Five Year Forward View
In October, 2014 the NHS England launched a government-backed, wide-ranging strategy entitled: The five year forward view (5YFV). 5YFW sets out templates for new models of care that will treat patients in more appropriate and less resource intensive settings, thereby closing the projected £30Bn annual gap between the demand for health and care services and the resources available by 2020. All central NHS initiatives should be viewed in this context.
In December 2015 the NHS issued Shared Planning guidance covering the period 2016/17-2020/21. NHS organisations were asked to produce two separate but connected plans. As well as the usual annual operational plan for individual organisations, local health and care systems were asked to come together to create a local blueprint for accelerating the implementation of 5YFW.
These Sustainability and Transformation Plans (STPs) are place based, multiyear and focussed on the needs of local populations as a whole and not the viability of individual institutions. The plans are the basis for local areas to access the Sustainability and Transformation Fund secured as part of the Spending Review.
44 STP areas have been identified across England, each with a single leader. The STPs are described as not an end in themselves, but rather a means to foster better local collaboration across the health and care space. Footprint leaders are a mix of Accountable Officers from Clinical Commissioning Groups and Chief Executives of Hospitals and Local Authorities.
Implications for ABHI Members
Some commentators are pointing to the STP footprints as the start of the NHS becoming a series of Accountable Care Organisations (ACOs) – local, fully integrated health and care systems, funded on a capitation basis and responsible for the needs of their populations in entirety. Not all planning can be done at STP level and not all footprints will be the same. Cornwall for example, covers a population of 500,000 with no specialised services on patch, whilst Greater Manchester covers 2.8 million and has a full range of services, some of which are commissioned nationally.
The initiative, though, yet again, points to the importance of out of hospital settings and will see a consequent direction of funding away from acute hospitals. This will add to downward price pressure in the acute sector on one hand, but does offer better opportunities to have the whole system benefits of technologies recognised on the other. The importance of the STP versus other local initiatives such as devolution deals and the emergence of hospital chains will also vary from place to place, and some areas will already have mature relationships across the footprint. A blanket national approach may not then necessarily be the most helpful approach. However, the 44 STP leaders will clearly be important figures and they and their respective geographies, ought to be a consideration in any members’ plans.
In March 2017, NHS England released its Next steps on the NHS Five Year Forward View. It spells out significant accomplishments in light of funding constraints and increasing demand. It also highlights the changes which will take place across the health service in key areas. Our statement can be read here. We have also provided a detailed analysis for Members.