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5YFV next steps – what they mean for commissioners


Step change: ‘Next Steps on Five Year Forward View’ is here, but what does it mean for commissioners?


The Five Year Forward View (5YFV) was Simon Stevens long, imploring, ultimately optimistic love letter to NHS England. That original manifesto, with its neo-healthcare, Atlantic-crossing ideas and crusade against the old order, promised a fresh perspective.

Now that it’s half way towards the original vision – or two and a half years into the five at any rate – the whole country watches and waits for the green shoots of change. Meanwhile, ‘Next Steps on the Five Year Forward View’ has been duly published, with new targets in some key areas – notably commissioning.

In order to shed some light on what this means we’ve got an expert who could not be closer to the action.


Julie Wood, NHS Clinical Commissioners Chief Executive

View from the expert:

Long before the publication of ‘Next Steps on the Five Year Forward View’ it was clear that the commissioning landscape was evolving. Clinical Commissioning Groups (CCGs) have been playing key roles as architects of this changing landscape and I’m pleased that the Next Steps document has the potential to support the vision that we and our members called for in our ‘future of commissioning’ paper, published last year.

Next Steps recognises just how far clinical commissioning has come since the ‘Five Year Forward View’ (5YFV) was published. Having local clinical leadership at the heart of healthcare commissioning has had immense benefits for patients. While, going forward, we are unlikely to see a single model of commissioning, it is evident that the local clinically-led element must remain, or the NHS will be poorer for it.


Facing up to the challenges

The delivery plan didn’t ignore the challenges. There was a welcome focus on improving primary care, urgent care, cancer and mental health, all of which are priorities for our members. The willingness to relax the 18-week waiting time was an important recognition that the NHS can’t deliver everything that is being asked of it within the resources provided by Government.

That said, the plan won’t solve every problem. The NHS is still being asked to deliver an awful lot with finite funding. CCGs are certainly up for the challenge of working with what they have and creating a sustainable health and care system – but this involves making tough decisions. That means working with those who provide care to establish how best to spend the NHS pounds – they can only be spent once.


Effective prioritisation

There must be recognition that sustainability needs to involve transformation and doing things differently. The NHS provides high-quality cost-effective care, but its ability to continue will be restricted if we can’t prioritise areas which get the best outcomes for patients, while also getting the best value for our limited budget.

Part of this relates to the work that NHSCC are carrying out on medicines spend, referred to in the delivery plan. We’ve worked with our members to produce a list of items that could be considered low priority for NHS funding , either because they offer no or minimal clinical value – because cheaper and equally effective alternatives are available – or are otherwise low priority.

We’re not calling for a blanket ban – there must be flexibility to allow individual patient needs to be met. Through NHSCC our members will work with NHS England, the professions and patient groups on the best way to implement this, ensuring we are taking these needs into account, while making the most effective use of NHS funds.

This work forms only one part of what will be needed to transform the NHS. Clinical commissioners are ready and able to play their part. They continue to work with partners – through Sustainability and Transformation Partnerships, as well as other local arrangements – to deliver a health and care system fit for the future.

Next Steps has the potential to help and drive forward the transformation agenda. It is vital that we work together across the system to make sure its vision becomes a reality, especially if we are to close the gaps laid out in the 5YFV – not in finance and efficiency but, critically, in health and wellbeing, and care and quality.


The Stevens Legacy

Words by John Pinching


In spite of a long cross-party, intercontinental career at the higher echelons of healthcare change management, Simon Stevens remains an enigma – a man on a journey where the destination has not come into sharp focus. Even so, his determination to navigate the chaotic landscape feels very real and there is no doubt that this NHS explorer has gained some very useful traction.

It is perhaps his lack of allegiance to a party (he has worked successfully under Labour and Conservative), and a seemingly stealth-like will to fundamentally and positively change the NHS, which have allowed him to avoid the extremities of political bun fighting. Indeed, Simon Stevens is not an unpopular operator and, when you compare that with Jeremy Hunt’s beleaguered public image, you realise that even a mild approachability in the hostile terrain of public health, is a remarkable achievement.

There have been elements of his conduct which provide clues to his modus operandi. When he told people in Britain to lose weight – he lost weight. He is passionate about reducing sugar from the diets of British citizens, and particularly children – he clearly worries about the same things we do. Furthermore, he hasn’t been afraid to bring elements of what he learnt during his spell in America at United Health, such as Accountable Care Organisations, into an antiquarian NHS. This raises the possibility that the public – contrary to popular belief – don’t reject change to our 1948 institution. We simply respect an honest approach and Stevens has adhered to that.

The targets laid out in the 5YFV and, in particular, his determination to integrate fragmented services – attaching GP surgeries to hospitals – use resources more efficiently and place an emphasis on public responsibility, could represent his lasting legacy.

Ultimately, Simon Stevens’s magic bullet could be a combination of political impartiality, an ‘I’m a user too’ mentality and a ‘Stateside’ perspective, but if the journey ends with an NHS that is both ‘beloved’ and functioning within its means, the appointment of Simon Stevens could just be the greatest decision David Cameron ever made.  




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John Pinching
John Pinching was editor of Pf Magazine until April 2018.


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