1. For Patient Participation Group Meeting Friday 19 December 2014
NHS 5 Year Forward View
For Patient Participation Group Meeting Friday 19 December 2014
Gail Hawksworth
Head of Communications and Engagement

2. 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.
Better health for all
R1: All health and care commissioners and providers should innovatively and energetically engage with Londoners on their health and care, share as much information as possible and involve people in the future of services.
R8: The NHS, Public Health England and Transport for London should work together to create a platform to enable employers to incentivize their employees to walk to work through the Oyster or a contactless scheme.
R9: The Mayor should encourage all employers to promote the health of Londoners through workplace health initiatives. The NHS should lead the way by introducing wellbeing programme, including having a mental health first aider for every organization.
Better health for London’s children
R13: Health and care commissioners should jointly develop a new model to improve support for parents of vulnerable children under three.
R16: Health commissioners and providers should launch a process to address the variation in quality of care for children and to propose actions to improve outcomes.
Better care
R17: Health and care commissioners should commission holistic, integrated physical, mental and social care services for population groups with similar needs, with clearly defined outcomes developed by listening to people who use services.
R18: Health and social care professional should partner with people who use services to ensure that their voice is heard in designing and implementing improvements to care.
R19: Health and care commissioners and the voluntary sector should promote the implementation of shared decision-making, care and support planning, education for self-management, personal health budgets and access to health records so that London becomes an exemplar in improving people’s participation in their own care and treatment.
R21: The Department of Health and NHS England should launch a five year £1 billion investment programme in GP premises so that all London are able to access care in modern purpose-built/designed facilities.
R22: Health commissioners should increase the proportion of total London NHS spending dedicated to GPs and primary and community services and facilities.
R23: Commissioners should set ambitious new service and quality standards for GPs in London, tailored to the different population groups of patients they serve.
R24: NHS England and CCGs should promote and support GPs working in networks to reduce professional isolation, to provide was wider range of services and to provide more appointments at more convenient times.
R25: NHS England and CCGs should allow patients to move freely within GP networks, so those registered with one GP practice are able to access services from other practices within the same network.
R26: NHS England and CCGs should put in place arrangements to allow existing or new providers to set up new GP services in areas of persistent poor provision in London.
R27: Health commissioners should improve specialist care by accelerating efforts to create centres of excellence for cancer and cardiovascular services, launching a new programme to review elective orthopaedics services and ensuring London Quality Standards are implemented.
R28: Health and care commissioners should ensure that all Londoners have access to digital mental health support, in the languages that they speak, and using the latest technology.
R29: NHS England should strengthen the role of mental health in primary care, with a particular focus on timely access to psychological therapies and early intervention services, and on improving the capacity and capability of GPs to care for people with mental illness.
R30: Health and care commissioners should develop a pan-London multi-agency (including the police and ambulance service) case for change and model of care for child and adult mental health patients in crisis.
R31: Health and care commissioners should develop a pan-London, multi-agency approach to healthcare for the homeless and rough sleepers, with dedicated integrated care teams, and commissioned across the capital by a single lead commissioner.
Maximizing science, discovery and innovation to enhanced economic growth
R36: Clinical Research Networks should establish a strategic clinical research office to increase late phase research/novel real work studies in smaller NHS Trusts and GP Practices.
R38: Academic Health Science Centres/Networks should forge greater links with commissioners to advise of the use of latest innovations for patient benefit and to support delivery by providers.
Making it happen
R40: NHS England should develop a single London-wide online platform to encourage and inform people about how they can actively participate in discussion and decisions about health, care and services, building on the NHS Citizen initiative and the Imagine Healthy London brand.
R42: AHSNs, CCGs and NHS England should work together to create matched patient-level data sets and real-time information sharing to improve both care delivery and service planning, with robust safeguards for privacy and confidentiality.
R44: Health and care commissioners should embrace advanced data analytics to better understand care needs and to commission higher quality care.
R46: London CCGs and SPGs should consider developing local initiatives to promote greater equity in financing the health and care system.
R47: NHS England should make clear the budget for the London Region of NHS England and for London CCGs for the duration of future spending review periods.
R48: NHS England and CCGs should establish a shared transformation budget for investment in strategic change, jointly managed for NHS England (London) and CCGs with investments agreed with sub-regional health economies.
R49: NHS England should work with CCGs and local authorities to trial capitated budgets for specific population groups, such as elderly people with long-term conditions.
R51: NHS England should reform the rent reimbursement system for GP premises, offer modern facilities for all practices and require practices to comply with disabled access requirements or accept new facilities.
R56: NHS commissioners and providers and local authorities should create Strategic Planning and Capital Boards to ensure that estates planning and a comprehensive asset database are part of wider health service planning.
R62: NHS England should further empower CCGs to work together – with their local authority partners – to improve care across multiple boroughs, by devolving further decision-making powers to SPGs.
R63: London should be the most transparent region of England’s health and care system by including representation of people who use services on decision-making committees, by holding meetings in public and publishing meeting documents online.

3. Summary
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

4. New Care Delivery Options
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

5. New Care Delivery Options
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 provider
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

6. New Care Delivery Options
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 services

7. 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 health- There 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

8. 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

9. 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

10. 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 quality

11. 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 everywhere
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

12. 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 (RCTs)
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 data
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 medtech

13. 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.

14. How will we get there 3 Funding Options-
NHS budget remains flat in real terms from 2015/ /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.
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.
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.

15. Questions?