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A new relationship with people and communities: Actions for delivering Chapter 2 of the NHS Five Year Forward View

The report from the People and Communities Board to the Chief Executive of NHS England

In autumn 2016 the People and Communities Board (PCB), as part of the NHS Five Year Forward View, was invited by NHS England Chief Executive Simon Stevens to recommend a set of ‘high impact actions’ for accelerating the adoption of person and community-centred approaches to health and care. More detail about the board, the terms of reference for this project, and the process adopted, is in section 8 of this report.

Why this matters

This project has arisen from the board’s work to champion and support the delivery of Chapter 2 of the Five Year Forward View. Chapter 2 sets out the vision of a health and care system which fully engages people in their health, care and wellbeing, including by working in partnership with communities and the voluntary, community and social enterprise (VCSE) sector.

A growing body of policy, evidence, thinking and practice is now pointing the NHS to work in these ways. The reason is that they improve health; improve the outcomes of care and treatment; improve the allocation of resources; and build social value and community resilience. Health and care professionals are increasingly finding that these approaches enable them to practice their disciplines in more humane, holistic and rewarding ways.

As long ago as 2002, the Wanless Review made the case for such approaches as a fundamental means of improving outcomes and containing cost increases. Chapter 2 updates this case: “a new relationship with patients and communities” is not an add-on but necessary to achieving the goals of the Five Year Forward View. Despite progress, and NHS England’s own leadership role, there is no delivery plan for Chapter 2: for systematically scaling and replicating the most effective person-centred and community-focussed approaches to health and care.

The result is to exacerbate the pressures currently being experienced in the NHS, especially unplanned emergency hospital admissions; increased demand on accident and emergency capacity; deteriorating waiting time performance, and delays in discharge from hospital. It also means worse care and worse outcomes, especially for people whose circumstances are further disadvantaged by a variety of social and economic inequalities.

There is an absence of consistent and coherent support for people with long term conditions, and inadequate engagement with the VCSE sector. We address these issues and more in our recommendations.