The nature of the NHS: is it changing?

Abstract

has got itself in first—in the shape of Simon Steven’s Five Year Forward View. The NHS may be cash-strapped, but the bid for extra funding is already in —almost certainly too low, but then it was almost certainly an opening bid. More importantly, if only at a pretty high level, the Five Year Forward View spelt out a strategy for the next five years to help deal with the finances, to which, at least on the face of it, all the main political parties have subscribed. That has bought time. One of the most notable things about the Five Year Forward View, is that, perhaps for the first time in NHS history, it made transparently clear that not everything has to be organised the same everywhere. The new, more integrated, models of care could involve hospitals reaching out into the community and even running general practice, or multi-speciality groups of GPs taking over hospitals, or something in-between. Not insisting that the structures need to be the same everywhere is quite some departure—and an encouraging one. The challenge, of course, is operationalising it. But here too, there is a difference with the past. Rather than NHS England (or NHSE, Monitor, the CQC etc) deciding on their own which of the pioneers, or ‘vanguardistas’ as Simon Stevens has dubbed them, will go ahead, a Eurovision-style vote from among the 268 applicants (an astonishingly high number) will play a part in deciding who goes ahead—and thus who, presumably, will get access to the modest £200 million ‘transformation’ fund that has been earmarked for next year. That’s a very different style to the past. Allied to the decision that 65 CCGs from April will take fully delegated powers for primary care budgets, and in operational terms, a different and more variegated NHS, with different and more variegated links to social care, can start to be glimpsed. The proposal for Manchester to take over the entire £6 billion health and social care budget for its area—an idea still a long way from fruition—is just the most extreme example of that. So it is just possible that the operational nature of the NHS—no longer so monolithically organised into similar models pretty much everywhere—is genuinely changing. And the fact that it is, and the fact that that provides a challenging agenda in its own right, might just help protect it from a political debate about new funding models, even though the money is running out. We will see. BJHCM Nick Timmins, senior fellow at the Institute for Government and the King’s Fund, argues that the nature of the NHS and debates surrounding it are changing The nature of the NHS: is it changing?