Nursing Times focuses on the key points in the Five Year Forward View report and how they may affect nurses and midwives.
What is the Five Year Forward View?
The Five Year Forward View is a 39-page report published on 23 October, which sets out ways the NHS in England needs to change over the next five years to ensure it remains affordable in the face of increasing demand and finance pressures.
As well as dealing with services and care models within the NHS, it also makes recommendations on how the public’s health and lifestyle must also change in order to reduce pressure on the NHS.
The plan is essentially the vision of new NHS England chief executive Simon Stevens, who has been in post for around six months.
It has been described by NHS England as a “road map for healthcare” for the next five years.
Why is it needed?
The NHS faces having a funding gap of £30bn by 2020 between the cost of the services it needs to provide and the money it has to spend on them.
NHS leaders warn that they must take decisive action now to protect the quality of services and ensure the NHS remains sustainable in future.
They say the actions set out on the Five Year Forward View, combined with NHS budget increases, could feasibly close the projected funding gap by 2020-21 – either by one third, one half, or all the way, depending on how successfully it is implemented.
Who developed the Five Year Forward View?
The plan was drawn up by the leaders of six key organisations involved in running and monitoring the NHS and related services.
These include the government arms-length bodies NHS England, Health Education England and Public Health England, which were created from 2011-13 to take over many roles formerly done by the Department of Health.
The other three are the healthcare regulatory bodies the Care Quality Commission, Monitor and the NHS Trust Development Authority.
What are its key recommendations?
The Five Year Forward View sets out actions that need to be taken in four main areas affecting healthcare.
- It argues more needs to be done to tackle the “root causes of ill health”, noting that future sustainability of the NHS depends on a radical upgrade in prevention and public health. The plan backs “hard-hitting action” on obesity, alcohol and other major health risks.
- It commits to giving patients more control of their own care, including the option of combining health and social care, and new support for carers and volunteers.
- It claims the NHS must change to meet the needs of patients, who are living longer, have more complex conditions and are more demanding. The plan sets out new models of care that break down the boundaries between traditional healthcare settings, physical and mental health, and health and social care.
- It sets out the actions needed to “develop and deliver” the new models of care, such as providing local flexibility in the way that payment, rules and regulatory requirements are applied – plus more investment in workforce, technology and innovation.
What are the new models of care suggested in the review?
The Five Year Forward View describes possible new care models that should be adopted to fit local situations, including:
- Allowing GP practices to join forces into single organisations that provide a broader range of services including those traditionally provided in hospital
- Creating new organisations that provide both GP and hospital services together with mental health, community and social care – involving community and primary care nurses in so-called Multispecialty Community Providers (see below)
- Helping patients needing urgent care to get it when they want by creating urgent care networks that work seven days a week
- Sustaining local hospitals where this is the best solution clinically and is affordable and has the support of local commissioners
- Concentrating services into specialist centres where there is a strong relationship between numbers of patients and the quality of care
- Improving opportunities for women to give birth outside hospital by making it easier for groups of midwives to set up NHS-funded midwifery services (see below)
- Improving quality of life and reduce hospital bed use by providing more health and rehabilitation services in care homes
- Finding new ways to support carers by identifying them more effectively and encouraging volunteering by, for example, offering council tax reductions
What are Multispecialty Community Providers and how might they involve nurses?
Multispecialty Community Providers are one of the new care models suggested in the Five Year Forward View, which have the potential to expand primary care leadership to include nurses.
They would permit groups of GPs to combine with nurses, other community health services, hospital specialists and perhaps mental health and social care to create integrated out-of-hospital care.
Early versions of this model are emerging in different parts of the country.
As larger group practices, these Multispecialty Community Providers would become the focal point for a far wider range of care needed by their registered patients.
For example, they could bring in senior nurses, consultant physicians, geriatricians, paediatricians and psychiatrists to work alongside community nurses, therapists, pharmacists, psychologists, social workers, and other staff.
What will modern maternity service look like?
The Five Year Forward View highlights the need to modernise maternity services and encourage different forms of service model, especially those led by midwives themselves.
The report notes that recent research shows that for low risk pregnancies babies born at midwife-led units or at home did as well as babies born in obstetric units, with fewer interventions. It also notes that while only a quarter of women want to give birth in a hospital obstetrics unit, over 85% actually do so.
To ensure maternity services develop in a “safe, responsive and efficient manner” – in addition to including increasing midwife numbers – the report said NHS leaders would:
- Commission a review of future models for maternity units, to report by next summer, which will make recommendations on how best to sustain and develop maternity units across the NHS.
- Ensure that tariff-based NHS funding supports the choices women make, rather than constraining them.
- As a result, make it easier for groups of midwives to set up their own NHS-funded midwifery services.