The NHS five year forward view: the first 100 days of the new government

The government has signalled strong support for the NHS five year forward view – the vision for the NHS published in October 2014 by NHS England – with the Prime Minister and Secretary of State endorsing it as the ‘NHS’s plan’ for improving services.

The scope of the vanguard programme – which will see a number of new service models rolled out across the country – has been increased and a package of support developed for them. However, the programme has found it challenging to move at pace, and the first tranche of ‘transformation funding’ to support the vanguard areas was not allocated until the end of July. Given the scale of change envisaged, full implementation within five years appears ambitious.

New vanguard phases

NHS England has launched further phases of the New Models of Care programme which will establish two additional groups of vanguards. The first phase of the programme was initiated in March and involves 29 vanguard sites exploring three models: integrated primary and acute care systems; enhanced health in care homes; and multi-specialty community provider vanguards.

In July, NHS England announced a second wave of eight vanguards that will pilot new models of urgent and emergency care. This follows the findings of Sir Bruce Keogh’s urgent and emergency care review, which recommended a re-design of emergency care over the next five years. The programme will focus on systems that are already making strong progress in this area, as well as those struggling with significant operational challenges.

An additional set of vanguard sites, to be identified in the autumn, will focus on developing new ways of delivering local acute services, with a focus on improving the viability of smaller hospitals through collaboration. This will build on the findings of the review led by Sir David Dalton, and may involve greater use of networks and joint ventures to facilitate shared working arrangements for specialist clinicians, as well as shared back office and management functions.

Next steps on Forward View governance and delivery

In June the seven principal national health bodies published Time to deliver, a statement on actions required (this year and in future) to deliver the Forward View, including identifying the responsibilities of specific groups and organisations.

This included initial details of the support that will be made available to the vanguard sites over the coming year, including personal sponsorship by one of the arms-length body chief executives for each vanguard area, with the twin objective of developing an understanding of barriers to implementation among the national bodies. It also outlined support to be provided by Health Education England, working through its local education and training boards, to develop workforce requirements for the new care models.

At the end of July the Forward View partners announced further details of the support package for vanguards, indicating that this would involve the vanguard leaders as well as national experts. It is also intended both to support individual areas in implementing changes, and to share learning across the 29 sites. The national package, designed following an engagement exercise, will include support in relation to eight ‘enablers’, including the design of care models, addressing barriers around commissioning, and engaging with patients and workforce re-design.

Vanguards also have access to a £200 million transformation fund, of which nearly £20 million has already been allocated to three of the 29 vanguards for 2015/16.

Finally, Time to deliver also set out the national partners’ plans for engaging with a range of stakeholders, drawing on their relevant expertise to inform national and local planning processes. This will include events about finance, quality and health and wellbeing.

Cancer strategy

In mid-July the Independent Cancer Taskforce published its recommendations for a cancer strategy for the next five years (2015 to 2020). The taskforce was one of three set up under the previous government to support the delivery of the Forward View (taskforces were also established for mental health and maternity services).

The report puts forward more than 100 recommendations for improving outcomes for people with cancer, but highlights six strategic priorities for the next five years: improving prevention; earlier diagnosis; improving the patient’s experience; better support for people after treatment; investing in priority areas; and an overhaul of the commissioning process. In relation to the last of these, the report argues that most cancer services should be commissioned for population sizes bigger than those in an individual clinical commissioning group. It recommends establishing Cancer Alliances at a sub-regional level by 2016, and piloting new commissioning models.

NHS England has indicated that it is backing the recommendations, although plans for their implementation are still being developed. The report indicates that a number of the initiatives will need additional investment, but argues they will in turn unlock savings that will contribute to the NHS funding gap.