The five year forward view’s publication gives good reason to suspend cynicism, stand together and work towards a transformed NHS fit for the 21st century

In recent weeks I have been talking to NHS Confederation members about “suspending cynicism”. With a general election campaign on the horizon this might seem a big ask but I believe growing consensus offers potential for a real transformation in health and care.

The publication of the NHS Five Year Forward View shows there is good reason for my optimism. In a late move, forward view stopped being an NHS England publication and became something that was a creature of all of the arm’s length bodies. In one step, we saw the national organisations take responsibility for their roles and put the accountability for funding squarely where it belongs – with politicians. This was the biggest single impact of its publication.

The challenge

At the NHS Confederation, we have been seeking a coherent view of the future NHS from national bodies and politicians. Members are sick of being told they are on a burning platform – the flames are licking around their ears – and are seeking an ambition that we can all support. Tired of waiting, earlier this year we published – with the largest and most powerful frontline coalition assembled – the 2015 Challenge manifesto.

It is a statement of what we need from politicians and national bodies if we are to deliver an NHS fit for the 21st century. The fact that patient groups, professional bodies, all the nursing and medical royal colleges, public health, local government and NHS leaders have signed up makes it an unprecedented statement.

‘NHS organisations are sick of being told they are on a burning platform and are seeking an ambition that we can all support’

The consensus between the vision of frontline organisations and that of national bodies is striking: approaches to wellbeing which focus on communities not organisations; supported self-care; integrated care in communities (particularly for the frail); local hospitals with new models of partnership; seven day services; specialisation with innovation, health and wealth – there is hardly a nicotine patch between them. The “asks” overlap to a great extent too, though we would seek longer term settlements, more on social care, payment system reform, simplified regulation and an improved health outcomes framework.

Consensus is one thing, but delivering change will require two things to be in place. The first is in our control. The national bodies need a genuinely new relationship with local leaders. This means a national framework that is locally delivered and locally led, something signalled by the forward view. To successfully do this we will need to overcome ingrained behaviours like risk aversion and intolerance of failure. Instead we need to stand together as we take the health service through unprecedented times and forge a new approach to what it means to lead in a 21st century NHS.

‘An honest debate with the public will, I believe, lead to a lasting commitment to the NHS’

The second is not in our control. Politicians need the courage to do what only they can do. They need to be facilitators of change. This means backing change – recent YouGov work commissioned by us is striking in terms of how the public will support change where it is evidence based (76 per cent) and in how little they know about care (40 per cent feel they know enough to engage in the debate). They also feel politicians aren’t honest with them about the future of the NHS (81 per cent). Research we have done into MP attitudes shows 81 per cent see change as essential in their local NHS but 58 per cent feel there is a lack of political will to deliver. Since 78 per cent of NHS leaders see this as a barrier to change too, there is much to do.

Silence on social care

Politicians will also need to find the resources to deliver a new health and care system. The forward view sets out very clearly what this means for the NHS. It is silent on social care. Whatever the outcome, we are now in a position where the accountability for funding sits squarely where it belongs. The amount we spend on health and care is a political decision and politicians need to be clear with the public about how much investment they will put in health and care and what kind of service this money will be able to fund.

It is six months until polling day. In the days and weeks ahead we need a general election campaign which facilitates an open and frank conversation around the future of health and care, a campaign which sets out the big challenges and agrees the solutions we need. An honest debate with the public will, I believe, lead to a lasting commitment to the NHS.

Rob Webster is chief executive of the NHS Confederation

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