It may only be 39 pages long… but NHS England’s new ‘Five Year Forward View’ packs more of a punch than many weightier tomes written in the corridors of the Department of Health. And it’s a breath of fresh air in comparison to past DH Green Papers that were the harbingers of massive conflict-ridden reorganisation.
Simon Stevens, the new chief executive of NHS England, has kept a low profile in his first six months in the job. He clearly wanted to craft a concise vision for the NHS which would make people sit up and take notice.
He is signalling a big shift in the way the NHS in England is managed and organised, in some ways the most radical since the service was born in 1948.
Mr Stevens and his colleagues want to see barriers being removed and an end to the age-old divide between GPs with patients, and consultants with hospitals. Plus they signal a far bigger role for patients and carers.
There should, in his view, be no more top-down reorganisations, but instead the development of new models to suit local needs.
He believes some communities will want to expand the role of GP practices allowing them to provide a much wider range of care. These practices might employ consultants and senior nurses with the aim of shifting most outpatient work away from hospitals. Alternatively leading hospitals might open their own GP surgeries. Smaller hospitals could be preserved if taken under the wing of larger institutions.
The most radical option flagged up in the document is the development of “Accountable Care Organisations” similar to those in Spain and parts of the United States. Translated from the jargon, this means a single organisation taking responsibility for all of a local population’s health needs. This could be a major hospital trust doing everything in its area, employing GPs and community health staff as well as acute care.
Another important priority will be a radical upgrade in prevention and public health. The NHS will therefore now back hard-hitting national action on obesity, smoking, alcohol and other major health risks.
They will help develop and support new workplace incentives to promote employee health and cut sickness-related unemployment. And we will advocate for stronger public health-related powers for local government and elected mayors.
And last but not least, something we at 3 monkeys have been calling for for months – when people do need health services, patients will gain far greater control of their own care – including the option of shared budgets combining health and social care.
The 1.4 million full time unpaid carers in England will get new support, and the NHS will become a better partner with voluntary organisations and local communities. This is big picture stuff and the skeptics will argue that it will take years to develop these new models of care. But it’s certainly going in the right direction!