Ambitious NHS plan a ‘leap in the dark’, Confed chief warns

hospital corridor

The NHS in England has no alternative but to embark on an ambitious transformation plan that poses significant risks and is a leap in the dark, the head of the NHS Confederation has warned.

The plan, drawn up by the Five Year Forward View partners, charts a series of steps the health service must take over the next two years.

This includes freeing up 2,000-3,000 hospital beds, clamping down on temporary staffing costs, creating new powers and freedoms for accountable care systems and delivering a ten-point efficiency programme.

“Given the difficult financial position in which we find ourselves, NHS England deserves credit for producing an ambitious plan for reform and transformation which must be the right approach,” Niall Dickson, the chief executive of the NHS Confederation said.

“But we have to acknowledge that there are significant risks and in some respects it is a leap in the dark.
“We have no alternative but to embark upon such fundamental change, but to do so when services are under enormous pressure and money is so tight is without precedent.

At a glance

Next steps on the NHS Forward View details how the goals set out in the Forward View, published in October 2014, will be implemented. 

Key points include:

  • To deliver financial balance across the NHS, three main 2017/18 national service improvement priorities have been identified:
    • Improving A&E performance.
    • Strengthening access to high quality GP services and primary care.
    • Improvements in cancer services and mental health.
  • Hospitals, primary and community care to ensure £1bn of additional funding for social care in Spring Budget is used in part to reduce delayed transfers in care, freeing up 2,000-3,000 hospital beds.
  • Specialist mental health care to be available in A&Es.
  • Evening and weekend GP appointments to be available to 50 per cent of the public by March 2018 and 100 per cent by March 2019.
  • More doctors and paramedics handling calls to NHS 111; more clinical pharmacists in GP surgeries.
  • GP practices encouraged to form GP hubs or networks
  • Faster and improved cancer diagnosis, increased capacity and new rapid diagnostic and assessment centres. 
  • Increase in access to talking therapies, better mental health care for new and expectant mothers, an extra 280,000 health checks in 2018/19 for people with severe mental illness.
  • Sustainability and transformation plans now referred to as sustainability and transformation partnerships; each STP to form an STP board
  • Accountable care systems (ACS), which are evolved versions of STPs, will gain new powers and freedoms to plan how best to provide care, while taking on new responsibilities for improving the health and wellbeing of the population they cover.
  • Further cuts in agency and temporary staffing costs in 2017/18, of which around £150m to come from medical locum expenditure.
  • All trusts required to take part in the Nationally Contracted Products Programme.
  • Measures to increase the nursing and medical workforce, and to address specific staff shortages, including emergency medicine, ultrasonography and radiology.
  • Roll out of new treatments funded by NHS England’s specialised commissioning unit.
  • Multiple programmes to scale up demand moderation relating to prevention, emergency care and elective services.
  • NHS providers to screen, deliver advice and refer patients who smoke and/or have high alcohol consumption in order to quality for applicable CQUIN payments in 2017/18 and 2018/19.
Implementation of the plan will rely largely on local action by NHS bodies and their partners, but the NHS’ national leadership bodies will also “step up and play their part, supporting local change with national action,” the plan says.

The NHS Confederation has produced a detailed briefing distilling all the key points and messages in the plan. Confed members can access the briefing from the resource library.

Reaction from across the Confed

The Mental Health Network, which represents mental health and learning disability service providers for the NHS, welcomed the plan’s focus on mental health but warned that significant shortfalls in funding threaten to undermine local progress.

NHS Employers welcomed the focus on workforce and plans to work in partnership with trade unions and lead STPs to find ways to de-risk service change.

The Independent Healthcare Providers Network, which represents independent sector providers of NHS clinical services, commented that the sector has a key role to play in delivering the plan's commitments.

And NHS Clinical Commissioners, which represents clinical commissioning groups, said it was pleased the plan had recognised how far clinical commissioning since the Forward View's publication in 2014.

View the organisations' full responses: NHS EmployersNHS Clinical Commissioners , the Mental Health Network and Independent Healthcare Providers Network.

Find out more

Access Next steps on the Forward View on NHS England's website.

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