Simon has the vision: we have to deliver. Why saving the NHS is down to everyone of us.

Simon Stevens was on the @BBCR4 8.10am interview this morning, answering questions posted on twitter #AskNHSEngland about the new NHS Five Year Plan. It was a shame really as the tweets really skewed the discussion, and the important questions of where the money would come from (at least another £8Bn requested), the demographic challenge (the current labour intensive approach is unsustainable practically and financially), public redress where services don’t improve /are poor, and the role for each of us in ensuring a sustainable NHS were left unanswered.

There is a telling sentence at the end of summary of the NHS Five Year Plan published today. It reads “there are viable options for sustaining and improving the NHS over the next five years, provided that the NHS does its part, allied with the support of government, and of our other partners, both national and local.” It is a call to arms to all of us. The Five Year Forward View (FYFV) sets out aspirations and ideas for ensuring a sustainable NHS which will require action from everyone of us if it is to succeed.

2020health is delighted that so much of what we have published in the past few years is echoed in this Plan including:

• In our ‘Going with the flow’ report we said there was a need to designate large, specialist hospitals, colour coded blue, as well as their being a role for small, local hospitals colour coded red. The Plan outlines the need to find viable models for smaller hospitals as well as strategic planning for specialist centres (FYFV pg 22).
• In our same report we promoted much greater involvement of individuals and community organisations in health and social care – as we also did in our reflections on nursing – this is echoed throughout the FYFV.
• In our ‘Careless eating costs lives’ report we detailed requirements to tackle obesity, many of which would help with other conditions too. The FYFV is determined or though not detailed on supporting action to deal with public health risks (FYFV pg 10).
• The Plan recognises the vital part that technology has to play; our latest initiative, the ‘Health Tech and You’ Awards is at the forefront of showcasing to the public what is available to help us look after ourselves better, and our reports on the VHA’s use of technology, Electronic Patient records and Healthcare Without Walls have all detailed the art of the possible across healthcare.

The NHS FYFV particularly looks to employers and local authorities to play their part:

• Getting serious about revolutionising prevention by incentivising healthier behaviours, giving local authorities more power on public health, targeted prevention strategies and employment support and workplace health.
• Empowering patients through providing information, voluntary sector partnerships to help with condition management and expanding choice.
• Engaging communities through supporting carers, promoting volunteering, voluntary sector partnerships and with the NHS as an exemplar local employer.

These are all noble aspirations, however much is required of local and national government to deliver the plan, and there are still some key components missing.

1. Whilst the Plan talks about workforce training, we need to horizon scan for the impact of technology which is democratising health in a transformational way. The public will have far more information about themselves, their conditions and their management. The role of professionals will change radically and they need to be ready for that.
2. Serious recognition that much of our health is determined by factors outside of the NHS: education, environment, housing, transport We know this is an NHS plan, but it doesn’t operate in isolation and can’t make improvements in the public’s health alone. Whilst it does reference the role of Local Authorities, this requires more of the coordinated approach that is already being talked about for health and social care.
3. On the public’s health the Plan boldly states that: “So for all of these major health risks – including tobacco, alcohol, junk food and excess sugar – we will actively support comprehensive, hard-hitting and broad-based national action to include clear information and labelling, targeted personal support and wider changes to distribution, marketing, pricing, and product formulation. We will also use the substantial combined purchasing power of the NHS to reinforce these measures.” We know it is outside of their powers, but this FYFV should have been an urgent call to government to act now. Without immediate, determined action on problems such as obesity, much of this plan could fail to deliver a sustainable service.
4. There is huge variation in the way the NHS adopts new technology and medicines and it often doesn’t provide the best, but just the best that can be afforded. If we allow patients to pay for the latest and best in class, then their cost will come down faster and they will be available to everyone more quickly. It is simply not fair to prevent people from choosing to spend some of their own money on a novel technology. The Plan does acknowledge the postcode lottery already in existence, but patients will increasingly look for themselves as to the best treatment available and what power will they have to ensure they receive it?

Elsewhere the report doesn’t pull its punches. It tells politicians to stop meddling:

“In particular, the tendency over many decades for government repeatedly to tinker with the number and functions of the health authority / primary care trust / clinical commissioning group tier of the NHS needs to stop.”

Whilst this is true for national NHS structures, this Plan does actually need local politicians to step up and intervene more to enable the prevention strategies of which this report gives exemplars. And the case still has to be made for intervention – Nigel Farage’s popularity is not independent of his propensity to drink and smoke in front of the cameras. Rebellious freedom appeals to us all in different ways. And that brings us back to the money. The NHS was not set up to prevent, but to treat. Local Authorities are in the early days of getting their heads around health and wellbeing with their Public Health colleagues. With more cuts to LA budgets on the horizon, improving public health could be pie-in-the-sky without at least transitional funding being found. We wait for the politicians to respond – but in the meantime we can begin to ask ourselves how we can Be The Change – for the good of our families, neighbour’s and country’s health.