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Five Year Forward View

Dr Neil GoulbourneDeputy Director, Strategy Group, NHSE

NHS Five Year Forward View – time to deliver

• The NHS Five Year Forward View (5YFV) was published on 23 October 2014

• Integral was the launch of the new care models programme

• The challenge now is implementing the models and maintaining momentum

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The NHS has achieved a lot

Currently ranked #1 healthcare system in the world

More than 2/3 UK public believe the NHS “works well”

Cancer survival is at its highest ever

Operation waiting lists are down - many from 18 months to 18 weeks

Early deaths from heart disease are down over 40%

160,000 more nurses, doctors and other clinicians

Single Sex Wards implemented

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We are delivering more care

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Compared with 2009 the NHS is delivering more care:

• 4,000 more people are being seen in A&E each day

• 3,000 more people are being admitted to hospital each day

• 22,000 more people have outpatient appointments each day

• 10,000 more tests are performed each day

• 17,000 more people are seeing a dentist each day

• 3,000 more people are having their eyes tested each day

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But demand for care is rapidly growing

Lifestyle

• 1 in 5 adults still smoke

• 1/3 of people drink too much alcohol

• More than 6/10 men and 5/10 women are overweight or obese

Other factors

• 70% of the NHS budget is now spent on long term conditions

• People’s expectations are also changing

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There are also new opportunities

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New technologies and treatments• Improving our ability to predict, diagnose and treat disease

• Keeping people alive longer

• But resulting in more people living with long term conditions

New ways to deliver care • Dissolving traditional boundaries in how care is delivered

• Improving the coordination of care around patients

• Improving outcomes and quality

…but the financial challenge remains, with the gap in 2020/21 previously projected at £30bn

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The future NHS

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The Forward View identifies three ‘gaps’ that must be addressed:

Radical upgrade in prevention

• Back national action on major health risks• Targeted prevention initiatives e.g. diabetes • Much greater patient control• Harnessing the ‘renewable energy’ of communities

Health & wellbeing

gap1

New models of

care

• Neither ‘one size fits all’, nor ‘thousand flowers’• A menu of care models for local areas to consider• Investment and flexibilities to support implementation

of new care models

Care & quality gap

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Efficiency & investment

• Implementation of these care models and other actions could deliver significant efficiency gains

• However, there remains an additional funding requirement for the next government

• And the need for upfront, pump-priming investment

Funding gap

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Getting serious about prevention

Focusing on prevention Empowering patients Engaging communities

• Incentivise healthier individual behaviours

• Strengthen powers for Local Authorities

• Targeted prevention programmes – starting with diabetes

• Additional support for people to get and stay in employment

• Create healthier workplaces – starting with the NHS

• Improve information: personal access to integrated records

• Invest in self- management

• Support patient choice

• Increase patient control including through Integrated Personal Commissioning (IPC)

• Support England’s 5.5m carers – particularly the vulnerable

• Supporting the development of new volunteering programmes

• Finding new ways to engage and commission the voluntary sector

• NHS reflecting local diversity as an employer

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Developing new care models

• We need to take decisive steps to transition towards better care models

• There is wide consensus that new care models need to:

o Manage systems (networks of care), not just organisations

o Deliver more care out of hospital

o Integrate services around the patient

o Learn faster, from the best examples around the world

o Evaluate success of new models to ensure value for money

• There are already examples of where the NHS is doing elements of this

• However, cases are too few and too isolated

• The answer is not ‘one size fits all’, nor is it ‘a thousand flowers bloom’

• We will work with local health economies to consider new options that provide a viable way forward for them and their communities

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Multispecialty Community Providers moving specialist care out

of hospitals into the community

Integrated primary and acute care systems

 joining up GP, hospital, community and mental

health services

Acute care collaboration

local hospitals working together to enhance clinical and financial

viability

Enhanced health in care homes

 offering older people better, joined up health, care and rehabilitation

services

Urgent and emergency care

 new approaches to improve the coordination of services and reduce pressure on A&E

departments

Five new care models

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Integrated primary and acute care systems (PACS)

1 Wirral University Teaching Hospital NHS Foundation Trust 2 Mansfield and Ashfield and Newark and Sherwood CCGs3 Yeovil Hospital

4 Northumbria Healthcare NHS Trust

5 Salford Royal Foundation Trust

6 Lancashire North

7 Hampshire & Farnham CCG8 Harrogate & Rural District CCG9 Isle of Wight

Multispecialty community providers (MCPs)

10 Calderdale Health & Social Care Economy 11 Derbyshire Community Health Services NHS Foundation Trust 12 Fylde Coast Local Health Economy13 Vitality14 West Wakefield Health and Wellbeing Ltd (new GP Federation)15 NHS Sunderland CCG and Sunderland City Council 16 NHS Dudley Clinical Commissioning Group

17 Whitstable Medical Practice

18 Stockport Together

19 Tower Hamlets Integrated Provider Partnership

20 Southern Hampshire

21 Primary Care Cheshire

22 Lakeside Surgeries

23 Principia Partners in HealthEnhanced health in care homes

24 NHS Wakefield CCG

25 Newcastle Gateshead Alliance

26 East and North Hertfordshire CCG

27 Nottingham City CCG

28 Sutton CCG

29 Airedale NHS FT

29 vanguards developing their visions locally

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Clinical engagement

Patient involvement

Local ownership

National support

Our programme’s principles

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• Built with patients and the health and care system

• Clinical leadership is central to all the activities

• Fundamental to its success is it is shaped by those affected by change

The programme is being designed in partnership

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New Care Models for the NHS

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A range of new care models that are locally delivered across the country and can be replicated across the system

• Greater focus on care out-of-hospital care and prevention

• NHS trusts, GPs, Local Authorities, the voluntary sector and other providers will all work together for the benefit of their population

• A long term focus • A focus on supporting vanguard sites to

embody nationally replicable models of care

How this is different

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• The programme will bring investment, both locally and in national support

• Dedicated national expertise to work with local systems to unblock barriers

• The programme will aim to play “matchmaker” in bringing together parts of the system

How will it address gaps

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What does success look like?

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A range of new care models that are locally delivered across the country and can be replicated across the system

• A need to manage systems of care not just organisations

• Integrated services around the patient giving the patient greater control in their care

New care models1

• A focus on meeting local population health needs

• Support from a diverse range of active delivery partners, local commissioners and communities

• Active patient involvement

Locally delivered2

• Fast learning from best practice examples that can be applied to other areas across the country

• Applying innovations and learnings across the system

National replicability

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 • Now inviting expressions of

interest from hospitals to develop new ways of delivering and improving their local acute services

• Builds on the proposals in Sir David Dalton’s recent report

• Aim is to enhance the viability of hospitals through new working arrangements

• Open to all acute hospitals

• Closing date: 31 July 2015

Acute care collaboration vanguard – launched

“Rather than automatically assuming that centralised bigger is better, we want to test new ways of sustaining local NHS hospital services, with more sharing of medical expertise across sites, and more efficiency from shared back office administration.”

Simon StevensNHS England Chief Executive

 

Urgent and emergency care vanguard – launched

• Call for parts of the country to step forward to be urgent and emergency care vanguards

• They will test new approaches to improve the coordination of services and reduce pressure on A&E departments

• Some five million people are expected to be covered by the initial phase of the scheme which could be rolled out across England in the next couple of years

• The selection process will be similar to that used for the first three vanguard models. Closing date for applications: 15 July 2015

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Further information…

More information can be found on the NHS England website:

www.england.nhs.uk/ourwork/futurenhs/5yfv-ch3/new-care-models/

You can also follow and join in the conversation using #futureNHS