NHS 5 Year Forward View
For Patient Participation Group Meeting
Friday 19 December 2014
Gail Hawksworth
Head of Communications and Engagement
NHS Five Year
Forward View
• The NHS Five Year Forward View was published
on 23 October 2014 and sets out a vision for the
future of the NHS.
• It has been developed by the partner
organisations that deliver and oversee health
and care services including NHS England, Public
Health England, Monitor, Health Education
England, the Care Quality Commission and the
NHS Trust Development Authority.
• It sets out how health services need to change
and promotes more engagement with patients,
carers and citizens.
Although the NHS has improved over the last 15 years, but quality of
care can be variable, preventable illness is widespread and health
inequalities deep rooted
Patients’ needs are changing and new treatment options are becoming
available. Service pressures are building.
This ‘Forward View’ sets out the direction for the NHS- showing why
change is needed and what it will look like
A radical upgrade in Prevention and Public Health is needed with
national action on obesity, smoking alcohol and other major health risks
Patients need to gain greater control of their own care- option of having
shared budgets for health and social care
NHS to take steps to breakdown the barriers in how care is provided
between family doctors and hospitals, between physical and mental
health, between health and social care
NHS National leadership will support local communities in choosing
from a number of new care delivery options. It will also need to act
coherently so will be looking at its payment rules, regulatory
requirements and other mechanisms that are applied
New Care Delivery
• Multispecialty Community Provider- Groups of GPs to
combine with nurses, other community health services,
hospital specialists and possibly mental health and social
care to create integrated out-of-hospital care
• Primary and Acute Care Systems- integrated hospital
primary care provider- general practice and hospital
services working together
• Redesigning of Urgent and emergency care- These
services will be redesigned to enable A&E departments,
GP out-of-hours services, urgent care centres, NHS 111
and ambulance services
New Care Delivery
• Smaller Hospitals- A number of actions will be taken
that include reviewing the NHS payment regime, new
models of medical staffing, new organisational models
e.g. Sharing of management for either the whole
organisation or back office roles with similar hospitals;
some of its services being provided by another
specialised provider; local acute hospital and local
primary and community services forming an integrated
• Specialised Care- NHS England will work with local
partners to create specialists providers to develop
network of services over an area; integrating different
organisations and services
New Care Delivery
• Modern Maternity Services- Review models for
maternity units to report on how best to sustain and
develop maternity units across the NHS, make sure the
tariff based funding supports the choices women make
and make it easier for groups of midwives to set up their
own NHS- funded midwifery services
• Enhanced health in Care Homes- NHS England will
work with the local NHS and the care home sector to
develop shared models of in-reach support, including
medical reviews, medication reviews and rehabilitation
Empowering patients
• Information- Access to information will be improved. Within 5
years all citizens will be able to access their medical and care
records (including in the social care contexts) and share them
with carers or others they choose
• Provide support to people to manage their own healthThere will be investment in evidence-based approaches e.g.
group-based education for people with specific conditions and
self-management educational courses
• Increase patients direct control over the care provided to
them- Ensure that patients have choice over where and how
they receive care
• Integrated Personal Commissioning (IPC)- A voluntary
approach to blending health and social care funding for
individuals with complex needs
Engaging communities
Supporting Carers- New ways will be found to support carers, by
working with voluntary organisations and GP practices to identify them
and provide better support
Encouraging community volunteering- Develop new roles for
volunteers which could include family and carer liaison workers,
educating people in the management of long-term conditions and
helping with vaccination programmes
Stronger partnerships with charitable and voluntary sector
organisations- The NHS will try to reduce the time and complexity
associated with securing local NHS funding by developing a short
national alternative to the standard NHS Contract where grant funding
may be more appropriate and encourage funders to commit to multiyear
funding wherever possible
The NHS as a local employer- The NHS is committed to ensuring that
boards and the leadership of NHS organisations better reflect the
diversity of local communities they serve. As an employer to ensure all
staff have support and opportunities to progress and create supported
job opportunities to ‘experts by experience’ e.g. people with learning
disabilities who can help drive changes in culture and services
How will we get there
• Clinical Commissioning Groups - NHS England will work
with CCGs to offer them more influence over the local NHS
budget for their local populations, ranging from primary to
specialised care
• Joint commissioning between the NHS and local
government- NHS England will work with local areas to
consider a limited number of models of joint commissioning
between the NHS and local government. This will include
Integrated Personal Commissioning (the blending of health
and social care funding for individuals with complex needs),
e.g. Better Care Fund –style for specific service, possible joint
management of social and health care commissioning which
could be under the leadership of Health and Wellbeing Boards
How will we get there
• Provide aligned national NHS Leadership- NHS England,
Monitor, the NHS Trust Development Authority, the Care
Quality Commission, Health Education England, National
Institute for Health and Care Excellence (NICE) and Public
Health England, collaborating with the patient and voluntary
sector organisations, will create a combined work programme
to support the development of local care models
– Monitoring- Greater alignment of local assessment, reporting and
intervention regimes for Foundation Trusts, NHS Trusts and CCGs
by Monitor, TDA and NHS England
– National regulatory, pricing and funding regimes- These will
support change in specific local areas where it improves services
– National Quality Board- This Board consisting of the key NHS
oversight organisations will come together regionally and nationally
to share intelligence, agree action and monitor overall assurance on
How will we get there
Support a modern workforce- Supported by Health Education England, NHS
England will address immediate gaps in key areas and put in place new measures to
support employers to retain and develop their existing staff, increase productivity and
reduce the waste of skills and money
Information Revolution- NHS England will focus on systems that provide the
‘electronic glue’ which enables different parts of the health services to work together
National Information Board- This has been established to bring together
organisations across the NHS, Public Health, Clinical Science, Social Care, Local
Government and Public health representatives who will provide a set of ‘road maps’
setting out who will do what to transform digital care.
– Key elements to include:
 Comprehensive transparency of performance data
 More NHS accredited health-apps for patients to use
 Fully interoperable electronic health records
 GP appointments and electronic and repeat prescribing available on line
 Bringing together hospital, GP, administrative and audit data to support quality
improvement, research and identification of patients who most need health and
social care support
 Technology- including smartphones- to build capacity for all citizens to access
information and train staff to help support those who are unable or unwilling to
use new technologies
How will we get there
• Health Innovation- NHS England will continue to support the
work of the National institute for health Research (NIHR) and
the network of specialist clinical research facilities in the NHS.
Steps will be taken to speed up innovation in new treatments:
– Radically cut the costs of conducting Randomised Control Trials
– Support the rollout of the Clinical Practice Research Datalink
– Will look at how to expand the use of ‘commissioning for evaluation’
i.e. looking at real world clinical evidence in the absence of full trial
– Will work with NICE to expand the work on devices and equipment
and to support the roll out of high value innovations
– Cancer Drugs Fund- This has been expanded access to new cancer
medicines. New approach to converging its assessment and
prioritisation processes with a revised approach from NICE
– Quicker adoption of cost effective innovation in both medicines and
How will we get there
• Efficiency and productive investment- Independent analysis
shows that there will be a mismatch between resources and patient
needs of nearly £30 billion a year by 2020/21
• Maintenance of a Comprehensive high-quality NHS- action will
be needed on 3 fronts to mitigate for this:
– Demand- A bigger preventative and public health agenda; greater support
for patients, carers and community organisations; new models of primary
and out-of-hospital care
– Efficiency- NHS has to accelerate some its current efficiency programmes
to achieving 2% each year- this would require investment in new care
models and the combination of less efficient providers matching the
performance of the best with the development of new and better ways of
working and moderating demand
• Funding- NHS funding has been protected in over the past 5 years
and this has helped to sustain services. Depending on the combined
efficiency and funding option taken, the £30 billion can be closed by
one third, one half or all the way.
How will we get there
• 3 Funding Options1. NHS budget remains flat in real terms from 2015/16- 202/21
and the NHS delivers productivity gain of 0.8%. This
combined effect will reduce the gap by a third from £30 billion
to £21 billion.
2. NHS budget remains flat in real terms but NHS delivers
stronger efficiencies of 1.5%. The combined effect is the £30
billion gap in 2020/21 is halved to £16 billion.
3. NHS gets needed infrastructure and operating investment to
move to new care models and ways of working, which results
in demand and efficiency gains of 2%-3% net each year. This
combined with staged funding increases closes the £30
billion gap by 2020/21.

NHS Five Year Forward View - NHS Enfield Clinical Commissioning