Cliff Mann, said: “These plans are welcome but it is disappointing that the pressing need to maintain a focus on recruiting and retaining the necessary skilled workforce in A&E departments is missing from this document.”
4.30pm Responding to the NHS’s Five Year Forward View, Dr Hilary Cass, president of the Royal College of Paediatrics and Child Health, said: “It’s encouraging to see NHS leaders acknowledge that getting it right early in life reaps huge health, social and economic benefits in the long term.
“Preventing ill-health is often not the most politically attractive policy to adopt. But as today’s vision points out, the health of ‘millions of children’ depends on doing everything possible to prevent ill health and not just fire-fighting in times of crisis.
“It is absolutely right that bold steps must be taken to ensure the future health of our children, who have some of the worst mortality and morbidity rates in Europe.
“We need to tackle the growing problem of obesity which affects over a third of children and young people under 19 and costs the NHS an estimated £5billion a year. It is also right that parity of esteem between mental and physical health becomes a reality, not least because mental health illnesses affect 1 in 10 children.
“And as we have said consistently, we have to look at new models of care new models of care to deliver services in the right place and right time for the benefit of children and young people – including enhanced care in the community, urgent care networks that work seven days a week and ensuring healthcare professionals across primary and secondary care work effectively together, breaking down traditional silos.
“This vision is grounded in the reality of the challenges facing today’s NHS; acute financial pressures, increasing strain on services and a squeezed workforce. More funding is part of the answer – but what’s most refreshing about this vision is its recognition that the culture of delivering services in the NHS has to change.
“The key now is for political leaders to take up the challenge. Without the will and long-term commitment of Government, this ambitious vision will fall victim to political short-termism, with the NHS struggling to meet the health needs not only of this generation, but future generations.”
4.27pm Royal College of Physicians president Professor Jane Dacre today welcomed the publication of NHS England’s Five Year Forward Review.
Professor Dacre said: “NHS England’s five-year plan offers several new models of care that echo the RCP Future Hospital report’s ideas of promoting integrated care and bringing care closer to the patient.
“The variety of new care models suggested in this thoughtful plan show that NHS England recognises the need for a flexible approach to providing local services, and supports integration of primary, secondary and community care much more effectively than before.
“The RCP’s recently published five point plan for the next government – Future Hospital: more than a building - asked for no top down reorganisation of the NHS, and for the removal of the financial and structural barriers to joined-up care for patients.
“We are therefore delighted that the plan recognises that top down reorganisation is not the way ahead, and that the default position for the NHS should be local reorganisation ideally arising from work to develop the new care models suggested in the plan.
“We also welcome the recognition of the need for transition funding to pump-prime and fast –track projects, and the awareness that the new models of care and service provision will need to be piloted and assessed for their effectiveness in improving patient care as well as reducing costs.”
Future Hospital: more than a building can be found here.
4.08pm Jeremy Hunt has said “difficult economic decisions” need to be made to allow for greater NHS spending.
The health secretary also said he “wholeheartedly” supports a real terms increase in the NHS budget.
His comments follow the publication of the five year forward view by NHS England, Monitor and other national NHS bodies today.
Speaking at the Best Practice general practice conference in Birmingham today, the health secretary said: “The direction of travel in terms of NHS expenditure and NHS funding - with the pressures that we all face day-in-day-out - can only go in one direction.
“It is really important that we take the difficult economic decisions to make sure that we can continue to afford this.”
He added: “One of the most important things is to make sure we have a strong economy that is able to continue to afford real terms increases in the NHS budget.
“That is one of the key recommendations in place in the five year forward view, and is one that I support wholeheartedly.”
Mr Hunt said the forward view set out a “fantastic vision” and he “fully endorse[s] what it says”.
4.07pm Dean Arnold, partner at lawyers Pricewaterhouse Cooper’s healthcare practice said: “The NHS Five Year Forward View is the most radical plan for changing health care delivery since 1948. It is well conceived and transformative, building on international best practice and new models of care delivery.
“There will be a number of challenges including leadership, culture, how money flows in the system, and allowing time for improvement. But the most difficult challenge will be political.
“The radical agenda will require political leaders to pick up the gauntlet thrown down by NHS leaders. Politicians will need to embrace the reform challenges as well as the resource challenges. Change of this scale will not be pain free. Each political party ahead of the next election will need to set out how it plans to champion changes to local health services including hospitals.”
3.55pm Responding to today’s publication of of the NHS’ Five Year Forward View, Bill Upton, partner and head of public healthcare at law firm Grant Thornton, said: “Today’s announcement is a well-argued one which highlights both the challenge in changing approaches to care and the overall funding needs driven by increasing patient demand.
“The NHS is clearly at a financial impasse, and although the ‘Forward View’ is a step in the right direction, a lot more still needs to be done in order to sustain the levels and quality of service which the public has come to expect from the NHS in the long-term.
“The announcement is particularly timely, given the important part that the NHS is going to play in political debates in the run up to the general election.
“The challenge has been thrown down to the politicians – without more substantive, radical change to public health services as well as extra funding, the NHS would remain on a dangerous cliff-edge.”
3.45pm A 41-year-old mother with terminal breast cancer was let down by her hospital when they failed to detect and treat her cancer, an investigation by The Parliamentary and Health Service Ombudsman has found.
West Hertfordshire Hospitals NHS Trust, which was responsible for the failures, has paid out £70,000 in compensation.
The mum-of-one, known only as Ms G, was referred to West Hertfordshire Hospitals NHS Trust’s breast clinic.
At her follow-up appointment in May 2010 the breast specialist failed to undertake the appropriate tests to rule out cancer.
When Ms G returned to the breast clinic in December 2011 biopsies revealed she had advanced inoperable breast cancer and secondary cancers of the liver, brain and bone.
The Parliamentary and Health Service Ombudsman’s report found that had Ms G’s cancer been detected and treated in 2010, her prognosis would have been much better and the cancer would unlikely be terminal.
Parliamentary and Health Service Ombudsman Julie Mellor said: “A 41-year-old mother has had her life cut short because of the serious failings by West Hertfordshire Hospitals NHS Trust to carry out the necessary tests to rule out breast cancer.
“They missed vital opportunities to diagnose the cancer and begin treatment.
“This is a very sad example of what can go wrong when doctors and trusts don’t carry out the necessary and proper diagnoses and tests, and the terrible impact it can have on someone’s life.
“Doctors and hospitals must understand and learn from complaints.
“There needs to be a cultural shift in the NHS where staff are encouraged to be open when things go wrong and to admit to mistakes.
“Only when listening and learning are truly embedded into an organisation’s culture will we see the improvements we need for a better and safer NHS for all.”
“The health ombudsman also discovered the breast specialist failed to make her aware of the importance of attending the follow-up appointment.
“The Trust also failed to tell Ms G about the potentially serious cause of her condition, the importance of attending her next appointment and inappropriately discharged Ms G without making her, or her GP, aware of the seriousness of her situation.
2.20pm In our Comment section National Voices chief executive, Jeremy Taylor, is cautiously optimistic about the NHS plan for the future, as long as it doesn’t descend into a tick-box exercise.
2.15pm Unite has concerns over how proposals in the Five Year Forward View will be paid for, and whether new models of care will be delivered by the NHS or the private sector.
Unite head of health Rachael Maskell said: “The best investment that the government could make in the NHS is the immediate scrapping of the Health and Social Care Act which has already squandered £3bn in a pointless reorganisation.
“Simon Stevens, the new chief executive of NHS England, makes precious little mention of the plummeting morale of the 1.3 million workforce which is becoming a worrying pattern for this government with its continued failure to invest in skills, retention and development.
“In the last four years the NHS has been battered by the funding crisis resulting in £20bn being sucked out of the service during this parliament.
“The picture remains very bleak and it is clear that the plan will not plug the predicted £30bn financial black hole by 2020/21.
“This will be impossible to deliver in five years – if you are talking about a real improvement in health prevention, retraining and realigning the roles of NHS staff, together with integration of health and social care.
“The NHS has been also been hit by the helter-skelter dash to privatise services with 56 per cent of new contracts going to private healthcare companies in the last year.”
The document - published today by NHS England, Monitor and the other national NHS bodies - made no reference to competition or private providers. It is understood that competition is not an important focus of the senior national leaders’ vision for service development.
However, Labour peer and former health minister Lord Hunt today told HSJ there “absolutely” needed to be a legal change to change the effect of competition rules, regardless of the shift in policy emphasis.
1.45pm In our Comment section, the Foundation Trust Network’s chief executive Chris Hopson says the Five Year Forward View sets a different tone from the accepted wisdom.
He writes: ‘At a time when too many believe that success is just about running harder within the existing system to meet current targets with less money. The report sets out with clarity, rare concision and excellent prose why the NHS has to change and do two things very differently.’
1.35pm The health committee will hold a hearing into public spending on health and social care on 28 October at 2.30pm. NHS England’s chief executive Simon Stevens, medical director Sir Bruce Keogh and chief financial officer Paul Baumann will be giving evidence.
1.25pm Here are some reader comments on the Five Year Forward View:
“Oh dear. More of the same. £22bn ‘efficiency’ savings is a euphemism for continuing the funding squeeze on the NHS budget. £22bn savings is a euphemism for more privatisations as GP’s naively believe the myth that is the way to reduce cost. What has not been revealed is the role NHSE will plan in implementing this plan or will it simply fund according to the presumed efficiency gains.”
“This appears to be a missed opportunity to tell the Government the truth albeit a carefully thought out document. The reality is that the NHS is one of the best value institutions in the world for the provision of health care but it is now scraping the bottom of the barrel and needs appropriate funding. No-one believes the efficiency gains and cost savings are deliverable at the level being suggested and we will simply have more failure and damage to the lives of those trying to deliver care. We need more candour at a national level.”
12.55pm Health Foundation leaders have pinpointed funding as the most pressing issue in the Five Year Forward View.
Anita Charlesworth, chief economist at the Health Foundation, said: “The Forward View sets out an ambitious programme of renewal for the health service. But it confirms that this can only be delivered with strong NHS staff, public and political commitment to change coupled with significant additional funding.”
Richard Taunt, director of policy at the Health Foundation, said: “The portrait the Forward View paints – including a future where patients have more control of their own health alongside a greater focus in tackling ill health prevention – is one we absolutely support. We also welcome the call for both a transformation fund and more support for local areas to improve the care they provide – both identified as important areas for action in our recent More than Money report.”
“However, the biggest challenge facing the NHS remains its future funding. Whether the ambitions set out in Forward View will be able to be realised depends in large part on whether the NHS receives the funding required to meet the demands put upon it. Politicians need to be explicit in their responses to the Forward View about whether they would provide the additional funding. This is clearly required to enable the NHS to adapt to meet the unprecedented challenges it faces. If they do not, a plan B is needed as to how quality can best be maintained in the NHS.”
12.50pm The Nuffield Trust’s response to the Five Year Forward View highlights that the NHS “cannot continue with ‘business as usual’”.
Chief executive Nigel Edwards said: “It sends a firm signal to MPs of the dangers of any future NHS reorganisation and offers a starting point for politicians considering how to reform the NHS in the future.
“The Forward View sets out a radical vision of the different approaches that local areas can take to adapt for the future - from hospitals running GP surgeries, to groups of medical professionals, therapists and social workers buying health services for patients in their area. Unlike previous centrally imposed blueprints for the NHS, Simon Stevens expects this transition to be driven by local clinicians and managers working closely with patients.
“The report also acknowledges the scale of the financial challenge ahead. It recognises that there are big opportunities to improve the efficiency of the NHS but that there is a limit to how far these alone can fill the gap. The concept of ‘flat-real per person’ funding is an important one as it reveals the true costs of caring for an ageing population. It would show politicians how much more they’d need to increase health spending above inflation to maintain high-quality services.”
“Without a sustainable long-term funding plan for the NHS, it is hard to see how these radical changes can happen. The plan outlines the intention to develop a ‘pump-prime model’ to help services make these changes. But with NHS organisations increasingly going into the red and 2015/16 looking to be a crunch year for the NHS finances, there is a real danger that any money from this will end up papering over the cracks caused by deficits. This is especially likely if a ‘pump-prime model’ or transformation fund is centrally funded and administered.”
12.25pm Freeman says the Transatlantic Trade and Investment Partnership will not threaten the NHS, it will exclude “any binding controls over public services, specifically the NHS”.
12.21pm Freeman says private provision in the NHS is at 6 per cent. He says the government are not driving a privatisation agenda.
12.20pm Government ministers Norman Lamb, George Freeman and shadow health secretary Andy Burnham are now on the Daily Politics Show.
They are being asked about the funding shortfall all the parties’ pledges have shown. Freeman said “there are no guarantees” and depends on how strong the economy is. Burnham says the NHS is a priority for Labour rather than tax cuts for Conservatives.
Lamb says the current shortfall “has to be affordable” to make the necessary improvements.
Freeman says there is no reason why the NHS can’t run at 2-3 per cent efficiency savings a year.
12.10pm Simon Stevens is being questioned on the BBC’s Daily Politics Show. Jo Coburn has asked what he will do if the money doesn’t materialise.
He says that if the health service makes changes and has the government’s backing funding issues can be resolved. Coburn asks if extra money can come from charging patients. Stevens says that a founding principle of the NHS is free treatment at the point of use.
On salaries, he says there has been a “shared sacrifice” but “we’re taking a look at the next five years and we’re going to have to do things differently, not just more of the same”.
11.55am There is concern that the Five Year Forward View fails to mention children’s mental health services “despite clear evidence about the importance of early intervention and of the cuts taking place to child and adolescent mental health services across the country”, according to Centre for Mental Health chief executive Sean Duggan.
Mr Duggan said that while the paper sets out “some bold new ideas to enable new forms of integrated care”, there is “little mention” of CAMHS services.
“From pregnancy to adolescence, the mental health of children and young people must be a priority for the NHS everywhere, working in tandem with local councils and schools and young people themselves to offer better, more engaging support.
“The five year forward view sets out the scale of the financial challenge facing the NHS. By investing in effective mental health interventions we can make much better use of scarce funding. The NHS spends £14bn on untreated mental health problems among people with physical health conditions and among its own staff. Targeted reinvestment can help to cut that cost while enhancing people’s health and reducing inequalities. The NHS can no longer afford to overlook mental health.”
Director of policy and strategy at the Foundation Trust Network, Saffron Cordery, has tweeted her agreement: “Commitment to mental health investment is welcome but you’re absolutely right re: CAMHS. It’s just not there..”
11.45am The Royal College of Nursing says the Forward View is “rigorous and realitsic”.
Peter Carter, chief executive, said: “The NHS is operating in challenging circumstances, faced with an unholy alliance of increasing demand, increased expectations, spiralling costs and straitened financial circumstances. Big changes are needed to close the health and quality care gap.
“The right clinical leadership to lead the new models of care, the focus on prevention and care closer to home and investment in staff are all positive suggestions and need to happen if the health service is to cope with the demands it is going to face in the years to come.
“None of these changes will be possible without the hearts and minds of NHS staff and the reality is that over the years they have seen policy initiative after policy initiative come and go whilst they have cared for record numbers of patients through the most disruptive reorganisation in the health service’s history and in the face of huge workforce cuts and pay freezes.
“Nurses, midwives and healthcare assistants will understand the analysis of the problem but will be sceptical, if not a little cynical, that without a clear commitment to more funding, they’ll just be facing more of the same.
“Paying nursing staff a fair wage is key and nursing staff will be delighted at the acknowledgement that unless they are paid competitive rates, nurses will vote with their feet and leave the NHS, exacerbating the retention and recruitment problems and impacting on the service’s ability to deliver this change.
“The NHS bodies have set out the direction of travel but they can’t do this by themselves. They will need the support of an engaged and motivated staff, organisations like the RCN and a firm commitment on the necessary finances. The next Government must listen and act.”
11.40am Gill Bellord, director of employment relations and reward at the NHS Employers organisation, has responded to the Five Year Forward View. She said: “This is a positive programme that can help local services to adapt and plan their care in ways that are best for patients. NHS Employers looks forward to working with NHS England on this programme.
“The emphasis in developing new roles as part of improving models of care is an important one and employers will want to engage and involve their staff early in any changes. At a national level NHS Employers will work to support Health Education England in this area.
“We welcome further development around its call for new incentives to support better health and well-being, and strongly support this in principle. Effective well-being programmes are expanding rapidly in the NHS but aren’t always prominent enough in board-level planning. There is a lot of good work in the NHS around staff health and well-being and this is an area where we can - and should - act as an example for employers in other sectors.
“Employers support the continued emphasis on expanding community services, which is where the greatest gains can be made for public health, but many will want to highlight the ongoing financial strain from expanding their clinical workforce both in hospitals and the community.
“We welcome its recognition that modernising pay terms and conditions for NHS staff is necessary to reward them for the quality of the care they give, encourage new ways of working, and make the provision of services effective and sustainable seven days a week.”
11.33am Judith Welikala: “@LordPhilofBrum: we don’t have organisational development, what we have is a blame culture… we have to turn that around”
11.30am HSJ reporter Judith Welikala is tweeting from an event about primary care in Birmingham.
Labour’s Lord Philip Hunt is speaking in Andy Burnham’s place.
She tweets: “@LordPhilofBrum says his three years at Heart of Engand was ‘a very tough and torrid time’”
“@LordPhilofBrum said in his last year at Heart of England he got tired of the monthly summons to Monitor in London…”
“@LordPhilofBrum: confess I took through a number of bills reorganising the health system but I have learnt lesson”
11.27am Stevens: A comprehensive tax-funded NHS remains entirely doable, even with the pressures faced.
11.26am Stevens: A quarter of cancer patients only get diagnosed when they turn up at an A&E department. Huge opportunity to continue to innovate. NHS invented modern nursing, IVF, CT scans.
11.25am Stevens: The health centre we’re in now on the Olympic site shows the future happening now. GPs, community nurses, specialists, therapists all working together under one roof.
11.24am Stevens: There is a real consensus across the health service about how to change what the health service looks like.
11.23am Stevens: Alcohol and obesity are problems. Keep junk food out of schools and hospitals.
11.22am We have got to get much more serious about taking our own health seriously, change the way services are provided and ask the next government to sustain the service the nation wants, he says.
11.20am The UK has a growing population and its an ageing country so people with more long-term health conditions, he says.
11.18am He says the NHS is coming together to set out an optimistic new direction for NHS services.
He says the service has “come a huge distance”, cancer treatments have improved, early deaths from heart attacks are “way down” and waits are down.
11.17am Simon Stevens is speaking at the launch of the Five Year Forward View.
11.15am A Conservative MP asks what should be done about a significant number of GPs retiring in the next few years.
Hunt says they’re looking at how to make it easier for GPs to do part-time work and for those who have left to have children to come back to work.
11.08am Hunt says that the new hospital inspection regime has shone a light on “outstanding leadership”. Cites Basildon’s chief executive Claire Panniker as an example.
11.06am Hunt says we should aspire to a smoke-free Britain and “we’re making good progress”.
“We need to integrate our thinking on public health with the services the NHS offers”.
11.05am Hunt says CCGs are not “forced against their will” to put contracts out to tender, in response to an MP saying CCGs fear falling foul of competition laws if they don’t tender.
11.00am Hunt says the report says we need to continue with real terms funding increase.
10.55am A full write-up on the debate in the Commons is coming up. Here are some highlights:
Hunt said he “warmly welcomes” the report and called for a “measured debate” on the future of the NHS.
He says that NHS England was set up as an arms length body to think strategically about the future of the NHS.
Burnham objects to the media being briefed on the report before Parliament, he says Hunt was “dragged” to the Commons to give his comments on report. He says the report supports Labour’s vision for the NHS and says that no mention of competition shows it “fragments” the system.
Hunt repeats he wants a “measured debate” and he wants both parties to focus on what they agree on - integration, more investment in primary care
Hunt says he doesn’t think the government has been as good as it could be at talking about urgent and emergency care. He says it is not sustainable for all urgent and emergency care to be dealt with in A&E departments and need to focus on primary care to reduce this demand.
10.40am Burnham asks if Hunt will make a statement on the Five Year Forward View
Hunt says the forward view “recognises the real challenges facing the NHS but is essentially positive and optimistic”.
10.30am King’s Fund chief executive Chris Ham has just tweeted: “Argued on BBC news channel that huge challenge for NHS to deliver £22bn efficiencies so more than £8bn may be needed”
10.25am Andy Burnham will ask an urgent question on the Five Year Forward View in the House of Commons at 10.30. Stay tuned for updates.
10.17am David Hare, chief executive of the NHS Partners Network, has said that developing new models of care, as laid out in the Five Year Forward View, will only be achieved by “harnessing the skills and experience of all parts of the health service includign independent sector providers”
“With more evidence available about the quality of NHS services delivered by the independent sector and the growing range of services being offered by independent sector providers it is clear that these organisations must play a big part in helping the NHS meet the demands of the future.
“NHS England’s renewed commitment to making good on patients’ legal right to choice is particularly welcome. Choice puts patients in control of the care they receive and when combined with meaningful comparative information enables patients to drive real improvements in the quality of local service provision. This issue must be put front of centre as NHS England and Monitor move to implement the proposals contained within the Five Year Forward View.”
10.10am More than half of England should be covered by new models of providing care, such as hospitals running GP practices and elsewhere GP groups taking over hospitals, under a major shift proposed by Simon Stevens and other national NHS leaders.
The NHS Five Year Forward View, published by NHS England, Monitor and the other national NHS bodies, says moving to new forms of providing and contracting services is essential to the NHS being sustainable in future.
It says there will be no “one size fits all approach” but calls on areas to consider adopting one of two leading types of new organisational model.
10.05am The King’s Fund’s Chris Ham says today’s forward view is a “significant moment for the NHS” which “throws down the gauntlet to the political parties to back fundamental changes to health services”.
He added: “The report makes a compelling case for change and articulates a clear vision of the future, with services organised around the needs of patients rather than outdated professional boundaries. The focus on prevention is particularly welcome – for too long the NHS has remained a service that diagnoses and treats sickness, rather than one that predicts and prevents it. The emphasis on developing new models of care by scaling up primary care and developing community-based services will also be widely welcomed, although more detail is needed on how this will be taken forward.
“But attention will rightly focus on the funding options. While it is right to emphasise a three-pronged approach which focuses on managing demand and improving productivity as well as the need for additional funding, there is no escaping the size of the financial challenge facing the NHS. Even if the very challenging estimates for productivity improvements outlined here can be achieved, an additional £8 billion a year in funding would be needed by 2020.
“With the national leaders of the NHS speaking with one voice on this issue, politicians now need to explain whether and how they will find this money. With deficit reduction still a high priority, this will not be easy, but today’s report is a reminder of how important it is to ensure the NHS is adequately funded in the next Parliament.”
10.00am Professor Terence Stephenson, chair of the Academy of Medical Royal colleges, says the Five Year Forward View sets out an “innovative and positive vision for the NHS”
He added: “Whilst we have not had the opportunity to consider the proposals in detail, the Academy of Medical Royal Colleges is clear that many of the ideas reflect thinking that is underway in medical royal colleges.
“Presidents of the Medial Royal Colleges are meeting Simon Stevens and NHS England next week and will take the opportunity to explore how the proposals can be taken forward and how doctors can help the NHS to be a world class service based on need not ability to pay.”
9.55am Responding to the publication of NHS England’s Five Year Forward View, Dr Mark Porter, chair of BMA Council, said: “Policymakers have tried to pretend that structural reorganisation and extending a competitive market can make up for lack of proper resourcing.
“NHS England’s Five Year View shows that you can’t, and contains a central message that the NHS needs a programme of sustained, long term investment that allows it to meet the difficult challenges that it currently faces. This is exactly what the BMA has been saying to policy makers for some time.
“When the NHS is given adequate resources it has a track record of delivering results. It is now for politicians to stop saying they understand this problem and act to give clinicians throughout the NHS the ability to deliver first rate care to patients.
“Many of the new models of working contained in these proposals could deliver benefits to patients and it is important that we look at new, flexible ways of working. As the report clearly states, the next Government must avoid another top down and expensive restructuring of the NHS that is driven by central political targets rather than local clinical priorities.”
9.52am Sir John Oldham has just tweeted: “#Today whilst correctly focussing on funding gap for NHS, unless gap for social care addressed as well, will never get full benefit xtra £”
9.45am The Royal College of GPs has responded to the five year forward view, Maureen Baker calling it a “landmark report” and hopes it will mark the moment when “we stared into the abyss and decided that general practice had to be saved from extinction”.
She said: “We welcome the fact that this landmark report recognises that general practice is one of the greatest strengths of the NHS, but that sadly primary care has been under-resourced compared to hospitals.
“The RCGP has been sounding the alarm for some time that there is a deep-seated funding crisis in general practice – which is leading to longer waiting times to see a GP and increasing concerns that family doctors might miss something serious in a patient.
“We hope that the publication of this report will prove to be the moment that, as a nation, we stared into the abyss and decided that general practice had to be saved from extinction.
“The politicians have acknowledged that there is both a lack of investment in general practice, and a shortfall in the number of GPs.
“This report sets out how general practice can be put on a sustainable footing, and empowered to work alongside other parts of the NHS to deliver excellent patient care.”
She added: “The recommendations of this report chime with much of what we have proposed already.
“We strongly support the need for new models of care, particularly for GP practices to work within federations. However, models under which GPs are made employees of hospitals – and therefore can no longer independently advocate for their patients – should only be considered where there is clear agreement across the local health economy that this is the best solution and that GPs feel this will benefit general practice and patients in that locality.
“We particularly welcome the commitment to introduce incentive schemes to attract more GPs to work in deprived areas and help tackle health inequalities.
“Our patients deserve better and we hope that today’s announcement will be the first step in reversing this decline so that we can deliver the care and the access to care that they so desperately need and want.
“We urge all three major parties to work with NHS England to set out a roadmap as to how they would implement the recommendations of this powerful report.”
9.40am The national leadership of the NHS has issued an unprecedented warning to politicians that it cannot continue at current funding levels, and will need additional resources worth more than 1.5 per cent a year in real terms over the next parliament.
The health service cannot make enough efficiency savings to bridge its projected £30bn funding gap by 2021 if its real terms funding remains flat over the next five years, according to a document setting out the shared view of national NHS leaders.
The NHS Five Year Forward View, published today, warns that even if the NHS can continue to make annual productivity gains at nearly double its long term average, its budget will be £16bn short at the end of that period.
9.30am Nuffield Trust chief executive Nigel Edwards argues in our Comment section that the Five Year Forward View puts politicians on the spot and has a welcome focus on improving maternity models of care.
9.25am Labour will question the government over the Five Year Forward View in the House of Commons at 10.30. We will provide updates from the debate.
9.20am NHS Clinical Commissioners echoes the Five Year Forward View recognition that CCGs are ‘harnessing clinical insight and energy to drive change in their local health systems’.
Dr Steve Kell, co-chair of NHSCC and chair of Bassetlaw CCG, said: “We are pleased to see more support to ensure the stability and security of primary care. Giving CCGs more influence over the wider NHS budget is something that we have been calling for in our CCG Manifesto for Change, so that it has been taken up by NHS England is very welcome. Giving CCGs that influence will mean they have the ability to invest in the new models of care for primary care and community services that are so crucial if we are to deliver the care needed for our patients out of hospital. CCG plans mean little without strong general practice, but we would want to see further alignment of these priorities in public health and specialised commissioning.”
Dr Amanda Doyle, co-chair of NHSCC and chief clinical officer of Blackpool CCG, said: “The commitment to dissolve traditional boundaries and look towards new models of care that emphasise out of hospital care and integration, aligns with the direction of travel that CCGs are already taking as they move towards outcomes based commissioning that puts the patient at the heart.
“This needs to be done by us all as a system, jointly and in true partnership. Aligned national leadership that supports and enables local decision making is what is needed, but that national alignment must not translate into extra oversight and performance management. We welcome the idea of a new risk based CCG assurance regime, but we need to proceed with caution when thinking about bringing together the Monitor, TDA and NHS England local assessment and reporting models to make sure that does not impose further reporting and bureaucracy requirements on CCGs that will distract them from doing their job. We will be working closely with NHS England as they develop their ‘special measures support regime’ for struggling CCGs, as the key to that will be how they will be judged and more importantly how they will be supported to improve.
“Key to the Five Year Plan is the commitment to no more distracting structural or top down reorganisation of the NHS. A sustainable NHS for the future can only be realised if we all have a stable environment in which to work together, with the freedoms and flexibilities to allow CCGs to work both within the health sector and with other sectors to make clinically led decisions in the best interests of their patients and local populations.”
The document says despite the NHS “spending several hundred million pounds” on quality improvement bodies, the way in which “improvement and clinical engagement happens can be fragmented and unfocused”.
It says support from these organisations, which include the NHS Leadership Academy and NHS Improving Quality as well as academic health science networks, clinical senates and strategic clinical networks, will be essential to introducing new models of care championed by the forward view “rapidly and at scale”.
9.00am In response to BBC Radio 4’s Today programme interview with Simon Stevens, Jeremy Hunt has tweeted:
“Real shame 2 see key Today prog interview wth Simon Stevens on #5YFV hijacked by 38 Degrees public/private scaremongering. Missed big issues”
8.52am Andy Burnham is on BBC News. He is being asked if his plans are another form of reorganisation? He says no, but he must get rid of focus on competition.
He says the funding challenge is a big one but the NHS will be Labour’s priority. He says lack of extra funding will “raise spectre of charging for treatment”.
Burnham says he will save money by care closer to home - more integration.
He says NHS staff will have to “fundamentally” change the way they work. Hospital staff in the community, and changes for GPs too.
The approach is outlined in The NHS Five Year Forward View, which sets out NHS leaders’ collective view on how the service will tackle rising demand and funding constraints.
The document says the health service has been “prone to operating a ‘factory’ model of care and repair” with “underdeveloped advocacy and action on the broader influencers of health and wellbeing”.
The NHS Five Year Forward View, which sets out the collective view of national NHS organisations, strongly cautions politicians against moving quickly to transfer more NHS money into the pooled fund for joint health and local authority commissioning.
Under the better care fund at least £1.9bn of money currently spent by clinical commissioning groups will be transferred to the pooled fund in 2015-16.
8.40am BBC Radio 4 asked listeners to send in their questions to Simon Stevens, usign the hashtag #asknhsengland.
Here is a selection of what was asked:
How can we integrate public health knowledge and skills further in to CCGs? Not just in prevention but intelligence & data?
My local GP has cut their hours to 3 days a week, why are NHS resources stretched so thin that this is necessary?
How much of the nhs budget now goes to private companies? How do you make sure public are aware of this?
How can GPs get £55 per dementia diagnosis when health care workers/nurses don’t see anywhere near as much?
Has the time come to have clear debate about what is sustainable & not sustainable from NHS ?
8.30am In the HSJ editor’s leader column Alastair McLellan looks at the intriguing idea of health and care ‘new towns’ -or Stevenstowns- as he has coined them.
The vision for the future of the NHS, published today, says the health service would “lock itself” to “outdated models of delivery” if it did not invest in workforce changes to support “necessary change”.
Among the national NHS oversight bodies’ proposals is expanding primary care leadership to include “nurses, therapists and other community based professionals”.
8.15am The Foundation Trust Network says the Five Year Forward View is a “statement of great confidence in the NHS”.
Chief executive Chris Hopson said: “It both recognises the strengths and unique place of the NHS in our nation to improve its peoples’ health and the changes it will need to make to achieve them. At a time when everyone is worried about coping with this winter’s huge demand and the tough tariff expected for next year, it is important to be able to look further forward with vision and ambition for the future. While noting the careful implementation it will require, the FTN strongly welcomes this tone and also the realism that recognises much of the vision can only be fulfilled with significant additional funding, including for mental health services.
“NHS England’s broad view under Simon Stevens helps us to step back and see what we can achieve and what we should want for ourselves and our country’s health. His talk of both patients and citizens is a meaningful affirmation that healthcare is not simple and only about treatment and transactions, but about lifestyle, social cohesion and community collaboration. While true, our members across the ambulance, community, mental health and acute sectors are already pioneering elements of the plan and collaborating with primary care, voluntary sector and local authorities to create new models of care.
“We are also encouraged that it has been developed in partnership with other NHS regulators and national bodies and seeks a new partnership for local and national bodies with a clear emphasis on enabling and emancipating providers across all sectors to innovate and collaborate by removing barriers and stimulating progress where necessary which we hope will reduce regulatory burden and barriers to rapid progress.
“With the general election looming the 5YFV presents a perfect opportunity for political unity on the way forward and a welcome first step would be for the political parties to commit to its vision. We have a tough winter and painful funding round to get through, and significant detail to work out to make a reality of the view. However, having a view and a route to it, beyond the short-term targets, quarterly figures and small pots of patching funding, provides hope and opportunity for the NHS’ sustainability and the improving health of this country.”
8.12am Here is a round-up of what we have covered so far today on HSJ Live -
- An exclusive interview with Andy Burnham in reaction to the Five Year Forward View
- Jeremy Hunt’s response to the forward view
- In-depth coverage of the plan, including proposed major sell-off of land, new care models, a call for more funding and the way forward for smaller hospitals
- Reaction from NHS Confederation and what’s being said on Twitter
The prospect of coordinated land sale programmes to enable “pump priming” investments in service reform is set out in the NHS Five Year Forward View, a document expressing the shared view of national NHS leaders on the coming half decade.
The document, published today, says that the health service could achieve efficiency gains even greater than those accomplished in recent years if it “gets the needed infrastructure and operating investment” to rapidly introduce new service models and ways of working.
In an interview with HSJ Mr Burnham said the NHS needed “capital investment” to drive service change, but added he had not yet worked out how the funding would be released.
The shadow health secretary admitted: “I haven’t yet identified how I would find that. I hear the call the report is making. I cannot say that we’ve identified a big chunk of money to provide for it. But the point is taken. ”
8.02am Several commentators have noted that there is no mention of competition in the forward view.
However, Chris Ham, chief executive of The King’s Fund, tweets: “and yet the architecture of competition remains firmly in place and could stymie implementation”.
The document reveals NHS England and Monitor will investigate whether the tariff system for trusts needed to be changed to “reflect the costs of delivering safe and efficient services for smaller providers relative to larger ones”.
It cites the latest quarterly data from the foundation trust regulator Monitor, showing that larger foundation trusts had an operating profit of 5 per cent, compared to -0.4 per cent for smaller providers.
7.55am NHS Conferederation has given a detailed response to different sections of the Five Year Forward View, including the call for change, the vision for the service and funding.
Chief executive Rob Webster, said in response to leading change that the “NHS requires a new burning ambition that we can all get behind – one that will deliver a 21st century health and care system for the future”.
“The Five Year Forward View provides many of the elements necessary, not least proof that a system that is true to the founding principles of the NHS is achievable. That will take funding, efficiency and service change at pace and scale.
“The commitment that the service has made, is that we will deliver if the conditions allow it. NHS England’s vision shows an appreciation of the commitment, talent and experience found throughout the health service and its leaders at all levels. The promise of a national framework with local delivery is welcome. It is vital that local leaders - clinical, managerial and patient/public leaders - are empowered to be bold. The promise of “place-based”, local approaches needs to be backed by a reformed performance and regulatory culture.”
He added that the “vision” set out looks “ambitious”.
“The focus on prevention, supported self-care, mental health and the increased emphasis on supporting people to stay out of hospital is a strong indication that NHS England is genuinely committed to helping make this step change move from discussion to reality. Sustainable, world class provision that builds on our excellent hospital, community, mental health and ambulance services is also welcome. The service delivery models – in advance of the Dalton Review – also suggest an appetite for change and improvement.
However, he said the expected contribution of “significant parts” of the service needs to be “clearer”.
“The document says little about the future and role of Mental Health, Community and Ambulance providers. These providers are closest in outlook and experience to the vision laid out in the document. They support millions of people each year and can point to many examples of innovative models of care, whole person approaches and personalisation. Their leaders can support the successful transition to the new world, alongside those in our hospitals and general practices. We need to make the most of the capacity and potential everywhere in the whole system to lead change: we cannot afford to ignore or under-use any type of provider.”
“No part of the health service has a monopoly on delivering high quality, good value, person-centred care. NHS values can be found in the statutory, independent and voluntary sectors - so it is disappointing that today’s publication has not taken the opportunity to explicitly clarify and recognise the contribution of plurality in the NHS.”
He said that funding for the NHS is “a political choice”.
“We have for some time been warning of the impact of the emerging NHS funding gap on our members’ ongoing ability to deliver the high quality care patients want and need. So we welcome the messages that, even if we are able to rapidly make changes to models of care and address demand, the next Government will still need to make a decision on additional funding to close the gap.
“We particularly welcome a clear recognition of the need for a ‘pump priming’ funding for new models of care, and a commitment to enable the NHS to move forward with faster adoption of innovation. Innovation in the NHS is about much more than new drugs, machines or even medical procedures, however, and we look forward to working with clinical leaders, patient representatives, staff and service leaders to develop a culture throughout the health service, which not only allows but positively encourages innovative change that makes a real difference for all parties.
“We do need a commitment to increasing the pace of payment reform. This will be vital to enable the new models set out by NHS England.”
7.45am Twitter is full of reaction to the 5YFV. Here are a selection of thoughts:
Steve Kell, NHS Clinical Commissioners - “Will politicians listen? HWBs seen as future by some. Mustn’t lose clinical leadership and NHS role.”
David Williams, HSJ - “the #5YFV pours cold water on expanding the Better Care Fund any time soon, and is pretty lukewarm on Health and Wellbeing Boards”
Michelle Drage, CEO Londonwide LMCs - “Crucial to maintain true values of general practice in delivering #5YFV”
Shaun Lintern, HSJ - “The words ‘competition’ and ‘private sector’ are completely absent from NHS Forward View.”
Tony Hockley, Policy Analysis Centre - “NHS #5yfv cash demand not a huge change from past couple of years. Deliverable if econ growth holds.”
7.40am Here is the five year forward view in full.
The NHS Five Year Forward View, published by NHS England, Monitor and the other national NHS bodies, says moving to new forms of providing and contracting services is essential to the NHS being sustainable in future.
It says there will be no “one size fits all approach” but calls on areas to consider adopting one of two leading types of new organisational model.
7.25am Here is shadow health secretary Andy Burnham’s response to the five year plan set out today, which he “welcomes”:
“This report lays bare the inadequacy of Tory funding plans for the NHS which, if left unchanged, will trigger an NHS crisis in the next Parliament.
“David Cameron’s decisions will leave patients facing even longer waits and raise the spectre that a re-elected Tory Government would have to introduce rationing, cuts and charges.
“I am encouraged by the authoritative endorsement for Labour’s plan for the NHS, including full integration of health and social care with more support provided in the home. This important reform, alongside Labour’s extra £2.5 billion investment in the NHS– on top of Conservative spending plans – through a Mansion Tax and a levy on tobacco companies, will go a long way towards solving the financial challenge.
“Labour today welcomes this report and calls on the Government to say whether it is prepared to match our plans.”
The health service cannot make enough efficiency savings to bridge its projected £30bn funding gap by 2021 if its real terms funding remains flat over the next five years, according to a document setting out the shared view of national NHS leaders.
The NHS Five Year Forward View, published today, warns that even if the NHS can continue to make annual productivity gains at nearly double its long term average, its budget will be £16bn short at the end of that period.
7.10am To kick off our live coverage of all the reaction to the NHS’s five year forward view, here is health secretary Jeremy Hunt’s response:
“We welcome this important report, which demonstrates conclusively that the NHS has improved dramatically in recent years and can do so in the future - but only if it continues to implement important reforms and is supported by a strong economy.”
7.00am Good morning and welcome to HSJ Live.
hsj.co.uk will be covering the NHS five year forward view, published today, in full including comprehensive analysis of what it will mean, and comment and reaction.
The forward view was instigated by NHS England chief executive Simon Stevens to set out the prospects for the health service in the run-up to the general election.
For full coverage sign up to receive HSJ’s daily news and breaking news emails, follow the hashtag #5YFV on Twitter and follow HSJ Live throughout the day.
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