Five Year Forward View

The Five Year Forward View was produced by NHS England in October 2014 under the leadership of Simon Stevens as a planning document.

It received praise for brevity, being only 39 pages, and lacking the illustrations which had graced its predecessors. Like the NHS Plan 2000 with which Stevens was also associated it was supported by the great and good of the NHS, but in this case it was regulators - Monitor, the Care Quality Commission and the like, rather than the Royal Colleges and Trades Unions of the earlier plan. This new national leadership of the NHS issues an unprecedented warning to politicians, none of whom are included in the endorsements, that it cannot continue at current funding levels, and additional resources worth more than 1.5 per cent a year in real terms will be required.

No more top-down reorganisation was proposed, but instead the development of new models to suit local needs, something quite radical for the NHS, which is accustomed to the imposition of uniformity regardless of local conditions. It seeks to break away from Enoch Powell’s 1962 Hospital Plan for England and Wales which established the district general hospital as the central pillar of British healthcare. Even more radical is the proposal to erode the distinction between hospital consultants and General practitioners, encouraging hospitals to employ GPs - a distinction which has lasted in the UK for more than a century - and permit the development of "Accountable Care Organisations" similar to those in Spain and parts of the USA. There is much stress on the fact that 70% of the NHS budget is spent on the management of the 15 million people with long term conditions. Two new models of care – multispecialty community providers, and primary and acute care systems – involve integrating primary care and hospital care in a single provider organisation.

The fact that the word “competition” does not appear once in the document was hailed by a victory by Labour.

Stevens said that the health service would have to break out of its “narrow confines” and promote healthy lifestyles. Employers are key to promoting better health in the population and there should be incentives to encourage participation in Weight Watchers-type schemes. The plan includes a focus on the health of NHS staff, saying that three quarters of hospitals fail to make available nutritious food for nurses and other workers on night shifts. Stevens said NHS staff should set an example by leading healthier lifestyles as part of a drive to improve the health of the nation. He pledged to get junk food out of hospital canteens.

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