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Reaction to the next phase of the NHS Five Year Forward View

President of the Royal College of Physicians Professor Jane Dacre

“Since its launch, NHS England’s Five Year Forward View has provided a positive direction for the NHS in what has been a challenging environment. It has provided a model for institutions and NHS staff to continue to do great work – providing timely and high quality care to patients despite growing financial and workforce pressures.

“The focus on public health, to improve cancer care and ease the pressure on our A&Es is of course welcome, however in the past few years such demands have meant that the opportunity and ability to transform services to improve the care we provide for patients has become much harder to achieve.

“Our hospitals and NHS staff are only just coping and we cannot underestimate either the time or effort needed to make these fundamental changes. Though satisfaction with the NHS remains steady, we cannot be complacent. Now is the time for more investment and for the STP leaders to involve patients, healthcare staff and the wider public in designing services that meet the needs of patients today and in the future.”

Mental Health Network Chief Executive Sean Duggan

“We welcome NHS England’s reaffirmation of the importance of mental health services and their vital role in overall public health.

“Mental health services are working hard to deliver the Five Year Forward View and are frontrunners in NHS local engagement and transformation of care.

“However significant shortfalls in funding threaten to undermine local progress. Mental health services are still not receiving funding they were promised and are not receiving parity with physical services, even in areas where they are incredibly stretched.

“NHS England is beginning to help us track investment and identify gaps, however delays are already forcing many mental health trusts to make difficult choices about what services to provide. Mental health is worsening among children and there is too much variation in the care available to people of all ages, so we need to get these problems fixed.”

Dr Mark Porter, BMA council chair

“The NHS is one of the best, and most efficient, healthcare systems in the world, which this report rightly highlights. However, rising demand and years of chronic underfunding means the NHS is now at breaking point.

“This plan contains many good measures but does not address the fundamental funding pressures undermining the delivery of health and social care. The efficiency targets set in this plan are fanciful, given that most hospitals have been pushed into the red.

“The constant calls for more GPs to be available for longer is not matched by the reality on the ground – far from delivering 5,000 extra GPs promised by the government, figures from earlier this week show that the number of fulltime GPs is, in fact, falling.

“There is a lot of emphasis on the role of Sustainability and Transformation Plans and a belief that they are sufficient to resolve the crisis. Yet we already know that the vital funding needed to carry out these plans simply isn’t available. Our own analysis found that the plans would need to deliver £26bn in savings to balance the books and require at least £9.5bn of capital funding to be delivered successfully. Given the scale of the savings required in each area, there is a real risk that these transformation plans will be used as a cover for delivering cuts, starving services of resource and patients of vital care.

“At a time when our hospitals are in deficit, GPs are unable to keep up with the number of patients coming through the surgery door and staff are working under impossible conditions, we need an honest look at the pressures facing the NHS and how to give the investment needed to match the promises made. We spend less on health than other leading European economies and cannot continue to do more, with less. Above all it’s time to end the chronic underfunding of our health service and put together a long-term plan to help solve the ever-growing issues around staffing and funding the health and social care system as a whole.”

Danny Mortimer, chief executive of NHS Employers

“We welcome NHS England’s delivery plan, which recognises the enormous pressure staff are under and the improvements that employers have seen in the engagement scores. The greater focus on our workforce is very welcome.

“Flexible working is integral to staff retention, but is not always easy to implement, especially as the health service remains under unprecedented strain. Alongside employers and staff organisations, we will work together to set out the best possible practice, and share this swiftly for the benefit of staff in all our organisations.

“We also welcome plans to work in partnership with trade unions and lead STPs to find ways to de-risk service change, and support the proposed ‘staff passport’ to facilitate collaboration between primary and hospital care.

“We applaud the proposal of the ‘Nurse First’ programme, a Teach First-style scheme designed to encourage people to enter careers in nursing. We are especially pleased to see this will begin with prioritising access to vital roles in mental health and learning disability.

“In relation to the clearer strategic focus on surplus NHS land, employers across the NHS – and especially in London and areas where property prices are extremely high – will be glad of the real opportunity for a greater number of affordable homes for NHS staff.”

Niall Dickson, the chief executive of the NHS Confederation

“Given the difficult financial position in which we find ourselves, NHS England deserves credit for producing an ambitious plan for reform and transformation which must be the right approach.

“But we have to acknowledge that there are significant risks and in some respects it is a leap in the dark.

“We have no alternative but to embark upon such fundamental change but to do so when services are under enormous pressure and money is so tight is without precedent.

“What is being asked of health and care organisations is to set aside their own interests for the good of the wider system – and that will require new ways of thinking at local level and much stronger and more consistent support from national bodies.

“The current system needs to be redesigned to meet the very different health demands of the 21st Century, but the proposed new structures and models of care will need to be tested. This will be challenging without the funds to grow them while existing services are still operating.

“There is currently wide variation across the country and it is important there is support that reflects local reality. Those areas which are most advanced should receive the backing to transform services. But we also need to support other areas where there is more to do in reshaping services, building the necessary relationships and engaging the public. It’s imperative that they are all given the time and resources to bring about the changes.

“Our members are also keen to stress the importance of NHS England’s plans being aligned with those of other national bodies, such as NHS Improvement and CQC, to avoid unnecessary duplication and conflicting priorities across the system.

“Finally we need a greater acknowledgement about the limitations as to what the NHS can deliver and the public can expect – commissioners and providers must be supported when they have to make difficult choices.”

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