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What you need to know about the NHS five year plan

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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.

Simon Stevens

Simon Stevens

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.

money

money

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.

  1. 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.
  2. 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.
  3. 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.
  4. 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.

community nurse

Community nurse

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.

Midwives

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.

 


  • 7 Comments

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Readers' comments (7)

  • Here we go again!

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  • Doesn't the "Multispeciality Community Provider" idea sound spookily like the old cottage hospital ?? As the previous post says "here we go again"

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  • Nothing will change until those with a vested interest are removed from the NHS. The RCN are too comfortable and why on earth would they want change

    Peter Carter RCN salary £109,000 No wonder he doesn't like upsetting the establishment, he is one of them!


    http://www.telegraph.co.uk/news/politics/10176757/Union-leaders-enjoy-bumper-pay-hikes-and-golden-goodbyes.html

    Dr Peter Carter, the head of the Royal College of Nursing has seen his pay package rise from £66,869 to £109,000.

    Dr Carter's gross salary rose from £59,540 to £97,000, while his employer’s national insurance contribution rose from £7,329 to £12,000. Nurses pay rose by just 1 per cent in April after two years of pay freezes.

    The Royal College of Nursing said his pay has not risen because he was previously paid separately for professional and charitable duties. That pay is now declared in the trade union accounts.

    A spokeswoman said: "“Dr Peter Carter has not received a salary increase for over 3 years, nor does he receive any non-salary allowances from the RCN. In 2011 we agreed a different allocation of Dr Carter’s salary with the Trade Union Certification Officer following a change in the RCN’s legal structure.”

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  • If it is true that 25% of women do not want to give birth in an obstetric unit, then no doubt women were asked at booking clinic. By the time they get to deliver many women have had time to reconsider and do not like the idea of delivering at home, or in a midwifery led unit not located close to the obstetric unit, because they want more pain relief than they can offer and worry that if baby is born in poor condition then there will be no expert care on hand for best outcome. Most women are discharged home within two days of birth, even following a caesarean section, yet they are often visited only twice by a midwife before being discharged. Presumably there are not enough midwives to provide anything more. So my question is - where are all the midwives coming from who are going to stay with the women during labour at home and then deliver them safely. Mothers may not want to deliver in a well equipped unit with experienced obstetricians and paediatricians on hand, but choose to do so because they do not want to risk the life of their child.

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  • The plan appears to be to continue to drive down terms and conditions for the vast majority whilst maintaining and improving them for higher management and 'the execs'.
    Adopt more jack of all trade models based on the failing 111 system that has a very high turnover of staff due to poor terms and conditions.
    Using that system to replace Health Promotion units throughout the country that then don't post results for two quarters then post ridiculously high results that must come under scrutiny.
    Maintain , 'improve', change and re change the commissioning system and commissioners and continue to deny decent care provision to the nation's populace through constant change, re organisation and disenfranchisment of staff continually and over prolonged periods in years of time....well done all!

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  • The plan appears to be to continue to drive down terms and conditions for the vast majority whilst maintaining and improving them for higher management and 'the execs'.
    Adopt more jack of all trade models based on the failing 111 system that has a very high turnover of staff due to poor terms and conditions.
    Using that system to replace Health Promotion units throughout the country that then don't post results for two quarters then post ridiculously high results that must come under scrutiny.
    Maintain , 'improve', change and re change the commissioning system and commissioners and continue to deny decent care provision to the nation's populace through constant change, re organisation and disenfranchisment of staff continually and over prolonged periods in years of time....well done all!

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  • District nursing is on its knees, there is never any mention of the pressures we are currently suffering or where we will fit in, not sure anyone knows whats going to happen anyway! Average 20 visits a day, no time allocated for paperwork etc, no lieu time is being paid if its accrued, the service is run on goodwill. Morale is the worst I have ever known in 18 years of district nursing, sickness due to stress is a common ailment, retention of staff is appalling, we have lost some amazingly experienced senior staff to other areas or early retirement and to speak out only reflects badly on you personally or on your team as "not coping". Such emphasis is on nurses performance, compassion and care, which is right, but as a nurse if I didnt have these qualities I would have never survived this long! Managerial roles should be scrutinised and performance achievements displayed for all!! Few jobs may go, what do they actually do, we feel abandoned!

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