David Oliver is President of the BGS, Visiting Fellow at the King’s Fund and Consultant Geriatrician at the Royal Berkshire Hospital, Reading. In part 1 of a 2-part blog, he discusses how the NHS “Five Year Forward View” is important for people involved in the care of older people.
October 23rd 2014 is memorable to me, as it’s my 23rd wedding anniversary. It’s also now of significance to the rest of us, as the date that NHS England’s “Five Year Forward View” plan was published. I realise not many of you will have had the time or necessarily inclination to read it, though at only 39 pages it’s an easy canter.
I also know it hasn’t attracted much Twitter activity from fellow BGS members. But it’s a document which I suspect will have far reaching influence and implications for the services we all work in. These implications seem largely positive. Let me explain why.
After the 2010 General Election, the NHS in England was given a “flat funding” settlement. Grants to local authorities were cut by a quarter. With population ageing and rising demand, this has led the NHS forecasting an estimated £30bn shortfall within the next decade (despite a concerted programme of efficiency savings and pay freezes).
It has also precipitated serious gaps in provision of social care even for those with care needs classified as substantial. Experts at both the Kings Fund and Nuffield Trust have acknowledged the need to increase funding by around 4% per annum in real terms just to keep up with demand, and to create a transition fund to help services shift more care closer to home during growing pressures on urgent care. Yet none of the political parties in the conference season have made such commitments.
The coalition government, via its Health and Social Care Act, hypothetically put the day-to-day operational leadership of the NHS in the hands of an “arm’s length body” in NHS England, notionally free of political interference and micromanagement from the Department of Health or from Number 10. In reality though, current ministers have been very “hands on” around issues such as Emergency Department performance, mental health, integration or the GP contract. Crucially, Simon Stevens, the new NHS England Chief Executive, was handpicked and head-hunted by this government as the right man for the job, despite his previous role with Labour and the NHS.
Mr Stevens, in conjunction with other national bodies in the form of Monitor, the Care Quality Commission, Trust Development Authority and Health Education England and Public Health England has set out a shared vision for the next 5 years – whichever government is in power. Each of these bodies was either created or overhauled during this government, so are effectively its creation. If you want to know how they all fit together, try watching the King’s Fund animation “An alternative guide to the new NHS in England”.
This has some “big picture” implications:
- Any politician from any party veering seriously away from the vision will look foolish: ignoring the combined expertise of all the system leaders they put in place and the “arms length” spirit of the Health and Social Care Act.
- Any politician from any party trying to foist more “big bang” top down re-organisation on health and care services will be equally unpopular. The coalition broke this promise at the last election, and the reforms are now acknowledged by senior Conservatives to have been the biggest mistake of this government. Labour has criticised them heavily for it, and its own vision for the NHS has warned of more large scale structural change.
- Hard on the heels of the King’s Fund Barker Commission on NHS funding, the Five Year Forward View has highlighted the serious funding gap and made strong recommendations that it needs to be closed: partly through increased productivity, partly through greater focus on prevention and proactive care, but even with this focus, through at least £8bn extra funding over the next 5 years.
The Treasury will doubtless be spitting blood. In my time working in Whitehall, I learned that Civil Servants tell “treasury official” jokes just like medics tell “orthopaedic surgeon” jokes. But this pressure, from both respected think-tanks and national service leaders, and reinforced by bodies such as the RCP, RCN, RCGP and BMA, will make it very hard for politicians to bury their heads in the sand about the health and care funding gap, even despite the ongoing challenge of reducing the deficit.