Integrated care: organisations, partnerships and systems Contents

3NHS Five Year Forward View

45.Sustainability and transformation plans and partnerships, integrated care systems, new models of care, integrated care partnerships and accountable care organisations are all mechanisms designed to achieve the aims of the NHS Five Year Forward View. This chapter describes the aims of the NHS Five Year Forward View and introduces these new ways of planning and delivering local health and social care services.

46.The NHS Five Year Forward View set a collective vision for how the NHS needed to change between 2015/16 and 2020/21. The vision sought to address persistent variations in health inequalities and the quality of care as well as address the growing gap between resources and patient demand.

47.The NHS Five Year Forward View set out three financial scenarios for closing the NHS’s £30 billion funding gap (between patient need and the available resources) by 2020/21. The third of these scenarios suggested that £22 billion of efficiencies could be delivered by 2020/21, meaning that the health service would be required to improve productivity by an average of 2–3% over the period. This is significantly higher than the average rate of productivity growth the NHS has delivered in the past but it also depended on adequate funding of social care and public health.29

48.As well as transforming care, sustainability and transformation partnerships, including integrated care systems, and new models of care are also intended to address the funding gap by managing and redistributing limited resources and improving efficiency by slowing the rate of activity growth in acute services. The Government set out an ambition to deliver £900million in savings from new care models by 2020/21.30

49.The delivery of the NHS Five Year Forward View is based on the following principles:

50.The new forms of planning local health and social care services (sustainability and transformation partnerships and integrated care systems—see Chapter 4) and delivering care (new care models, integrated care partnerships and accountable care organisations—see Chapter 5) can be seen a manifestation of these principles, although there are examples where these principles have not been adhered to.

51.Unlike previous efforts to reform the NHS, the national bodies have opted to make evolutionary changes within the existing legislative framework rather than introduce changes through primary legislation. As Simon Stevens described:

Our whole process of change through the Five Year Forward View has not been just about issuing a single administrative blueprint and then a reshuffling of the administrative deckchairs. It has been entirely grounded in the question of what care should look like and how patients should be looked after, and then everything else, be it funding flows, organisational structures or governance, is the means to the end of trying to get that right. That is what distinguishes this set of changes from just about every other reorganisation the health service has been the victim of since 1948.32

29 NHS England, Five Year Forward View, October 2014

30 National Audit Office, Health and social care integration, HC 1011 Session 2016–17 8 February 2017, page 9

31 NHS England, Next Steps on the NHS Five Year Forward View, March 2017, page 29

32 Q325

Published: 11 June 2018