NHS will not improve while new models of care delivery remain “minority interest,” conference hears

BMJ 2015; 350 doi: (Published 19 February 2015) Cite this as: BMJ 2015;350:h981
  1. Matthew Limb
  1. 1London

NHS England’s grand vision to transform health services and promote radically different models of care is still only a “minority interest” for the health workforce, a conference has heard.

Chris Ham, chief executive of the healthcare think tank the King’s Fund, said that the Five Year Forward View set out at the end of last year by NHS England’s chief executive, Simon Stevens,1 had still not “penetrated sufficiently into the clinical community.”

“Most of the 1.4 million people who work in the NHS are not focused on this agenda—let’s get real about this,” he said.

Ham was speaking at a King’s Fund breakfast debate in London on 18 February, the second this year to focus on the challenges facing health and social care in the run up to the 2015 general election. He said it was encouraging that some GPs had “spontaneously” formed federations and networks as a means of delivering the change widely viewed as necessary.

However, he added, “When you go beneath the surface level of GP leaders locally who do understand where we’re trying to get to with the Five Year Forward View I don’t think there’s been any kind of penetration of this thinking of new care models.

“And I’d say exactly the same about most staff who work in mental health, in community [care services], and in our hospital services.”

Ham said that consideration of the Five Year Forward View could be termed “a minority interest conversation,” as its aims were not yet widely understood or being acted on. He said that the benefits of new, more integrated care models would be realised only when there was “genuine clinical engagement and genuine clinical leadership,” which would then lead to “change of culture and services and better outcomes for patients.”

Stevens told the breakfast meeting that the Five Year Forward View had attracted broad agreement across the country and across political parties but that implementing it would be “hard work.” He said that NHS England had received 268 applications from organisations and partnerships looking to be in the “vanguard” of establishing new models of care with a share of £200m (€270m; $310m) of transformation funds in 2015-16.

But this did not represent most services, and more profound changes were needed across the health service, he said. Stevens said, “We are at a pivotal moment where either we move to something quite different or we see services beginning to run into the sand.”

He said he believed that people were generally “up for more profound and transformational change” and would be able to see policy intentions being supported by investment decisions.

“We cannot continue to underinvest in primary and mental health services at a time when we are talking about the need for strong out-of-hospital services to help relieve the rate of increase in pressure that genuinely is being experienced inside hospitals,” he said.

Stevens added, “In some cases I think we’ve almost got to have a bit of righteous anger about how things currently are.” He cited examples of “unacceptable” levels of care, such as high rates of late diagnosis of some cancers.

He said that health prevention measures—and in particular action on sugar and a minimum price for a unit of alcohol—should be priorities early in the next parliament.

Ham said there was a big risk that the day to day operational pressures facing NHS and local government would “crowd out” opportunities to think ahead over the medium and longer term. “That will be a huge mistake: the two are part and parcel of the same discussion,” he said. “Unless we pay attention to the new, more integrated care models, we’ll only be able to find sticking plaster solutions to the huge operational problems facing health and social care.”


Cite this as: BMJ 2015;350:h981


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