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Let's Take a Forward View

11 January 2016

It was another interesting and challenging year for the NHS in 2015. With the continuing financial pressures as a result of the country’s deficit, an aging population, and the rising expectations of patients with regards to new technology and 24 hour healthcare, the NHS continued to feel the pressure. However, with the introduction of the Five Year Forward View in late 2014 we saw how Simon Stevens intended to address this through improved efficiencies.

With this extra focus on delivering the plan we saw the Government get behind the Five Year Forward View, with George Osborne committing in the Autumn Statement to give an above inflation cash injection of £3.8bn to front-line services in England; helping release some of the pressures in the system, as the NHS struggles to meet the demand for services, and ensure the Forward View has enough funding to succeed. However, as part of the deal the NHS had to commit to delivering £22 billion of efficiency savings by 2020. When Jeremy Hunt announced this in his speech to Confed back in June, he spoke at length about how this would be achieved and gave the example of how Gary Kaplan had turned around the Virginia Mason Hospital through the adaption of the Toyota LEAN principles across their secondary and primary care services, which saw them move from a significant deficit to a surplus. Surprisingly, as a by-product of driving out efficiencies the quality of care they provided significantly improved. This led to the Secretary of State for Health quoting Gary Kaplan, “the path to lower cost is the same as the path to better care”, a philosophy that he was keen for the NHS to follow. 

Following this we saw Lord Carter publish plans for what a model hospital should look like and deliver his plan on how the NHS could save up to £5bn a year by 2020. As highlighted by the CQC, Lord Carter said that just as there are variations in levels of care around the NHS there are also variations in how money is utilised in different hospitals and as with Jeremy Hunt and Gary Kaplan, he believes that good leadership leads to efficient use of resources and, most importantly, better quality of care. His review finished by saying that if every hospital adopted the best practice for all surgical procedures and treatments that outcomes for patients would improve and money would be saved. 

With this, one of the first areas to be tackled was procurement, with agency staff being at the top of the list with an annual agency spend of £3.3bn. We saw the introduction of an agency spend cap in November which dictates how much a trust can pay per hour for agency staff including doctors, nurses and all other clinical and non-clinical staff. Through the cap the Government hopes to make an annual saving of 10% and by mid-2018 to have saved a total of £1bn and reduced the NHS’ overall reliance on agency staff.

As one of the first steps towards delivering the Five Year Forward View, we saw the NHS invite organisations and partnerships to apply to become a ‘Vanguard’ site for the new care models programme. By September, 50 sites had been selected covering integrated primary and acute care systems, enhanced health in care homes, multispecialty community providers, urgent and emergency care and acute care collaborations. With the agenda for each site to take the lead on the development of new care models which, according to the NHS England’s website, will act as the blueprints for the NHS moving forward and the inspiration to the rest of the health and care system. 

So what will happen in 2016? With the commitment of extra cash, how will it be utilised? Will it be used to stabilise the system? If so, how will the remaining funds be invested in the Five Year Forward View? Whatever the decision, with the majority of funds in the five year commitment coming in the first three years, investing in transformation and the future long term stability of the system will be top of the list as we move towards a globally highly regarded, modern and innovative NHS. 

Nick Behan, Consultant

Nick Behan is a Consultant in the Healthcare Practice, read Nick's profile.

Categories: Healthcare


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