Implementing the NHS five year forward view: Aligning policies with the plan

I agree with what Andrew Moulin, we should start with the outcome we want and workout how it will be achieved. Otherwise we are just a moving things around without out actually changing anything!

This is an excellent and very welcome development of thinking about implementing the five year plan. However it does seem to me that there are two key elements of the programme missing.

The first is a concern that we are immediately talking about organisational structures. What I want to hear about is what care Mrs Smith of Acacia Avenue who is 93 and has 4 additional health needs will receive from her PAC or MCP, how that is different to what she gets now, and why it will be more effective and efficient.

The second is the need to ensure that a key objective is the integration of physical and mental health in all the new services. We know that an effective hospital psychiatric liaison service enables older people to get back home faster, its better quality for the person, cheaper for the hospital. We know that people with long term conditions are 2-3 times more likely to be depressed or anxious, and that people with chronic heart failure are eight times more likely to die within 30 months if they also have depression.

Unless we redesign structure and services from the ‘bottom up, starting with what will be offered for people receiving services, and ensure that the ‘offer’ is a single physical/mental health service, we may find at the end of the five year plan we have only succeeded in moving the deckchairs into a different pattern.

As Catherine Foot quite rightly points out in her accompanying blog, let's not forget Empowering Patients and Engaging Communites within the discussion. I appreciate and acknowledge the main thrust of this publication focuses upon Implementing the 5YFV and aligning key NHS policies with the plan. It is indeed an interesting and well thought through read with welcome recommendations at the end of each chapter. I did shudder on occasion at the suggestion of moving financial resource from one organisation to another in order to implement some of the recommendations, I can hear my colleagues on NHSIQ quivering in Skipton House.

Can I respectfully suggest there was one thing missing for me within the publication and that is any reference to the statutory legislation pertaining to the Duty to Consult and Involve the public and patients in system change and the complexities any health economy faces when trying to redesign services. Public and patient consultation is time consuming, politically sensitive, very costly and does not always deliver the intended results. I pose 2 questions, how will local health systems actively engage and communicate with its citizens and communities and take them on the necessary journey needed in implementing new models of care. How will they manage the decommissioning of current service which will be required to realise the necessary funds for reinvestment?

Please do not misunderstand my intent on posing these two questions, I am heavily in favour of new models of care which are centered around the patients and their carers/families. I am a passionate advocate of change and new leadership models. I consider myself a distributive innovator and positive deviant (Part of Helen Bevan's army) and I fundementally believe the NHS is not sustainable without radical change. I just know from experience how challenging decommissioning and service redesign can be when try to effect local change.