Nuffield Trust responds to “Next steps on the Five Year Forward View”

Responding to NHS England’s “Next steps on the Five Year Forward View”, Nuffield Trust Chief Executive Nigel Edwards said:

 “Today’s plan is an important outline of the historic changes now needed across the NHS – from working more closely with local authorities to reduce pressure on hospital beds, to making better use of land and property. It builds on the work local leaders across the country are doing through STPs: it is the right vision for our health service

“The document confirms a significant move away from a system of competition, rightly recognising that patients need every part of the NHS to work together – from district nurses to specialist consultants to GPs. But the legal framework under which the NHS is operating pushes against this, promoting competition and discouraging team working. This is therefore a heroic attempt to work around laws that are not fit for purpose. While nobody wants another top down reorganisation, legislative change of some kind in the future is a certainty.

“Perhaps the biggest stumbling block facing these plans is the make-up of the NHS workforce. The plan rightly sets out an aim to do more outside hospital. Yet we have fewer district nurses than ever before, and although plans to increase GP numbers are very welcome, they come after a long history of underinvestment and missed recruitment targets. The latest figures show numbers fell by 400 last year. [1]

“The funding situation also casts a shadow over this plan. This will be the leanest decade in the NHS’s history, and the financial year starting in 2018 will see a cut in per person funding. This plan accepts that there will be a serious impact on standards, dropping the eighteen week waiting time target for planned care. Raids on the capital budget and the need to plug hospital deficits have removed money needed for change. There is a risk that local plans will have to set targets for reducing hospital care beyond what our analysis suggests is possible, setting them up for failure. [2]”


  1. NHS Digital’s workforce figures yesterday showed a fall of over 400 GPs last year.
  2. Shifting the Balance of Care looked at the evidence for schemes to reduce reliance on hospitals. It found that only a minority had clear evidence for delivering savings, and significant further investment would be needed.