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Next steps on the NHS Five Year Forward view

1. Next year the NHS turns 70. New treatments for a growing and aging population mean that pressures on the service are greater than they have ever been. But treatment outcomes are far better - and public satisfaction higher - than ten or twenty years ago.

2. With waiting times still low by historical standards but on the rise, and the budget growing - but slowly - it is the right time to take stock and confront some of the choices raised by this challenging context. This plan is not a comprehensive description of everything the NHS will be doing. Instead, it sets out the NHS’ main national service improvement priorities over the next two years, within the constraints of what is necessary to achieve financial balance across the health service. (Chapter One)

3. Perhaps most importantly, we all want to know that the NHS will be there for us and our families when we need it the most - to provide urgent and emergency care 24 hours a day, 7 days a week. Staff are working with great skill and dedication to do so, and looking after more patients than ever. But some urgent care services are struggling to cope with rising demand. Up to 3 million A&E visits could have been better dealt with elsewhere. There are difficulties in admitting sicker patients into hospital beds and discharging them promptly back home.

4. That’s why over the next two years the NHS will take practical action to take the strain off A&E. Working closely with community services and councils, hospitals need to be able to free up 2,000-3,000 hospital beds. In addition, patients with less severe conditions will be offered more convenient alternatives, including a network of newly designated Urgent Treatment Centres, GP appointments, and more nurses, doctors and paramedics handling calls to NHS 111. (Chapter Two)

5. Most NHS care is provided by general practice. One of the public’s top priorities is to know that they can get a convenient and timely appointment with a GP when they need one. That means having enough GPs, backed up by the resources, support and other professionals required to enable them to deliver the quality of care they want to provide.

6. We have begun to reverse the historic decline in funding for primary care, and over the next two years are on track to deliver 3,250 GP recruits, with an extra 1,300 clinical pharmacists and 1,500 more mental health therapists working alongside them. As well as improved access during the working week, bookable appointments at evenings and weekends will be available covering half the country by next March, and everywhere in two years’ time. (Chapter Three)

7. Cancer remains one of the public’s most feared illnesses, affecting more than one in three of us in our lifetimes, meaning most of us will face the anxiety of ourselves or a loved one receiving this diagnosis at some point. Fortunately cancer survival rates are at record highs, and an estimated 7,000 more people are surviving cancer after NHS treatment than would have three years before. Identifying cancer earlier is critical to saving more lives. So we will speed up and improve diagnosis, increase current capacity and open new Rapid Diagnostic and Assessment Centres. Patients will have access to state of the art new and upgraded linear accelerators (LINACs) across the country. By taking these actions we expect at least an extra 5,000 people to survive their cancer over the next two years. (Chapter Four).

8. Increasingly, the public also understand that many of our lives will at some point be touched by mental health problems. Historically, treatment options for mental health compare unfavourably with those for physical conditions, particularly for children and young people. The public now rightly expect us to urgently address these service gaps.

9. Substantially increased investment will enable 60,000 more people to access psychological, or ‘talking’ therapies, for common mental health conditions over the coming year, rising to 200,000 more people in 2018/19—an increase of over 20%. We will also address physical health needs by providing an extra 280,000 health checks in 2018/19 for people with severe mental illness. New mothers will get better care. Four new Mother and Baby Units across the country, more specialist beds and 20 new specialist perinatal mental health teams will provide help to 9000 more women by 2018/19. An extra 49,000 more children and young people will be treated by community services. Both children and adults will benefit from reduced travel distances when they need inpatient care through an expansion and rebalancing of specialist beds around the country. 24-hour mental health liaison teams in A&Es, investing in crisis response and home treatment teams and placing 1,500 therapists in primary care will ensure more people get appropriate care when they need it. (Chapter Five)

10. As people live longer lives the NHS needs to adapt to their needs, helping frail and older people stay healthy and independent, avoiding hospital stays where possible. To improve prevention and care for patients, as well as to place the NHS on a more sustainable footing, the NHS Five Year Forward View called for better integration of GP, community health, mental health and hospital services, as well as more joined up working with home care and care homes. Early results from parts of the country that have started doing this – our ‘vanguard’ areas – are seeing slower growth in emergency hospitalisations and less time spent in hospital compared to the rest of the country. The difference has been particularly noticeable for people over 75, who often face a revolving door of emergency admission, delayed discharge and then hospital re-admission. (Chapter Six)

11. We now want to accelerate this way of working to more of the country, through partnerships of care providers and commissioners in an area (Sustainability and Transformation Partnerships). Some areas are now ready to go further and more fully integrate their services and funding, and we will back them in doing so (Accountable Care Systems). Working together with patients and the public, NHS commissioners and providers, as well as local authorities and other providers of health and care services, they will gain new powers and freedoms to plan how best to provide care, while taking on new responsibilities for improving the health and wellbeing of the population they cover.

12. Mirroring this local action, we will also be taking further action nationally to ensure that the NHS can deliver more benefit for patients from every pound of its budget. While the NHS is already one of the leanest publicly-funded health services in the industrialised world, there are still opportunities to do better, as set out in the NHS’ 10 Point Efficiency Plan. (Chapter Seven)

13. None of this is possible without the outstanding staff of the NHS. Although we have 3,000 more doctors and 5,000 more nurses than 3 years ago, and productivity continues to improve, frontline staff face great personal and organisational pressures from rising demand. As a crucial part of delivering the next steps of the Five Year Forward View, we therefore set out in this document how we will continue to support the NHS frontline over the next two years, with Health Education England expanding current routes to the frontline, and opening innovative new ones to attract the best people into the health service, whatever stage of their career they are at. (Chapter Eight)

14. In doing so, the NHS is on a journey to becoming one of the safest and most transparent health systems in the world. Chapter Nine describes next steps on this agenda. As well as harnessing people power, the NHS also needs to leverage the potential of technology and innovation, enabling patients to take a more active role in their own health and care while also enabling NHS staff and their care colleagues to do their jobs - whether that is giving them instant access to patient records from wherever they are, or to remote advice from specialists. (Chapter Ten)

15. There are considerable risks to delivery of this stretching but realistic agenda, but taken together the measures set out in this plan will deliver a better, more joined-up and more responsive NHS in England. One that is focussed on the issues which matter most to the public. That collaborates to ensure that services are designed around patients. And that is on a more sustainable footing, so that it can continue to deliver health and high quality care - now and for future generations. (Chapter Eleven)