Forward view analysis: Apply proven change now

The NHS Five Year Forward View published by Simon Stevens and NHS England is bold. It is radical, insightful, essential and welcomed. It is also risky.

The forward view sets out a vision of a new NHS that our country must create, which is more proactive, responsive, personal, productive and viable. Because, simply, our current NHS has served us outstandingly through generations but cannot, unreformed, meet our future needs.

‘Stevens has set the NHS on a journey’

Mr Stevens has set the NHS on a journey, where politicians invest and the NHS simultaneously transforms itself, which is a wish that citizens must hope comes true.

The report describes an NHS that is true to the values of our country, but builds on the best innovation and experience in healthcare internationally.

The best health organisations and systems across the world have achieved some of what the forward view envisages. Few, if any, have done it all. In this way, it is bold, radical and insightful. The NHS has an almost unique opportunity now to consistently transform healthcare, which will make it a world class leader. It is essential that this opportunity is seized.

Risky business

The forward view is risky. Asking politicians for £8bn in a time of austerity felt very bold, and offering to find the other £22bn required if politicians provide the £8bn may prove overly generous, if the chancellor or his successors continue as he has started with his autumn statement commitment.

However, having found £2bn, it may prove politically much easier, and frankly attractive, to any future chancellor to find the other £6bn if doing so commits the NHS to the excruciating challenge of finding £22bn to make good on their own deal.

Five years of unprecedented “Nicholson challenge” cost constraint will be followed by five years of unprecedented savings funded transformation under the forward view. The NHS should now be prepared for its bluff to be called. And that’s not a lot of notice; even Joseph (he of technicolour coat fame) had seven bumper years to prepare for seven years of famine.

‘The best systems internationally provide care at home, not just close to home’

So, like the patients and communities it serves, the NHS faces not just a short term diet programme - this is a question of a permanent lifestyle change. The forward view is of an NHS with greater pace, greater power, greater stamina and greater flexibility - the pace and power of a sprinter, stamina of the marathon runner and flexibility of a gymnast.

Combining all these skills simultaneously is rare - even Daley Thompson (for those of a certain age) didn’t possess all those qualities.

So is this possible? In short, the answer is yes. But only if the NHS focuses on rigorously implementing proven change now, rather than losing time seeking a new silver bullet solution.

The future NHS faces unprecedented challenge. But so do almost all other health systems.

The challenge of responding to this is well understood, but in most systems leaders are not confident to change. They often delay acting even when the need to change is known. During 2014 KPMG surveyed over 500 healthcare leaders in 50 countries.

Seventy-three per cent said their systems need to change fundamentally, but only 35 per cent said their organisations need to change, and only 19 per cent said they were definitely ready to change.

We also brought together in London 65 healthcare leaders from 30 countries across six continents and asked them to sum up the keys to healthcare transformation - what to do and how to do it. We then compiled the findings into a report, to set out what works, and how this can be achieved by the NHS leaders.

Long term thinking

How the best systems have transformed themselves is clear: they have applied long term thinking to fix short term problems; they are continually self-questioning in search of greater improvement; they never deviated; and they started immediately.

There are also similarities in the way they implement the best systems: they provide care at home, not just close to home; they use information excellently and engage their people consistently; and they change care across systems, not just within organisations.

Above all they know that patients are their purpose and key players in the solution, not the problem.

‘The future the forward view describes is essential for the NHS to succeed’

The forward view embraces this and other learning. The future it describes is essential for the NHS to succeed.

It is something that we as citizens must wish for. Getting there will require a huge effort by the NHS. It appears that the politicians are lining up to play their part.

The NHS can lead the healthcare world if it achieves the transformation of care the forward view envisages.

Andrew Hine is UK head of public sector and healthcare for KPMG