The NHS Five Year Forward View: transforming care

Over the past 15 years the NHS has performed remarkably well

Cancer survival is at its highest ever, elective surgery waiting times have been cut from 18 months to 18 weeks, and public satisfaction with the NHS has nearly doubled.¹

However, despite almost £20 billion of efficiency improvements, the system is showing strain, both financially and in terms of performance. We are faced with the challenges of a growing and ageing population with greater prevalence of long-term conditions, 5 years of protected but nearly flat funding, rising costs attributable in part to expensive new drugs and treatments, in addition to growing expectations; all converging to a crucial inflection point for the NHS.

Change we must. And not alone

To address these challenges the NHS needs the next government and the public to support changes as they happen; a cross-sectoral responsibility for the health of our population, fitness of our children, and care of our older people is required. A well-funded and redesigned health and social care system with erosion of historical demarcations between primary, community, and specialist care, and between health and social care is necessary. Demand growth must be moderated: the Five Year Forward View sets a case for a more active prevention and public health agenda with greater support for patients, carers, and community organisations; in addition to new models of primary and out-of-hospital care. Hospitals need to do less, through fewer unnecessary emergency admissions, and general practice also needs less to do, through helping promote the avoidance of unnecessary ill health.

The assets are available. The UK is one of the most innovative countries in the world; our economy is recovering, we have thriving pharmaceutical and medical technology industries, and a number of globally-leading academic institutions. The NHS was recently ranked the highest performing health system of 11 industrialised countries by the Commonwealth Fund.² It is time to leverage these resources to realise our ambitions.

This will require a range of strategies

Services need to be integrated around the patient. New models of care must be designed around this, locally driven and matched to local needs, adopting, for example, multispecialty community providers, primary and acute care systems, urgent and emergency care networks, and enhanced care homes. Interwoven with these models will be cross-cutting initiatives: embracing the panoply of newer technologies available, ensuring medical records are accessible across the system within 5 years, improving transparency with openness of more outcomes and patient-reported outcome measures. There will be a greater drive towards 7-day services; pilots are already underway across hospitals and GP practices to determine how they can be best delivered.

It’s time to act

The way services are provided needs to change. What is not needed, is another system-wide administrative re-organisation; current arrangements need to be given a chance to work, evolve, and improve. How far and how fast we change will depend on money and political permission. Fixed 5-term parliaments offer an opportunity for firm commitments to funding and stability. Although there is reason for optimism, without necessary investment the NHS will decline. We are presented with a real choice. If the right decision is made, with the help of others, we can achieve a world-leading service fit for the 21st century, a service that remains true to the founding values and mission of the NHS.