167.The Five Year Forward View looks beyond immediate pressures and sets out a vision for the future of the NHS. However, while the Forward View sets out the vision, it does not say how to get there. The scale of that challenge is colossal, especially given the timescale for achieving it.
168.There are grave doubts about the capability and capacity in both the NHS and the social care system to achieve the vision set out in the Five Year Forward View, especially given the acute and increasing financial pressures which are apparent in the hospital sector and in social care. With much of the upfront investment flowing from the Spending Review being used to address deficits, there is a real danger that greater integration and the move to the new models of care set out in the Five Year Forward View will stall.
169.Some parts of the system—such as those we visited in Salford—are performing well and making progress towards achieving the aspirations of the Five Year Forward View and the Government’s plans for seven-day services. This has been made possible by the determination of teams working together in the best interests of their communities, and has in many places been supported by extra money made available from the centre.
170.New models of care and the measures to achieve demand reduction which are crucial to the achievement of the Five Year vision are not being embedded across the whole system. These changes are not happening at sufficient scale and pace across the wider NHS and social care. The integration of health and social care—not just the integration of funding, as in the Better Care Fund, but getting commissioners and service providers in each sector to work more closely together to deliver a service to their local population—is not proceeding at the required pace. Furthermore, there is a risk that cuts to funding outside NHS England, such as public health and social care, will put the achievement of the Five Year vision at risk.
171.The Forward View needs to be accompanied by strategic thinking from Ministers about what priorities will best support achievement of the vision when resources are constrained. They should be prepared to set out the evidence as it develops on the value delivered by seven-day services and how that compares with other priorities such as action on prevention and public health.
172.Given the scale of rising demand and costs we are not confident that the efficiency challenge is achievable. We are concerned about the failure to plan for the consequences if the current plan for savings is not achieved.
173.We believe it is time for the Government and NHS England to set out how they will manage the shortfall in NHS and social care finances and the decline in services to patients if the measures proposed in the Forward View fail to bridge the funding gap. If the funding is not increased, there needs to be an honest debate about what that will mean for patient care.
174.As we have noted at various points through this report, we will continue to monitor the situation closely throughout the Spending Review period. We expect to return to the subject of the impact of the Government’s spending decisions on health and social care on a regular basis and hold Ministers, NHS England and NHS Improvement regularly to account over the course of the Spending Review period.
15 July 2016