Weren't new care models supposed to solve the NHS crisis?

For a document that has been supported by pretty much everybody, NHS England's Five Year Forward View has had very little impact on how leaders in the NHS actually do their job. The document’s narrative – that developing new models of care in the NHS holds the answer to the triple crises of quality, health and resources – appeared to gain blanket assent. However, 18 months on, most leadership behaviour takes place outside of that solution.

In fact, most leadership actions take place within only one part of that narrative. While there is agreement with the Five Year Forward View about the cause of the NHS crisis (namely that there is a growing set of intersecting problems around health, health care quality and resources), current leadership behaviour seems to argue that in order to address these crises we should stabilise the current model of care.

This means that the part of the Forward View narrative which says that the crises will be solved by the NHS developing new models of care has slipped into the future. Leadership actions now take place as part of a two-stage process that seems to run as follows:

1. First, let's stabilise the current model of care to get rid of the problems...

2. ...And then let’s turn to transformation.

Putting off the hard work of transformation until we have ‘dealt’ with the deficit was not the narrative of the Five Year Forward View. There, the analysis was based upon the belief that the crisis is caused by the way in which the current models of care fail to meet new and increasing demand. So, stabilising the current system of fragmented care will do nothing to enable services to meet these new demands. Indeed, if we go on treating the increased demand for new health care with the fragmented services of the past, we will in fact build the crisis further into the system.

So the two-stage approach of stabilising first and transforming next doesn’t fit with NHS England's analysis of the depth of the problems. Put simply, the Forward View would argue that pumping this year’s transformation money into the 2015/16 deficits will do nothing to solve the bigger deficit in 2017/18 and onwards.

Stabilising the fragmented system of care is not a long-term answer in 2020. But it's also not an answer now.

The extra people coming through the door with several comorbidities in 2016 can’t be dealt with by the existing model today. The development of the new care models is not being carried out because we like something bright and shiny and new. According to Simon Stevens's blueprint, ‘the new’ is being developed to come to the aid of the crisis in the NHS right now. 

That means that ‘the new’ has to answer some difficult and crucial questions. The NHS has, over the years, been very good at creating new services. Every day, somewhere in the NHS, someone is creating something new. It is also the case that most of the new services that are created actually care for people that they are already serving. So the new and the care bit have been a part of the NHS for ever.

What has to be special about the new care model is that it creates a model that can be followed by others. Forming these into a replicable model means that all the different Vanguards have to shave some very local aspect of what they are doing in their locality into something that can be applied everywhere.

But the question the new care models need to answer is bigger than that. Are they capable of filling in the three gaps of health, quality and resources? Do they provide better care, cheaper per patient, than the current old models of care? If they do, they carry out the task that is needed. If they don’t, then we are left trying to stabilise a system that cannot be stabilised.

The crisis of increased demand is here now. It’s already arrived. Rather than striving to stabilise a system that cannot solve these problems, we need to pay much closer attention to exactly how the new can come to the aid of the old and move the problems on.

The views presented in this blog are those of the author and do not necessarily represent the views of the Nuffield Trust.