Thoughts on the Five Year Forward View

NHS Management

I have heard Simon Stevens speak, and read the Five Year Forward View.  His utterances and writings are very intense, and have to be thought carefully about.

First let us dismiss the canard that because he worked for United Health in America he is automatically bon a mission to privatise the NHS.  In fact he worked for the part which dealt with Medicare, a state-funded scheme.

I think his ideas have merit and the SHA should consider them. (Bear in mind of course that he did not write the Five Year Plan single-handed.  It is the result of much debate in the NHS.  I have been aware of this.)  The SHA may not agree with all he says, but I think we should endorse some of his ideas.  In particular I note the following points which he makes in the HSJ lecture:

  • He points out the “perverse incentives” in the NHS, whereas hospitals have incentives to acquire more patients, whereas CCGs are trying to stop people going to hospital when they can.
  • He notes the importance of local initiatives, and stresses collaboration between different agencies. He wants flexibility.
  • He also comments on the “two axes” (not about cuts!) of increased scale for some specialist surgery, whereas better technology and “miniaturisation” (first noted by Willmott and Young) will enable more to be done locally, and could benefit smaller hospitals. Much of the debate is about reorganisation of services, and the fact that not all hospitals can do everything.  Perhaps we should think instead about what smaller locally based provision can do.
  • There is an overall thread of collaboration and integration, between primary and specialist services, physical and mental health, and health and social care. Later he talks of “Multispeciality Providers”, and in true NHS manner, invents an Acronym.

None of this is about public or private provision, and seems to stress collaboration which the SHA should favour.

The funding mechanisms may prevent this, and I would think Trusts will have to cease being independent and enter into some sort of agreement with local authorities and CCGs.  At the moment we have money going to the Better Care Fund, and Trusts blithely ignoring this, assuming that the government will bale them out.

All this probably makes sense to us, but we then have the sort of attack on successful local authority/NHS collaboration as reported in the Guardian on Tuesday under “Top Tory wants bigger role for private firms in NHS”.  (That headline doesn’t exactly win a prize for originality. Perhaps they should have added that Queen Anne was dead too.)

It is about Frances Maude’s thoughts about the Better Care Fund.  He comments “ I think the disappointment about the Better Care Fund has been how public-sector a lot of these solutions proposed have  been, and it would have been, I think, better if we had seen coming out of it more ideas for different groups forming themselves together”. He then extolled how Inclusion Healthcare was both cheaper and more efficient, on the basis of one example.

Even when the public sector responds to a challenge you cannot win with this lot.  Our task, I think is to convince the electorate that the public sector can be flexible, innovative , and cooperate between silos, if we are to meet the challenges ahead.

(Advert:  I have thought about these ideas further in my book “Reclaiming the Big Society”)