Blog Article

NHS Five Year Forward View: flexible, optimistic, but demanding on leaders

Posted by Simon Bird

Simon Bird

With just seven months until an election, there was speculation that the NHS chief executive’s Five Year Forward View, might be a bit hollow – low on commitment and very diplomatic. Nothing could be further from the truth. Instead, Simon Stevens has acknowledged the achievements of the NHS and laid out clearly the choices facing the current (and next) government in terms of NHS funding.

The Forward View is genuinely exciting in terms of tone, outlook and overall spirit. It is epitomised by a sense of reality, honesty and practicality. It feels like a working plan from a chief executive, rather than a piece that has been driven by PR with ambiguous content.

As I was reading it on my commute, three themes struck me.

1. Flexibility, and the sense of permissiveness that NHS England may be prepared to tolerate. Moving from a centralised ‘blueprint’ for the NHS, there are a range of different care models that have been outlined – all of which will require radically new ways of working.

2. Moral courage. Simon Stevens makes clear the options which exist to preserve the NHS. These have been laid squarely at the feet of government. The Forward View makes it absolutely clear that funding at the same level for the next five years, with the same level of efficiency and productivity gains, still leaves a funding gap of more than £20 billion by 2020/21. But Simon Stevens outlines options – focusing on the three related elements of demand, efficiency and funding – with the conclusion that the NHS can be sustained IF all three can deliver.

3. ‘Breaking down barriers’. On the surface this is a structural problem – but if it was this easy, care would already be delivered in ways that are better for patients and their families.

So who’s going to do this ‘breaking down’?

This could be the greatest challenge for Simon Stevens. He needs to breathe life into the new models of care to really get them going – and it’s going to take people with immense amounts of resilience, courage, vision, tenacity and energy.

It will also take consistent and unambiguous support from NHS England for leaders in the system to broach the most difficult conversations, to take on those who are adamant that no change is needed and to embody the optimism and vision of The Forward View.

The models of care laid out are intriguing, the tone is optimistic and the funding choices are stark. But fundamentally, the delivery of this vision will come down to individual behaviours and confidence. These behaviours will be able to be nurtured and developed, but only if given enough explicit support.

Whilst leaders in the system will be challenged, the biggest test for NHS England will be to ensure they support people and continue to demonstrate their belief in those leaders – and not get in their way.


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