Health service cannot continue with ‘business as usual’: Nuffield Trust responds to NHS England Forward View

Nigel Edwards responds to the NHS England Forward View and outlines three challenges for NHS England.

Press release

Published: 22/10/2014

Responding to NHS England’s Five Year Forward View, Nuffield Trust Chief Executive Nigel Edwards said:

“This important report makes crystal clear that the NHS cannot continue with ‘business as usual’ if it is to meet the needs of a diverse and ageing population. It sends a firm signal to MPs of the dangers of any future NHS reorganisation and offers a starting point for politicians considering how to reform the NHS in the future.

“The Forward View sets out a radical vision of the different approaches that local areas can take to adapt for the future - from hospitals running GP surgeries - to groups of medical professionals, therapists and social workers buying health services for patients in their area. Unlike previous centrally imposed blueprints for the NHS, Simon Stevens expects this transition to be driven by local clinicians and managers working closely with patients.

“The report also acknowledges the scale of the financial challenge ahead. It recognises that there are big opportunities to improve the efficiency of the NHS but that there is a limit to how far these alone can fill the gap. The concept of ‘flat-real per person’ funding is an important one, as it reveals the true costs of caring for an ageing population. It would show politicians how much more they'd need to increase health spending above inflation to maintain high-quality services.”

This important report makes crystal clear that the NHS cannot continue with ‘business as usual’ if it is to meet the needs of a diverse and ageing population. Nigel Edwards, Chief Executive, Nuffield Trust

Nigel Edwards outlined three challenges for the Forward View:

1. NHS funding

“Without a sustainable long term funding plan for the NHS, it is hard to see how these radical changes can happen. The plan outlines the intention to develop a ‘pump-prime model’ to help services make these changes. But with NHS organisations increasingly going into the red and 2015/16 looking to be a crunch year for the NHS finances, there is a real danger that any money from this will end up papering over the cracks caused by deficits. This is especially likely if a ‘pump-prime model’ or transformation fund is centrally funded and administered.”

2. Social care

"Much of the change needed is to encourage more care out of hospital, which relies on properly funded social care. We have shown that the need for 17,000 extra hospital beds by 2022 could be avoided if there is excellent and coordinated care in the community. But this would cost money and social care has been cut to the bone. We now need a Five Year Forward View for social care.”

3. Behavioural change

"The report is a refreshing break from the top down diktat so often seen in health policy, which relies too heavily on detailed financial incentives and eye-catching initiatives. But this will require local clinicians, communities and commissioners to step up to the plate, and it will need politicians to step back from the desire to ‘fix’ problems with one-size fits all solutions. If we can get this right, it promises to be more effective than past attempts to reform the NHS. But it is a risky approach which needs high quality leadership at all levels of the NHS – from clinicians right through to political leaders.”

Notes to editors

  • Nigel Edwards played an informal advisory role to NHS England on the development of the Forward View, particularly focusing on new models of care
  • The Nuffield Trust’s recent analysis on the pressures on hospital beds is cited in the NHS England Forward View. This found that the growing and ageing population alone would mean the NHS needs an addition 17,000 hospital beds by 2022 unless significant progress can be made in improving hospital productivity and community care.