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NHS pressures could undermine Five Year Forward View

Short-term pressures could damage long-term NHS plans

Adrian O'Dowd

Wednesday, 18 February 2015

The current financial and service pressures on the NHS risk undermining the universally welcomed Five Year Forward View to transform the NHS, concludes The King’s Fund.

The health think tank has today published a report which says that fundamental policy changes will be necessary to deliver the NHS five year forward view – a document published in October of last year that sets out how NHS services will need to change in future and which has the blessing of all three main political parties.

However, without changes to policy and new approaches to leadership in the NHS, The King’s Fund argues that it could fail to become a reality because the NHS is focused on the immediate problem of dealing with growing financial and service pressures.

The new report Implementing the NHS five year forward view: aligning policies with the plan argues that the NHS requires fundamental changes in how health services are commissioned, paid for and regulated to be able to deliver the vision set out in the five year forward view.

It argues that delivering these changes will require leadership of the highest order, with a lot resting on whether the coalition of NHS bodies assembled behind the five year forward view can be kept in place.

The report makes several recommendations to align national policies with the agenda for change outlined in the forward view including:

  • having an integrated approach to commissioning, with a much greater emphasis on pooling budgets currently held by NHS England, CCGs, and local authorities
  • finding new ways of paying for NHS services to incentivise the delivery of integrated care instead of encouraging admissions to hospital as under the current system of payment by results
  • the CQC’s work focusing on assessing how well care is integrated across local systems of care rather than just inspecting individual NHS organisations.

The report discusses a model of care described in the forward view as the multispecialty community provider (MCP), which involves the development of federations, networks and super partnerships to enable general practices to operate on the scale required to deliver a wider range of services, including those provided by some specialists alongside other professionals such as nurses, therapists, pharmacists, social workers and psychologists.

The report’s authors ague that multispecialty medical practice could lead to savings in the cost of hospital care because of the opportunity it creates to provide proactive care in the community and rapid responses to crises.

However, caution would needed to manage potential conflicts of interest, such as practices involved in bidding to provide services under the terms of the new contract being excluded from the process of commissioning these services.

Chris Ham, chief executive of The King’s Fund and lead author of the report, said: “The NHS five year forward view offers a compelling vision for how NHS services need to change but risks gathering dust on the shelf unless fundamental changes are made to the way health services are commissioned, paid for and regulated.

“While NHS leaders will understandably be tempted to focus on dealing with short-term pressures, the reality is that improving operational performance and implementing the changes to services outlined in the Forward View are two sides of the same coin – both must be priorities if the NHS is to confront the challenges it faces.”

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