Summary of NHS England’s Five Year Forward View and ...

Summary of NHS England’s Five Year Forward View

and potential implications for North West London

North West London Collaboration of Clinical Commissioning Groups

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Contents

I. Purpose of this document .............................................................................................................. 3

II. Structure of the document ............................................................................................................ 3

III. Executive summary ...................................................................................................................... 4

1. Overview of Five Year Forward View ........................................................................................ 5

1.1. What will the future look like ..................................................................................................... 6

1.1.1. New relationships with patient and communities ............................................................ 6

1.1.2. NHSE New Models of Care ................................................................................................. 7

1.2. NHSE Five Year Ambitions ........................................................................................................ 9

1.2.1. How the NHS will get there .............................................................................................. 10

2. Five Year Forward View key themes and alignment in NWL and WLCCG ........................... 11

2.1. How the transformational work in NWL and RBKC is currently aligned with the 5 year forward view ..................................................................................................................................... 12

2.1.1. Alignment of new care models ........................................................................................ 14


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I. Purpose of this document

This document provides a summary of NHS England’s (NHSE) 5 Year Forward View and describes the potential implications for North West London, including how transformational work in North West London and RBKC aligns with the 5 Year Forward View.

II. Structure of the document

• Overview of five year forward view outlines the gaps that NHS England’s strategy is trying to prevent the widening of and how they intend to achieve this

• Implications of the Five Year Forward View and focus areas for NWL outlines what impact NHS England’s Five Year Forward View has on the focus areas for NWL

• How the work North West London and West London CCG is doing is currently aligned to the 5 Year Forward View outlines what specific actions NWL are doing within their aligned focus areas to deliver their strategy whilst supporting the ambitions for NHS England


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III. Executive summary The NHS Five Year Forward View was published in October 2014 by NHS England (NHSE). It sets out the vision for the future of the NHS over the next five years, including the strategy by which the NHS can prevent the widening of the health and wellbeing, care and quality, and the funding and efficiency gaps. The two focus areas for NHSE over the next five years are new relationships with patients and communities and new models of care. Over the last five years the NHS has generally been successful in responding to the growing aging and sicker population, as well as new drugs, treatments and changing social care providers. Although some of the fundamental challenges faced by the NHS are common to all industrialised countries health systems, some of NHS England’s five year ambitions are focused more specifically to the needs of England, including quality, a healthier NHS workplace and support for people with dementia, mental health and cancer. In order to fulfil these ambitions a number of enablers have been identified around the workforce, leadership, information, investment and utilising health innovation.

North West London (NWL) has an ambitious vision for the future transformation of its health and care system. NWL is driving a person-centred vision for health and care, where care is personalised and coordinated around the individual, localised where possible, integrated and then where necessary centralised for specialist services.

NWL key implication areas for improvements are in line with NHS Englands two areas of focus; new relationships with patients and communities, and new models of care. NWL’s approach includes greater prevention and empowerment, developing out of hospital service, greater integration, and mental health and developing the workforce.

The implementation of North West London’s strategy is already under way. Throughout its implementation NWL continues to review its transformation plans to ensure they continue to strengthen the alignment with NHS England’s and achieve their own overarching vision:- to improve the quality of care for individuals, carers and families, empowering and supporting people to maintain independence and to lead full lives as active participants in their community.

http://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf


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1. Overview of Five Year Forward View

The NHSE’s Five Year Forward View was published in October 2014 by NHSE. It sets out the vision for the future of the NHS over the next five years, including the strategy by which the NHS can prevent the widening of three gaps:

The Five Year Forward View describes how the future will look, both in terms of relationships with patients and communities, and models of care. Five year ambitions in specific areas, e.g. Cancer, are also identified. The final chapter describes how the NHS will achieve these ambitions and the wider vision.

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http://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf


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1.1. What will the future look like

NHSE does not believe their identified three gaps are inevitable (pg5) and believe a better future is possible with the right changes, right partnerships and right investments.

1.1.1. New relationships with patient and communities

NHSE believe renewable energy represented by patients and communities, or the potential positive health impacts of employers and national and local governments have not fully been harnessed. The health service can’t do everything that’s needed by itself, but it can and should become a more activist agent of health-related social change, including:

Getting serious about prevention:

• Supporting Public Health England strategy to reduce obesity, smoking, harmful drinking, childhood obesity, risk of dementia through lifestyle risks.

• Local democratic leadership on public health - working through Health and Wellbeing Boards to support LA initiatives to improve health.

• Clear information and labelling, targeted personal support, wider changes to distribution, marketing, pricing and product formulation.

• Targeted prevention – become the first country to implement at scale a national evidence-based diabetes prevention programme.

• Support to help people stay in employment.

Empowering patients:

• Improve the information to which people have access including information about their condition and history.

• Increase support for people to manage their own health, with the help of voluntary sector partners, and investment in evidence-based approaches.

• Make good on the NHS’ longstanding promise to give patients choice over where and how they receive care. NHSE will also introduce integrated personal commissioning (IPC), a new voluntary approach to blending health and social care funding for individuals with complex needs.

Engaging communities:

Committing to four further actions to build on the energy and compassion that exists in communities across England:

1. Better support for carers.

2. Creating new options for health-related volunteering.

3. Designing easier ways for voluntary organisations to work alongside the NHS

4. Using the role of the NHS as an employer to achieve wider health goals.

The NHS as a social movement

It is believed these initiatives and others like them will help shift power to patients and citizens, strengthen communities, improve health and wellbeing, and—as a by-product—help moderate rising demands on the NHS.


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These ‘slow burn, high impact’ actions are now essential – and need to be matched by action to transform the way NHS care is provided.

1.1.2. NHSE New Models of Care

Chapter 3 of the Five Year Forward View sets out proposals for new models of care, to be tested by specific “Vanguard sites” across the country from April 2015. The document states that:

NWL is not a Vanguard site but are supportive of NWL Whole Systems models and the new models of care include:

1. Multispecialty Community Providers (MCPs):

• Expanded primary care proactively targeting services at patients with complex ongoing needs, working much more intensively with these patients.

• To offer this wider scope of services, and enable new ways of delivering care, extended group practices will form – either as federations, networks or single organisations.

• These larger group practices would shift the majority of outpatient consultations and ambulatory care out of hospital settings. They could take over the running of local community hospitals to expand their diagnostic services as well as other services such as dialysis and chemotherapy.

• They could in time take on delegated responsibility for managing the health service budget for their registered patients. Where funding is pooled with local authorities, a combined health and social care budget could be delegated to MCPs.

2. Primary and Acute Care Systems (PACS):

• NHSE will now permit a new variant of integrated care in some parts of England by allowing single organisations to provide NHS list-based GP and hospital services, together with mental health and community care services.

• In some circumstances hospitals will be permitted to open their own GP surgeries with registered lists. In other circumstances, the next stage in the development of a mature Multispecialty Community Provider (see section above) could be that it takes over the running of its main district general hospital.

• At their most radical, PACS could take accountability for the whole health needs of a registered list of patients, under a delegated capitated budget - similar to the Accountable Care Organisations that are emerging in Spain, the United States, Singapore, and other countries.

3. Urgent and emergency care networks:

The NHS will do far better at organising and simplifying the system. This will mean:

“While the answer is not ‘one-size-fits-all’, nor is it simply to let ‘a thousand flowers bloom’, all models will be predicated on the need to expand and strengthen primary and out of hospital care.”


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• Helping patients get the right care, at the right time, in the right place, making more appropriate use of primary care, community mental health teams, ambulance services and community pharmacies, as well as urgent care centres.

• Evening and weekend access to GPs or nurses, greater use of pharmacists.

• Developing networks of linked hospitals that ensure patients with the most serious needs get to specialist emergency centres.

• Ensuring that hospital patients have access to seven day services where this makes a clinical difference to outcomes.

• Proper funding and integration of mental health crisis services including liaison psychiatry.

• A strengthened clinical triage and advice service.

4. Viable smaller hospitals:

• NHSE and Monitor will work together to consider whether any adjustments are needed to the NHS payment regime to reflect the costs of delivering safe and efficient services for smaller providers.

• NHSE will create new organisational models for smaller acute hospitals that enable them to gain the benefits of scale without necessarily having to centralise services.

5. Specialised care:

In some services there is a compelling case for greater concentration of care. In services where the relationship between quality and patient volumes is this strong, NHS England will now work with local partners to drive consolidation through a programme of three-year rolling reviews.

• NHSE will also look to these specialised providers to develop networks of services over a geography, integrating different organisations and services around patients, using innovations such as prime contracting and/or delegated capitated budgets.

6. Modern maternity service:

• NHSE will commission a review of future models for maternity units, to report by next summer, which will make recommendations on how best to sustain and develop maternity units across the NHS.

• Ensure that tariff-based NHS funding supports the choices women make, rather than constraining them. As a result, make it easier for groups of midwives to set up their own NHS-funded midwifery services.

7. Enhanced health in care homes:

In partnership with Local Authority social services departments, NHSE will work with the NHS locally and the care home sector to develop new shared models of in-reach support, including medical reviews, medication reviews, and rehab services.


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1.2. NHSE Five Year Ambitions

Over the last five years the NHS has generally been successful in responding to the growing, aging and sicker population, as well as new drugs, treatments and cuts in local council’s social care. Although some of the fundamental challenges faced by the NHS are common to all industrialised countries health systems, some of the improvements needed over the next five years are more specific to England:

Quality:

• To narrow the gap between the best and worst, and raise the bar for everyone.

• Publish measurements for all major pathways of care, and redesign the payment system to reward for improvements in quality.

• Invest in leadership by refocusing work of the NHS Leadership Academy.

• Develop a framework for how seven day services can be implemented.

A Healthier NHS Workplace:

It has previously been estimated the NHS could reduce its overall sickness rate by a third. NHSE will:

• Cut access to unhealthy products on NHS premises.

• Measure staff health and well-being; introduce voluntary work-based weight watching and health schemes, and support “active travel” schemes for staff and visitors.

• Promote the Workplace Wellbeing Charter, the Global Corporate Challenge and the TUC’s Better Health and Work initiative, and ensure NICE guidance on promoting healthy workplaces is implemented, particularly for mental health.

• Review with the Faculty of Occupational Medicine the strengthening of occupational health.

Support for People with Dementia:

One in three people aged over 65 will develop dementia before they die. The NHS’ ambition over the next five years is to:

• Offer a consistent standard of support for patients newly diagnosed with dementia, supported by named clinicians or advisors, with proper care plans developed in partnership with patients and families, and the option of personal budgets.

• Provide full support for initiatives drawing together a broader coalition of statutory services, communities and businesses so that people with dementia can continue to participate in the life of their community.

Mental Health:

Over the next five years the NHS must drive towards an equal response to mental and physical health, and towards the two being treated together, including:

• Waiting standards introduced for mental health.

• Investment in new beds for young people with most intensive needs to keep them near home.

• More money for better case management and early intervention.

• Achieve genuine parity of esteem between physical and mental health by 2020.

• Aiming for waiting time standards to improve to 95% of people referred for psychological therapy to start treatment within 6 weeks and for psychosis, within a fortnight.


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• NHSE will also want to expand access standards to cover a comprehensive range of mental health services, including children’s services, eating disorders, and those with bipolar conditions.

Cancer: One in three of us will be diagnosed with cancer in our lifetime, but cancer survival is below the European average. Action on three fronts:

• Better prevention – access to high quality smoking cessation services, increase focus on pregnant women and those with mental health conditions, and on reducing obesity.

• Swifter access to diagnosis – reduce number of patients diagnosed at A&E (25%). Extending screening, supporting GPs to spot symptoms earlier. Over the next five years, the NHS can deliver a 10% increase in those patients diagnosed early.

• Better treatment and care – better implementation of quality standards and NICE guidance. Consolidating specialised care, while also make some care available much closer to people’s homes. Promote the provision of the Cancer Recovery Package, to ensure care is coordinated between primary and acute care.

1.2.1. How the NHS will get there

A number of enablers are identified to support achievement of the vision and ambitions:

• Diverse solutions and local leadership - There is no appetite across the NHS for wholesale structural reorganisation. Change should arise only from local work to develop the above new care models or in response to clear local failure and ‘special measures’.

• Aligned national NHS leadership – NHSE, NHS TDA, CQC, NICE, Health Education England, PHE. Supporting the development of the new care models development.

• Supporting a modern workforce – to deliver new models of care. HEE working with employers and commissioners to identify education and training needs of workforce. Greater investment in training for existing staff and expanding new health and care roles.

• Exploit information revolution – National Information Board (NIB) to publish a set of ‘road maps’ – who will do what to transform digital care. Transparency of performance data, a set of NHS accredited health apps for patients to manage own health care, electronic health records, repeat prescribing online

• Accelerate useful health innovation – supporting research facilities – NIHR. ‘combinatorial innovation’ – more benefit from combining different technologies.

• Drive efficiency and investment - £30 billion funding gap by 2021 caused by growing demand, no further annual efficiencies and flat funding.


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2. Five Year Forward View key themes and alignment in NWL and WLCCG

North West London (NWL) and WLCCG have an ambitious vision for the future for the transformation of health and care system. We are driving a person-centred vision for health and care, where care is personalised and coordinated around the individual, localised where possible, integrated and then where necessary centralised for specialist services. NWL is working collaboratively as commissioners, providers, the voluntary sector, patients and public, with the community, NHS England and other partners to deliver its vision for change across the eight Clinical Commissioning Groups (CCGs) of NWL.

To understand the implication of the Five Year Forward View for RBKC and NWL the key themes are summarised below:


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2.1. How the transformational work in NWL and RBKC is currently aligned with the 5 year forward view

Implementation of the NWL and WLCCG strategy is already under way. Throughout its implementation we will continue to review our transformation plans to ensure they align with NHSE and achieves their overarching vision:

“To improve the quality of care for individuals, carers and families, empowering and supporting people to maintain independence and to lead full lives as active participants in their community”


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West London CCG specific responses to the Five Year Forward View are detailed below:


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2.1.1. Alignment of new care models

NWL has also appraised the work that is either planned or underway to address the new care models described in the 5 Year Forward View.

New Model Alignment to North West London Five Year Plan

Multispecialty Community Providers (MCPs)

Whole Systems Integrated Care:

• Putting support in place to nurture and grow GP networks to deliver long term sustainability, and extending access and continuity in the short term (end of 2014/15, completion of Challenge Fund)

• GPs will be at the centre of organising and coordinating people’s care

• Developing systems and processes will enable and not hinder the provision of integrated

care.

Primary and Acute Care Systems (PACS)

Primary and community care • Transforming out-of-hospital services and improving access to GPs • Putting the right support in place to nurture and grow GP networks so they are able to

deliver sustainability in the long term • Developing a primary care estate strategy.

Urgent and Emergency Care Networks

Shaping a healthier future (reconfiguration):

• NWL is centralising emergency specialist services into 5 major hospitals. NWL focus on access, continuity and convenience of care. SaHF work will give patients across NWL access to high quality Emergency Departments at major acute hospital sites and 9 UCCs operating 24/7. SaHF is also working to implement seven day services across the emergency care pathway.

Modern Maternity Services


• All NWL maternity units will be working towards a common model of care, with midwifery led care in the hospital and community and access, choice and continuity of care for women.

Specialised care


• Significant investment is being made in specialist care to improve health outcomes for patients including investing in 5 major hospitals, all of which will have an A&E and maternity service – Chelsea &Westminster, Hillingdon, Northwick Park, St Mary’s and West Middlesex. There will also be 24/7 UCCs at all 9 acute hospitals treating the majority of current A&E attendees.

• The Acute Reconfiguration will enable the achievement of seven day services across the acute hospitals in NWL.

Enhanced Health in Care Homes

Shaping a healthier future (reconfiguration)

• GP service for nursing home residents aims to reduce the levels of A&E attendance and non-elective hospital admissions.

• Care Homes Pilot brings health and social care professions together with care home staff to look at reasons for ambulance call outs and admissions to hospital from care homes. The teams have looked in particular at preventing falls and managing medication.


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