Health leaders' panel survey four: looking forward

This fourth survey looks at the future of the NHS, and in particular whether NHS England’s Five Year Forward View has accurately diagnosed the challenges faced by the health service.

Data story

Published: 19/03/2015

Download the survey [PDF 1.9MB]

Our fourth poll was conducted between 20 February and 6 March 2015, via an online survey.

In total, 66 of our 100 panellists responded. Of the 66 respondents, 28 are senior NHS managers, 20 are clinicians or clinical leaders, ten are from local Healthwatch bodies and six are from the social care sector. Of the health service managers and clinicians, 22 are from acute hospitals, nine from CCGs, five from private or voluntary sector providers, four from mental health providers, four from NHS ambulance trusts and four from NHS community trusts. Two did not provide information to identify themselves.

The panel members are named on our website, but their individual responses to the survey are anonymised.

Our survey results are accompanied by a series of policy briefings on the issues and challenges we believe are critical to the longer-term success of the health and social care system, and which any new administration following the election will need to prioritise. Find out more about our policy briefings and our other General Election work.

Key points

  • 77% say adequate funding for health and social care is key for the next government
  • 61% think the 5YFV identifies challenges they are experiencing locally
  • 3/4 are not convinced the NHS can make the 5YFV's £22bn efficiency savings
  • 4 in 5 see ‘In-reach support in care homes’ as the new model most likely to improve quality
  • 82% expect volunteers to play a greater role in their own organisation in the next five years
  • Only 41% think the voluntary sector is well equipped to perform a wider role in the NHS

Findings

Question one: Which are the two greatest challenges facing the incoming government?

In the first Health Leaders’ Panel survey in June 2014, panellists were asked for their priorities for the next government. From these answers we produced a shortlist of the most common priorities they identified and in this survey asked them to select from this list the two greatest challenges for the next government.

Unsurprisingly, ensuring ‘adequate funding for health and social care’ was chosen by 77% of respondents, but the second most popular choice was ‘integrating health and social care’, selected by 38%.

This suggests that the sector believes further integration will be necessary in the next parliament, regardless of whether this has been set out as a policy commitment by the major parties.

Question two: How effective do you feel NHS England’s Five Year Forward View (5YFV) is in identifying the challenges you are experiencing locally?

In a vote of support for NHS England’s Five Year Forward View, 61% of respondents said that the plan is very effective or quite effective in identifying the challenges they are experiencing locally.

However, there was less certainty about how well placed the service is to achieve the objectives set out in the document. One described the document as “politically astutely placed” but added:

[There is a] risk of confusion and too many options being run and wasted effort, but [it] has galvanised hope amongst many that finally we have an NHS leader that understands not only the need to change, but allowing the operationally expert frontline to design and run with what works best for patients

Acute trust panel member

Another said:

I think the diagnosis on the strategy is good, but am not so sure that the proposed steps will achieve the objectives

Healthwatch panel member

New care models set out in the Five Year Forward View

The next two questions asked panellists about these new care models outlined in the 5YFV.

  • Further concentration of specialised surgery and cancer services: Centralising cancer and surgery services where there is evidence that bigger units with more senior doctors, support staff and technology can improve quality.
  • In-reach support in care homes: New ways for the NHS to work with people in care homes to stop their needs intensifying, including rehabilitation programmes and reviews by doctors.
  • Making small hospitals viable: Sustaining smaller hospitals by creating chains, integrating or inviting specialist providers to provide some services at smaller hospitals.
  • Multi-speciality community providers: Groups of GP practices forming larger organisations and employing specialists to deliver outpatient treatment and targeted support for people with long-term illnesses.
  • Primary and acute care systems/accountable care organisations: Combining primary and acute provision, potentially leading to new organisations taking accountability for the whole health needs of a registered list of patients.
  • Urgent and emergency care networks: Linking hospitals to make sure emergency patients get to where their needs can be met in the quickest and most efficient way, along with improved mental health crisis services and expanded GP out-of-hours provision.

Question three: How effective will the new care models set out in the 5YFV be in helping the NHS meet its qualityobjectives over the next five years?

We asked panellists to think about the likely impact of some of the new models of care outlined in the Five Year Forward View. These are summarised in the box above.

Of the new care models, the one viewed as best placed to help the NHS meet its quality objectives by most respondents was ‘in-reach support in care homes’, with 81% of respondents selecting this as either very or quite effective.

This was followed by ‘multi-specialty community providers’ (67%), ‘further concentration of specialised surgery and cancer services’ (66%), ‘urgent and emergency care networks’ (64%) and ‘primary and acute care systems/accountable care organisations’ (63%).

The only care model not viewed as effective by a majority of respondents was ‘making small hospitals viable’ (47%).

Question four: How effective will the new care models set out in the 5YFV be in helping the NHS meet its efficiency objectives over the next five years?

When efficiency objectives were considered, ‘in-reach support in care homes’ was once again viewed as effective by most people (60%), but ‘primary and acute care systems/accountable care organisations’ also achieved this score. This suggests that participants are much more confident about the ability of primary and acute care systems to release efficiency gains than to drive quality, but feel that ‘in-reach support in care homes’ would achieve both objectives.

‘Further concentration of specialised surgery and cancer services’ was viewed as very or quite effective by 56% of respondents, and ‘multispecialty community providers’ by 53%. Neither ‘urgent and emergency care networks’(44%) nor ‘making small hospitals viable’ (31%) were viewed as very or quite effective by a majority of respondents.

Question five: Will the development of multi-specialty community providers and primary and acute care systems lead to a significant change in the way commissioning is organised?

Sixty-seven per cent of respondents feel that the development of multi-specialty community providers and primary and acute care systems (two new care models outlined in the Five Year Forward View) would lead to significant change in how commissioning is organised.

One respondent suggested payments and incentives would need to change, with ‘year of care’ approaches becoming more common. Another said:

Commissioning should become very high-level and based on outcomes and value for money, it should be combined health and social care. The footprint for commissioning should also be over a much wider area than currently

Acute trust panel member

A further respondent said:

If it doesn’t [lead to a significant change] we will not get the benefits out. Capitation funding needs to be part of the new model and most of the transactional commissioning activity will be required

Acute trust panel member

Question six: How confident are you that the NHS can meet the £22 billion efficiency challenge, as implied by the Five Year Forward View?

Although respondents are broadly positive about the Five Year Forward View’s success in identifying the challenges they face, they are not convinced about its ability to help them generate the significant savings required.

Three quarters of respondents (76%) said they are either not very or not at all confident that the NHS can meet the £22 billion efficiency challenge, as implied by the Five Year Forward View. No respondents said they were very confident that the NHS could meet the efficiency challenge.

Question seven: How well equipped do you think the voluntary sector is to perform a wider role in the NHS?

Views were mixed in response to this question, with 41% of respondents stating that the voluntary sector was very well or quite well equipped to perform a wider role in the NHS (as suggested in the Five Year Forward View), while 35% said it was quite unequipped or very unequipped.

Respondents suggested the voluntary sector was under-resourced and often had problems ‘gaining traction’ at local level. One respondent said:

Parts are well established and can contribute, others less so. Some of the big voluntary sector players are running businesses with ethical values and not for profit, but they are businesses. The costs they are generating are similar to other providers so one must question the added value. Smaller-scale mid-sized local organisations that can maximise local social capital are better placed to be part of a PACS [primary and acute care systems] solution

Acute trust panel member

Another spoke of ‘some stunning examples of high-quality voluntary or community interest company provider organisations’ (Healthwatch panel member). However, there were also concerns about poor governance and management.

Question eight: Do you envisage volunteers playing a greater role in your organisation in the next five years?

In spite of the mixed response to the previous question, a significant majority of respondents (82%) said they expect volunteers to play a greater role in their own organisation in the next five years.

Many respondents described advisory and support roles such as patient buddying, advocacy and peer support, but others suggested supporting direct care and fundraising, and even care-giving on wards, and administrative and clerical support functions.

Question nine: Which area or areas of the NHS workforce do you think will experience the greatest staff shortages over the next five years?

The most frequent response from our panellists on which area of the NHS workforce will experience the greatest staff shortages over the next five years was general practice, an option selected by 81% of respondents. Seventy-six per cent selected accident and emergency doctors, and 53% chose community nursing.

More than one respondent commented on the challenge that already exists in recruiting paramedics.

Question ten: What obstacles do you think there are preventing the implementation of the ideas set out in the Five Year Forward View?

Several panellists spoke of the need to fight fires and to focus on day-to-day survival getting in the way of implementation of the Five Year Forward View goals. Others identified culture and poor leadership as obstacles.

One highlighted cynicism and a desire to centrally control rather than to ‘allow local expertise to be freed and focused on patient care’ (Acute trust panel member).

Another said ‘lack of courage in our NHS leadership and interference by local politicians – NIMBYism will rule’ (Community trust panel member).

More than one respondent said that CCGs were too small in size to drive the changes effectively.

Question eleven: Which mechanisms do you think have been the most and the least effective in improving the NHS to date?

Asked to choose between the options set out in the figure above, a quarter of respondents (26%) selected 'clinical leadership' as the most effective improvement mechanism, with 'organisational leadership' being chosen by 23%, 'learning from the Francis review' and 'other service failures' chosen by 13%, and 'local innovation' by 13%.

One respondent said:

Francis was a wake-up call and has definitely had an impact on how people approach improvement

Healthwatch panel member

But another said:

There is no one silver bullet – it is a combination of many initiatives taken by management and staff at all levels

Healthwatch panel member

Nineteen per cent of panellists selected financial penalties such as the marginal tariff as being the least effective mechanism in improving the NHS, with 15% choosing competition, the same percentage picking locally led system management, and 11% choosing central targets and performance management.

Several respondents were critical of the regulatory system, with one saying:

The system of economic regulation pushes organisations to act in their own best interest, not those of the system as a whole

CCG panel member

Another said:

There’s no evidence that regulation improves quality

Acute trust panel member

Suggested citation

Crump H and Thorlby R (2015) Health leaders' panel survey four: looking forward. Nuffield Trust, 19 Mar 2015.

Comments