The King’s Fund has warned that funding problems could derail the Five Year Forward View’s aspirations to transform NHS services.
In a report on the progress of the Forward View, the healthcare think tank says that almost all of the additional funds available to the NHS in 2016/17 have been used to sustain existing services, specifically to reduce deficits in NHS acute providers, rather than on new experimental endeavours.
“NHS leaders both nationally and locally have been preoccupied with sustainability because of the growing pressures on health and social care and evidence that NHS organisations are missing key targets for patient care,” the report says. “Much less of their time has been dedicated to transformation than might have been expected given the central importance of the Forward View.
The report adds: “This matters because the pressures on health and social care will not be tackled simply by additional funding, staff working harder, and patching up existing services through ‘sticking plaster’ solutions. These pressures result from a growing and ageing population placing ever greater demands on a system already under huge strain. This is evident in year-on-year increases in A&E attendances and emergency admissions to hospital, high bed occupancy rates, and rising delayed transfers of care.
“The rationale for new care models is precisely that they hold out the prospect of moderating rising demands for care by focusing on prevention, early intervention, admission avoidance and support for people to remain independent in their own homes. The challenge is that developing alternatives to care in hospitals and care homes requires investment, which is currently in short supply.”
The authors point to the transformation of mental health services, which started in the 1970s and resulted in a much-reduced role for hospitals and a much stronger focus on care in the community, as an example of where such experimentation has been done well. “Mental health services were transformed as successive governments provided funding to pump-prime investment in community services… [This] shows that major changes of the kind foreshadowed in the Forward View are possible with adequate funding for transformation and if sufficient time is allowed for them to be planned and implemented.
“With two out of the five years covered by the Forward View already elapsed, the lessons are clear and need to be acted on with urgency. Leaders at all levels need to redouble their efforts and recognise that transformation holds the key to dealing with the sustainability of services.”
Responding to the publication of the report, Professor Derek Bell, president of the Royal College of Physicians of Edinburgh, commented: “The issues highlighted by the King’s Fund clearly resonate with our members working in England. Investment in services needs to be targeted at the areas for which it was intended, otherwise we risk being unable to achieve the aims set out in the NHS Forward View. Part of the underlying problem is the development of too many short-term initiatives without adequate evaluation.
“With growing demands on the NHS and our ageing population, there must be a commitment to invest in and improve health and social care integration to create a sustainable NHS able to deliver the best possible patient care in the most appropriate setting.”
