The NHS five year forward view, published in October 2014 set out a view for the future to ensure sustainability of healthcare services and economic prosperity with strong emphasis for the following:
a. Radical upgrade in activist prevention and public health
b. Removal of barriers between family doctors and physicians, between physical and mental health and between health and social care with significant localised or community-based care delivery supported by specialised centres
c. Shared budgets and combining health and social care
Models of Care
Seven new models of care were introduced for the development, testing and implementation.
1. Multispecialty community providers comprising of GPs, nurses, mental and social care specialists providing localised care
2. Primary and acute care systems – integrated hospital and primary care provider to operate like an Accountable Care Organisation being responsible and accountable for their financial performance and management
3. Urgent and emergency care network to comprise of A&E, GP out of hours, urgent care centres, NHS 111 and ambulance services
4. Acute care collaborations across different providers
5. Specialised care to be semi-centralised for better clinical outcomes and economies of scale
6. Modern maternity services to allow mid-wife led units and exploring deliveries at home
7. Enhanced healthcare in homes linked with secure video to hospital allowing consultation in and out of normal hours
In the past two years, the NHS has been testing new models of care across the country at 50 pilot sites. Local leadership has been asked to come together to draw up sustainability and transformation plans (STPs) that map out how they intend to transform services in their local areas within the funding available to them.
A Sustainability and Transformation Fund (“STF”) of £2.1 billion was established for 2016/17, with almost 90% being used to cover current provider deficits. The latest guidance has again earmarked £1.8 billion of the fund per year to help cover provider deficits in both 2017/18 and 2018/19.
The plans are ambitious and right for the country but with little money left for transforming services, the goals may not be realistic where they depend on investment in new services that is not available. Funds for capital investment are limited, and this may inhibit the implementation and spread of new care models. In addition to financial funding, issues around commissioning and contracting, incentives to support new model of care, investments in health-related IT and leadership development are some of the other challenges which needs to be addressed to get the ball rolling.