Daily Insight: No view from the top

The NHS plan you’ll never read

When NHS England published the Five Year Forward View many moons ago, a core message was the need to shift funding and activity from acute to primary and community services.

We’ve since had “forward views” for general practice and mental health, recognising the need to strengthen these services and set out a solid plan for their future. Surely, it would follow that the same should be done for community services?

According to an internal NHS England document leaked to HSJ, this was certainly the national commissioner’s plan – until it wasn’t.

Proposals to produce a “forward view” for community services were drawn up by NHS England officials last year. According to the leaked document, they acknowledged the risk that without a plan for community services, sustainability and transformation partnerships may not reach their full potential, efficiencies will be missed out on, and unwarranted variations will continue.

It is surprising then that no such community services forward view, or any other kind of national plan for the sector, has seen the light of day.

You could argue that the NHS is now in forward view delivery mode, and doesn’t need another policy document setting out dos and don’ts for providers and commissioners.

But the GP and mental health sectors might counter that their respective “forward views”, while not perfect, have given leaders clarity on priorities and set ambitions for how those sectors should develop. They have shown that national leaders value these underappreciated services and their success is important to the future of the NHS.

Community service leaders are sadly coming to their own conclusions on the latter point.

Today’s nonsense

“This piece is nonsense” is not a reaction HSJ normally welcomes after we publish an article – but when it comes from the health and social care secretary we can’t dismiss it out of hand.

On Wednesday, we published a column by Thomas Cawston, which argued that part of the reason for Jeremy Hunt’s outstanding longevity as health and social care secretary (nearly five and a half years) is his Madonna-like ability to reinvent himself every 18 months to reflect changing political priorities. These have shifted between patient safety, adopting digital innovation, reforming mental health and now making social care sustainable – a brief he once farmed out to his Liberal Democrat colleague Norman Lamb.

Mr Cawston argued that, savvy though this may be, the consequence is that none of these agendas ever get properly finished before Mr Hunt moves on to the next one.

“He’s a bit inconsistent” is far from the worst thing anyone has written on the internet about Mr Hunt – but just 13 minutes after the piece was shared on Twitter, Mr Hunt fumed: “This piece is nonsense. I have a purpose and in five years it has never changed: to transform patient safety. But in a large brief that doesn’t mean you don’t also focus on other key areas eg: mental health, cancer, social care, workforce, tech (& like all health secretaries, performance & money)”.

It’s a reasonable rebuttal: patient safety has always been Mr Hunt’s Big Idea and the job requires different themes to be emphasised at different times. But the strength and speed of the reaction was unusual – have we touched a nerve?