The entire NHS can back the forward view's vision

The NHS Five Year Forward View of what successful NHS reform should look like over the next parliament illustrates the axiom that “success has many parents, but failure is an orphan”.

Initially billed as an NHS England document, it has turned into a co-production with Monitor, the NHS Trust Development Authority, the Care Quality Commission, Health Education England and Public Health England, while drawing on input from a range of organisations including the Foundation Trust Network.

This sets a welcome tone of collaborative cross-system leadership: a prerequisite for the improvements in the nation’s health and individual patient care that the document envisages. There is a real danger the Health Act 2012 has left the NHS’s strategic planning fragmented and atomised.

The five year forward view provides a vision behind which the entire NHS can unite and makes the case that we can only deliver the changes required if we work together, at both national and local levels. It also recognises the scale of what’s been achieved over the last five years, in a way that other system leaders would do well to match.

A flexible framework

Like all good documents, the title sets the tone – this is a long term, five year vision of where we need to go, 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.

‘The forward view is not a centrally driven, top-down, blueprint to direct a single organisation that doesn’t actually exist’

First, deliver the “radical upgrade in prevention and public health” that has long been a rhetorical mainstay of NHS policy documents but where progress has been uneven, to put it charitably.

Second, move to new models of care: models that integrate health and social care; transfer care that can be delivered out of hospital into the community; treat spending on mental health as an investment not a cost; and ensure primary and secondary care is one seamless service.

But the document, as its title suggests, is also a forward view, not a plan. It’s a flexible strategic framework for an NHS system composed of hundreds of local organisations. It’s not a centrally driven, top-down, blueprint to direct a single organisation that doesn’t actually exist. “Meaningful local flexibility” – more diversity without a thousand flowers blooming – rightly replaces command and control.

A challenge to the authors

The document helpfully points to the changed relationship between local and national needed to deliver this, with the centre backing local leadership and diverse solutions. It also recognises that we have to invest in local change capability and capacity, enabling hard pressed local leaders to come out from the operational waterfall where many are currently trapped.

• Full coverage of the five year forward view

This is one area where the view places a major challenge on its authors. Are they really capable of changing their current somewhat silo-ed, interventionist, top-down, culture and behaviours and become coordinated, enabling, supportive, facilitators of local change? The document, it might be argued, recognises the scale of change needed but, as in a number of areas, lacks a clear delivery plan.

What will happen to the interesting, radical, proposed models of care when they hit the Scylla and Charybdis of the NHS’s competition regime and the vested interests that will oppose them?

‘It doesn’t aspire to be a detailed funding plan but it has to leave the funding solutions hanging in the air’

And what about the money? The document recognises that its attractive vision is undeliverable without appropriate extra funding and investment in change: in the end you get what you pay for. It rightly argues that extra funding to meet rising demand has to be matched by the NHS continuing to driving efficiencies, but only at a reasonable, sustainable, 2 per cent level. It doesn’t aspire to be a detailed funding plan but it has to leave the funding solutions hanging in the air, for a political class that struggles with difficult, long term challenges like these.

So while we’ve got a good, clear, ambitious, vision, there is still much work to do establish how this vision will be funded and implemented – some of the more difficult bits.

But it seems only fair to take the document at its word. It seeks to set out a five year forward view for the NHS. Perhaps its greatest, much needed, quality is to show all of us in the health service that there is a five year route out of our current travails and that, together, we can guarantee the sustainable future of “one of the great strengths of this country”.

Chris Hopson is chief executive of the Foundation Trust Network