NHS Five Year Forward View is light (silent?) on competition, commissioning and procurement issues

The Five Year Forward View for the National Health Service was published last week, with Simon Stevens, the fairly new CEO of NHS England, the main author of the 35 page report. It has been well received generally, with a lot of praise for its commitment to the principles of the NHS, focus on prevention, and more joined up structures like this:

One new option will permit groups of GPs to combine with nurses, other community health services, hospital specialists and perhaps mental health and social care to create integrated out -of-hospital care - the Multispecialty Community Provider”.

Both Polly Toynbee and Fraser Cameron liked it, from very different political ends of the spectrum, and even Roy Lilley, the excellent but acerbic health commentator and expert, has been positive. The report also suggests that the NHS will need a further £8 billion a year by 2020 to meet demand, and even that assumes some pretty impressive efficiency gains.

For the NHS repeatedly to achieve an extra 2% net efficiency/demand saving across its whole funding base each year for the rest of the decade would represent a strong performance-compared with the NHS' own past, compared with the wider UK economy, and with other countries' health systems. We believe it is possible–perhaps rising to as high as 3% by the end of the period provided we take action on prevention, invest in new care models, sustain social care services, and over time see a bigger share of the efficiency coming from wider system improvements”.

Whilst I can see why the report has gone down well, and it is a perceptive piece of work, and a good clear read, personally I was left disappointed for two reasons. Firstly, and perhaps selfishly, I was disappointed that there was not the smallest mention of anything procurement related, or even about the commercial and payment structures and routes that are in place. And secondly, but linked to that, I couldn’t help thinking “yes, but how are you going to get to that wonderful place within the current constraints”?

There is nothing here on the mix of public and private provision that is desired or likely; nothing on just how we are going to get GPs (independent contractors, remember) to agree to new roles and responsibilities; nothing on procurement of pharmaceuticals, equipment (or anything else) or the legacy PFI issues; nothing on competition, the commissioning structures or regulatory regime; or how we are going to get these complex new structures as outcomes from what has been set up now as a competitive market driven commissioning system. Even when there is some discussion of efficiencies, they seem to focus on workforce issues and opportunities, not third party spend.

Now I suspect Mr Stevens, were he sitting next to me in Camberley at this moment, would say that this is a directional and strategic document. It is about where we want to go, not the detail of how we are going to get there. And some observers suggest he is avoiding mention of anything (like competition) that might scare people. Even so, given the amount of money that goes to third party suppliers in the health system (including those GPs), it seems a shame that there is no mention of anything related to that huge part of the total expenditure.

So, if nothing else, this highlights one issue. Our professional colleagues in the sector have a job to do in order to get onto Stevens’ agenda – clearly, procurement is not exactly front of mind for him at them moment.

And here is the document if you want to read it yourself... NHS 5 yr plan


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