We have today published Shaping the future, setting out the broad strands of action for system leaders local and national to meet the system’s vision for health care in the future. We argue a strategy is needed to take the NHS to 2020 and beyond.
So, one might ask, why do we need a strategy for the NHS when we have the Five Year Forward View?
The Forward View (wonderful though it is) does not provide a roadmap to get from where we are to the vision it paints. The vision is what it does well: person-centred, preventatively focused health services that deliver care in ways that are both efficient and suited to the populations they serve.
It has generated a huge amount of enthusiasm, and nine months after publication is still very much the guiding force behind policy actions – no mean feat. The changes it demands are gargantuan, and what is now needed is a practical plan to make them a reality.
And like any vision, implementing the Forward View is where the real controversy and difficulty lies. Health policy over the next few years will need to bring the system back into balance, find more efficiency savings than ever before, finally learn how to spread improvements at scale, find out the best ways of delivering care safely, efficiently and well, translate this understanding into whole scale service change (including the dreaded closing of facilities) and support a shift towards preventative care and wellbeing. None of these are easy, and they all take time.
Achieving these changes will mean difficult conversations about almost every aspect of life in the NHS: pay, culture, roles and working patterns, where the power lies in the NHS, what it is here for at all.
All NHS bodies, and especially those at national level, will need to go beyond merely coordinating their work to owning a joint plan to address key priorities together, with a completely new style of relationships between national and local players.
Anyone attempting this set of changes would be intimidated, and it is so easy to prioritise the urgent over the important – focus everything on balancing the books this year while leaving building the understanding needed to radically transform the way care is delivered to another year. To help take an overview, and balance effort and activity across the things that must be done, we have suggested a layered framework for health policy.
Our five layers of action are illustrated below: active cost management, process improvement for quality and efficiency, investigating and rolling out new ways of delivering care, focusing on population health, and supporting scientific discovery, technology and skills.
Within each strand the NHS needs to assess what the critical and high value actions are, and do what is needed to make them happen (we have suggested some areas to provoke thinking in our publication). For instance, there are a myriad of initiatives that could be chosen to improve quality – but why on earth should we do anything but put our energies into those that can provide the biggest improvements? And ideally reduce cost the most? Initiatives that do little for the quality of care people experience take resource away from those that can do more – an opportunity cost the NHS cannot afford.
Running through all of the layers of action is people: the hard-pressed people delivering and managing services, the people using them, or caring for those that do, and the people at the top, who set the tone of the whole service. They remind us that choosing the right priorities is only half of the solution - the whole comes from involving staff, service users and the public meaningfully, and from the right kind of relationships all the way through the system: how things are done is as important as what.
By organising what needs to be done into five areas we hope people working nationally can look at their activity in the round: is what they are doing the optimised set of actions to best deliver these five priorities? Are there things they are doing, however well intentioned, that distract attention away from these aims? Are their actions across the layers of action coordinated, or could they conflict?
Those working locally can also assess their activity against them, and should also challenge central directives if they don’t align, or if they distract from the five central strands of action – or the priorities within them.
The Five Year Forward View is not the end of strategies for the NHS – it is a vision for a new round of strategic thinking, with the potential to align the disparate and wide ranging set of action and stances that is health policy behind a central set of themes. The way forward for the NHS can only come from those leading and working in it.
Coordinating policy, facing the difficult issues while dealing with the crisis of the day is no easy task. We hope the framework we’ve suggested will provide a basis for further conversations at a national and local level, and are interested in your views – do let us know thoughts either by commenting on our website, by discussing with us in person, or on twitter using #shapingfuturenhs
Felicity is a Senior Policy Fellow at the Health Foundation, www.twitter.com/FelicityTHF