The Five Year Forward View: One Year On – Dr Mahiben Maruthappu

Recent times have seen the National Health Service experience significant pressure, while making significant progress.

Just over a year ago the NHS Five Year Forward View was launched – our vision for the future of the health system. We proposed that to achieve the triple aim of improved population health, quality of care and cost-control, this needed to be matched by triple integration, removing the boundaries between mental and physical health, primary and specialist services, health and social care.

We launched 50 so-called Vanguards, localities across the country taking the lead on new ways of providing care; while also developing clear roadmaps for the improvement of cancer, maternity, mental health and learning disability services.

In parts of the country where service delivery was particularly stressed, we initiated Success Regimes, lending support and challenge to local systems by working across whole health and care economies, taking a more holistic approach. We have sought to strengthen pressured parts of our workforce with greater investment in primary care infrastructure, new support for skills including clinical pharmacists, a nationwide wellness programme for NHS employees, and collaborative efforts to improve the attractiveness of general practice for new doctors.

Turning our eyes to the present, the equipoise between financing and efficiency represents one of the most pressing issues facing the future of the NHS. The government’s recent £3.8 billion investment into front-line services is certainly welcome. This will help stabilise pressures on primary and specialist care, while kick-starting transformation in the NHS, enabling momentum around key initiatives such as our Vanguard programme to build and spread. The Chancellor’s announcement that local authorities will be able to increase council taxes by 2% specifically to fund adult social care will also enhance system improvements.

Looking forward, the next five years signify a phase of implementation – the Forward View has shown what’s necessary, but we now need to put this vision into operation and to develop a more sustainable NHS through new models of care, efficiency savings, and moderation of service demand. Three tensions will need to be resolved:

First, current pressures need to be balanced with our longer-term vision; delivering today and tomorrow together rather than in juxtaposition.

Second, the traditional focus on individual organisation performance and accountability needs to be shifted to place-based whole systems and population health, incorporating broader components of the care system, including prevention and social care, into conventional working.

Third, we need to support local initiatives while improving our capabilities to spread these nationally, balancing bespoke approaches with ambitions to reduce countrywide variation of care.

We have reached a pivotal moment in the history of the NHS; there is unprecedented demand due to an aging, growing population with more complex long-term-conditions. Change is no longer optional.

The widely supported Forward View has provided direction, but it is our delivery in the coming years that will determine how we define, fund and provide British healthcare long into the future.

Image of Dr Mahiben MaruthappuDr Mahiben Maruthappu is a practicing doctor and Senior Fellow to the CEO of NHS England. He advises on NHS England’s innovation, technology and prevention portfolio, co-founding the NHS Innovation Accelerator and the NHS Diabetes Prevention Programme. He has advised a range of organisations, from start-ups to multilaterals, including the Swiss government and the Experiment Fund and the World Health Organisation (WHO).

Mahiben has a strong interest in research with over 80 peer-reviewed publications and 50 academic awards. His work has been featured by BBC News and the international press. He is Chairman of the UK Medical Students’ Association (UKMSA), and has written three medical books. Mahiben was educated at Oxford, Cambridge and Harvard universities and was the first person from British healthcare to be included in Forbes’ 30 under 30.

This article was first published in the Lancet.

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