NHS Leaders set out vision for healthcare in England

The NHS is at a crossroads and needs to change and improve as it moves forward.

That was the message from NHS England’s Chief Executive Simon Stevens today as a Five Year Forward View for the NHS was launched.

As the Forward View document was published, Mr Stevens told an audience of key stakeholders: “Healthcare in this country has improved dramatically over recent years and has weathered recent financial storms with remarkable resilience, thanks to protected funding and the commitment and dedication of NHS staff.

“But the NHS is now at a crossroads – as a country we need to decide which way to go. The Forward View represents the shared view of the national leadership of the NHS, setting out the choices – and consequences – that we will face over the next five years.

“It is perfectly possible to improve and sustain the NHS over the next five years in a way that the public and patients want. But to secure the future that we know is possible, the NHS needs to change substantially, and we need the support of future governments and other partners to do so.”

He explained: “We need to get serious on three fronts: we need to take our own health seriously, change the way services are provided, and yes ask the next government to support us financially to carry on delivering high quality services.

“There’s a broad health campaign that we need to take because the fact is if we keep piling on the pounds on our waistline we carry on piling on pounds needed to sustain the health service.”

Mr Stevens said the Forward View is not a blueprint for care throughout the entire country, adding: “England is too big for a one-size-fits-all plan, and nor is the answer to simply let ‘a thousand flowers bloom’. It’s horses for courses.

“The NHS continues to be highly valued by the British people. But what’s great about the NHS cannot disguise what needs to change in the NHS.”

The Five Year Forward View is a collaboration between six leading NHS groups including Monitor, Health Education England, the NHS Trust Development Authority, Public Health England, the Care Quality Commission and NHS England.

It represents the first time the NHS has set out a clear sense of direction for the way services need to change and improve.

Professor Sir Bruce Keogh, NHS England’s National Clinical Director, set the Five Year Forward View into context, telling stakeholders: “We need to find new ways of doing things or quality will suffer.

“We can cope with increased demand through better prevention and greater efficiency of care. Any financial debate must simply be a consequence of the value we place on healthcare.”

As well as the national leadership of the NHS, the Five Year Forward View has also been developed in partnership with patient groups, clinicians, the voluntary sector and think tanks.

The document, published in full on the NHS England website today, sets out why the NHS needs to evolve, the challenges that lie ahead and how these can be met.

It details the actions that will be taken to deliver transformed care for patients, and the help that will be needed from others.

It sets out the stark choices facing the country, arguing that unless decisive action is taken now, in five years’ time we will face a growing health and care quality gap.

Simon Stevens outlined how action needs to be taken on four fronts:

  • Do more to tackle the root causes of ill health. The future health of millions of children, the sustainability of the NHS and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health. The Forward View backs hard-hitting action on obesity, alcohol and other major health risks.
  • Commit to giving patients more control of their own care, including the option of combining health and social care, and new support for carers and volunteers.
  • The NHS must change to meet the needs of a population that lives longer, for the millions of people with long-term conditions, and for all patients who want person centred care. It means breaking down the boundaries between family doctors and hospitals, between physical and mental health and between health and social care. The Five-Year Forward View sets out new models of care built around the needs of patients rather than historical or professional divides.
  • Action needed to develop and deliver the new models of care, local flexibility and more investment in our workforce, technology and innovation.

The document also concludes that action will be needed on demand, efficiency and funding.  More action on any one of the three will reduce the pressures on the other two.

It shows how delivering on the transformational changes set out in the Forward View, combined with staged funding increases as the economy allows could feasibly close the £30 billion gap by 2020/21, and secure a far better health service for England.

Supporting the launch of the NHS Five Year Forward View David Bennett, Chief Executive of Monitor, said: “If the NHS is to provide the best service it can to the public, and live within its means, it has got to change the way it delivers care to people. The Forward View sets out our vision of an NHS which can deliver better care and a better experience for patients, and is able to do more of this for however much money we can give it, and is therefore sustainable.

“The NHS will do its best to achieve this, but we do need to ensure that funding reflects our growing population, and to invest in making this change happen in order to get all the productivity improvements we could achieve.”

Ian Cumming, Chief Executive of Health Education England said: “We simply cannot respond in the same old ways if we are to respond to the challenges of the new. That is why we have worked with other partner organisations to take a five year forward view and agree the actions we need to take together to secure the necessary improvements. At HEE we will ensure we have enough staff with the right skills and behaviours to deliver the future set out in the Five Year Forward View.”

David Flory, the Chief Executive of the NHS Trust Development Authority, explained: “The NHS has shown real and significant improvement over the last 10 years but to ensure those improvements can be sustained and built upon we need to address the challenges of the future. The Forward View gives us a strong platform to begin the conversation about how we meet those challenges.”

Duncan Selbie, the Chief Executive of Public Health England, added: “We are fully aligned with the actions set out here and agree that all this is possible with determined leadership from all of us.”

David Behan, Chief Executive of the Care Quality Commission said: “Our inspections are continuing to tell us there is too much variation in the quality and safety of health and social care. This is why we support the Five Year Forward View for the NHS, which sets out how the service needs to evolve, so that the needs of patients can be met and so that we can close the care gap.

“As the regulator of health and social care, our role is to use our inspections and what people tell us, to identify what is working well and why, and what does not work. We want this to drive improvement, with providers learning from the services that we rate as good and outstanding.”

The NHS Forward View details new models for how care could be provided in future. These include:

  • allowing GP practices to join forces into single organisations that provide a broader range of services including those traditionally provided in hospital;
  • creating new organisations that provide both GP and hospital services together with mental health, community and social care;
  • helping patients needing urgent care to get the right care, at the right times in the right place by creating urgent care networks that work seven days a week;
  • sustaining local hospitals where this is the best solution clinically and is affordable and has the support of local commissioners;
  • concentrating services into specialist centres where there is a strong relationship between numbers of patients and the quality of care;
  • improving opportunities for women to give birth outside hospital by making it easier for groups of midwives to set up NHS-funded midwifery services;
  • improving  quality of life and reduce hospital bed use by providing more health and rehabilitation services in care homes;
  • finding new ways to support carers by identifying them more effectively and encouraging volunteering by, for example, offering council tax reductions for those who offer help and more programmes to help carers facing a crisis.

Read the NHS Five Year Forward View in full.

For the very latest updates on the Five Year Forward View on twitter go to @nhsenglandmedia and @NHSEngland #futureNHS


  1. Janet Quested says:

    More health care in care homes for the elderly should include a named geriatrician for every home, who would oversee care. This would free GPs for other work, and be a more effective use of trained doctors. My mother was in a residential home. Her quality of life would have been improved hugely by earlier input from a geriatrician. Such a system would reduce difficult visits to hospital, and admissions. Regular physiotherapy in care homes would also improve health and reduce falls.

  2. Michelle Durham says:

    I like the idea of a 5 year plan but with an election looming we know this is just rhetoric, as, whilst the NHS is a political football, with politicians more intent on votes and scoring points off each other rather than providing decent healthcare for the nation, we are powerless to implement a 5 year plan. Instead after the next election essential resources will be diverted into whatever scheme the politicians comes up with, based on their personal views rather than hard evidence.
    Isn’t it time that the NHS was removed from the power of one indivdual party. I feel an independent board accountable to the Government would be a far better option.

    • NHS England says:

      Hi Michelle,

      The Health and Social Care Act 2012 established NHS England (the NHS Commissioning Board) as an arms-length body of the Department of Health. In the NHS Five Year Forward View, for the first time, this new organisation joined with other arms-length bodies involved in the health service to describe a shared vision of the future of the health service independently of the Department of Health.

      Kind Regards,
      NHS England

  3. Logan Van Lessen says:

    Healthy lifestyles need to start in the young. My observations have been that young school children head for their nearest fast food place and commercial sandwich places during their breaks. Most usually have a burger and chips in their hands.Sports/activity in schools have to be encouraged as healthier children will perform better at school.Not rocket science but it seems to be be difficult to promote good lifestyle behaviour. The evidence is out there around poverty and deprivation equals poor health and life expectancy.

    • NHS England says:

      Hi Logan,

      Thank you for your interest and comments on the NHS Five Year Forward View publication. Local NHS bodies will continue working with local government and public health teams to promote healthy lifestyles for our younger generation.

      Kind Regards,
      NHS England

  4. tony Langham says:

    The NHS appears to be out of control. Gps are the right people to shape and commission services locally but they do need to be seriously managed.
    Our politicians are not honest about the NHS, they are reluctant to put their head above the parapet.
    Our workforce isn’t able to cope with the demand.

    The country isn’t prepared to increase taxes to pay for it. Money available will never be enough to satisfy demand.
    So things have to change.
    You have to make that message very clear.

    It is time to get the users to take more responsibility for their usage, that in reality is the only way to make strategic change without open ended resources.

    We need to introduce a pay as you see fee to see GPs akin to the prescription charge? we pay for dentistry and glasses and prescription!

    We need to Pay a flat fee for hospital admission for elective procedures, no one will pay for rubbish food.

    We need to stop diverting NHS funds into cosmetic procedures.

    We need to Prioritise more clearly what the NHS will fund, i.e. expand NICE

    We need to prevent misuse by overseas residents/visitors

    I hope this can be fed into the debate.

    It is simply not practical to expect another £8Bn.

    Tony Langham ( previous NHS CEO)

    • NHS England says:

      Hi Tony,

      Thank you for your comments. The NHS Five Year Forward View sets out a vision for a better NHS, the steps we should now take to get us there, and the actions we need from others. More work is now being undertaken to plan how these actions will be taken forward.

      Kind Regards,
      NHS England

  5. Fiona Bell says:

    How will NHS England help resolve the issues of the past? There are so many bereaved families up and down the country , looking for resolution, looking for changes that ensure what happened to their relatives doesn’t happen again.

    It’s always been the bog standard line of defence to say “lessons will be learnt” but it is clear in some instances lessons have not been learnt.

    When will the NHS provide the evidence of those lessons learnt?

    In addition to the above , How will NHS England support whistle blowers? will they be committed to rebuilding trust and relationships by re employment of those whistle blowers?

    My message to NHS England & DoH on behalf of Bereaved families and NHS Whistle blowers that have approached me for help and support is this;

    Our staff teams need the tools and resources in order to carry out their roles effectively

    Until you have resolved the issues of the past , there is little hope of moving forward.
    You must provide the evidence of change for families and provide those staff that whistle blow in order to protect lives a safe route back to work.

    • NHS England says:

      Hi Fiona,

      Thank you for your comments. The NHS Five Year Forward View sets out a vision of a better NHS that recognises that the NHS has dramatically improved over the past fifteen years, but that there is still progress to be made. NHS England will continue to work with its partners and wider stakeholders to plan how we can work towards this vision by delivering the actions proposed in the Forward View.

      Kind Regards,
      NHS England

  6. Peter Pinfield chair Healthwatch Worcestershire says:

    I could not agree more with the challenge that Simon Stevens has laid down, many of us volunteers and none executive directors who have tons of experience on the Health andSocial Care Sector have been warning for several years now that the current NHS model is not fit for the purposes it is supposed to provide for. I meet and represent dozens of service users, Carers and patients , volunteers here in my own County we have to have a health and social care economy that is fully integrated , owned by those who use it and contribute. We are getting pretty fed up of having things done to us instead of with us! The massive culture change that Simon Stevens is outlining the next Government must be delivered on…he and is team certainly have the support of Worcestershire Healthwatch support although I expect he is going to need more bigger players than us in order to achieve the changes the country so des patently needs. Peter Pinfield

    • NHS England says:

      Hi Peter,

      Thank you for your comments and for your support for the NHS Five Year Forward View.

      Kind Regards,
      NHS England

  7. Michael Vidal says:

    One change that is needed is to have patients in at the start of any reorganisation or reconfiguration of services. The old way of doing things were you produce a case for change which includes the solution does not work. In the last seven years I am not aware of any occasion where a proposal has been radically changed as a result of a consultation. It is almost as the officials are too scared to admit they are wrong.

    Also when building new premises you should have people with local knowledge on the project group to avoid building a new centre costing hundreds of thousands only to find it is not fully used as people cannot get to it.


    Michael Vidal

    • NHS England says:

      Hi Michael,

      Thank you for your comments. The NHS Five Year Forward View recognises the importance of integrating services around the patient, as well as the importance of engaging communities and empowering patients in their own healthcare. The Forward View also highlights the importance of local democratic leadership for public health and that we will work with health economies to develop viable ways forward for local health and care services over the next five years and beyond.

      Kind Regards,
      NHS England

  8. Gerald Smith says:

    This is just the thing needed to improve things in the NHS.
    But why not put more taxes on the fast food places that serve up all that fatty stuff which puts on the weight.
    Also, make people learn to cook healthier meals.
    I am 77 years old and have nener bought any fast food from any of the fast food services.
    I cook a lot of my own food to ensure that it is fresh and good for me and my wife.
    Also could you please add me to your Email list because I do a lot of health work in this area. I put on Men’s life events and others to try and get the message over to the men in this area.

    • NHS England says:

      Hi Gerald,

      Thanks very much for your comments.
      I’ve signed you up to receive NHS England news that appears on the website as an email. NHS England also has a number of other email bulletins you could sign up for, and you can find a list here –

      NHS England Digital Team

    • Metis says:

      Taxation has never been an effective way of deterring any kind of behaviour and it almost always penalises the poor. For example, the UK has the highest tax on wine in Europe. In March the government raised the duty on each 75cl bottle of still wine with an alcohol volume of less than 15% wine by 10p to £2.00. On top of that British citizens pay VAT at 20% of the total price of the bottle. Despite that the UK remains the sixth biggest wine consuming country in the world. If the Government wants to help people to eat healthier it needs to take on big business and regulate the amount of salt, additives and saturated fat that is put into pre-prepared food.

      • NHS England says:

        Hi Metis,

        Thank you for your interest and comment on our Five Year Forward View publication. We will continue to work with our health partners and government bodies to promote healthier lifestyle choices.

        Kind Regards,
        NHS England

    • not fat says:

      I am 43 and in perfect health.
      Why on earth should I pay more for fatty food? Why should I pay more for alcohol as well while we are on the subject of these idiotic tax increases.

      Just because many people do not have the self respect to moderate fat or alcohol intake why should people who CAN pay more?

      Makes my blood boil when i hear these suggestions! How about targeting the glutonous binge drinkers and NOT the rest of society who are not the problem.
      Charge £100 to all drink related A&E attendees, charge obese patients at point of care for a self inflicted disease! Obese people do or will use NHS services more than people with a normal BMI, so CHARGE THEM for it!

  9. peter says:

    Watched news…looking for 8 billion by 2020. How about this idea. See below.

    Saving a billion a year.

    • NHS England says:

      Hi Peter,

      The NHS Five Year Forward View articulated the ambition to establish new models of care that are more integrated, more responsive and better suited to patients’ needs. In a large part, this means providing more care in the community, and pharmacists are well placed to contribute to this. We also anticipate that future models of care will make far greater use of pharmacists in delivering urgent care. NHS England and its national partners will work to support local areas to develop new care models that are tailored to their local needs and deliver these ambitions.

      Kind Regards,
      NHS England

  10. William Hooke says:

    Abusers of the NHS should be charged a full commercially costed fee and refused future treatment in default of payment and/or with repeated abuse.

    A separate NHS Debt Recovery Department should be established to relieve the hospitals and NHS institutions the trouble and cost of pursuing charges due, with international legal remit. This should include pre-treatment assessment, if risk of default is suspected or likely and treatment provided only with advanced payment.

    • NHS England says:

      Hi William,

      The NHS Five Year Forward View confirmed that we remain committed to the values of the NHS for universal healthcare, irrespective of age, health, race, social status or ability to pay, providing high quality care for all.

      Kind Regards,
      NHS England

  11. Judy Shadbolt says:

    FAO Simon Stevens, chief executive of NHS

    A Suggestion to save money & provide better services to the general public!


    Drop in centres could be purpose built or be housed, as you suggested on Today programme, within local hospitals.

    I suggest having 24 hour Drop-in Centres with small private cubicles/rooms where a person entering the Centre could see a trained admin person who would assist the person to complete an on line questionnaire with a programme that would identify possible medical issues. The person could then take the print out to the most appropriate doctor/consultant within the centre (or hospital). This would avoid GPs missing vital signs of, say, cancer or Alzheimer’s disease- the printout might recommend an x-ray or blood test rather than taking up a GPs time at this stage. Gone are the days when you had your own GP and he cared about you…even if this was the case today..the NHS couldn’t afford it. Most people today want good care…and not sarcastic, unknowledgeable GPs…as some unfortunately are. Gone too is the day when a person trains to be a GP because of a calling….the calling is money now…or that they were not able to qualify as a Consultant or Surgeon!

    I am concerned about GPs as referrers…or even SSDs. I would prefer to see self-referral Drop-In Centres. However, with the numbers with mental health problems this could be a problem unless there was a good structure.
    I suggest having Drop-in Centres with small, non-threatening, comfortable relaxing rooms where people entering the Centre could be met by a trained empathetic admin person who would assist the person to complete an on line questionnaire set by the Multidisciplinary Team- headed up by the Clinical Psychology Team. It would have to be a NON-THREATENING environment & EASY to ACCESS.
    The multidisciplinary team could then assess the best discipline to meet the needs of the person – Clinical Psychology, SSD, Benefits Dept. Housing Dept, O/T, Psychiatry, GP, Relate, Cruse etc. This would keep costs at a minimum and yet address the needs of the person with the mental health problems, thus avoiding self-harm, suicide etc.
    The Mental Health Drop in Centres could be part of the GP replacement Drop in Centres which would take away any stigma associated with visiting MH establishments.

    Both these suggestions would provide a more cost effective NHS service…and also better quality care for the patient.

    • NHS England says:

      Hi Judy,

      The NHS Five Year Forward View articulates the ambition to establish new models of care that are more integrated, more responsive and better suited to patients’ needs. This includes providing easier access to urgent consultations and making use of the potential of new technologies to help streamline care and make it easier for patients to access care in the most appropriate location at the time when they need it. We are also committed to delivering transformational improvements in the quality and accessibility of mental health care. NHS England and its national partners will work to support local areas to develop new care models that are tailored to their local needs and deliver these ambitions.

      Kind Regards,
      NHS England

  12. Joe Sheehan says:

    It is encouraging that all the key players have collaborated on this and this does bode well for the future.

    Patients, clinicians and voluntary groups have been involved – but not independent sector providers? This is a signal for significant investors to put their cheque books away? If the exclusion of the independent sector, or the lack of reference to this important stakeholder is meant to avoid bringing the “vision” into a contentious PR area, then the report is not completely honest.
    If the independent sector contribution is to be scaled down, let’s be honest about it. Which is it?

    • NHS England says:

      Hi Joe,

      The Forward View was developed with input and engagement from a wide range of stakeholders – which did include some independent sector providers including providers of primary care and community services. We will continue to engage a wide range of stakeholders as we progress the thinking outlined in the Forward View and the implementation of the proposals made within it.

      Kind Regards,
      NHS England