Five Year Forward View (FYFV)
Last Updated: March, 2019

This is a 39 page plan written by  Simon Stevens  in 2014 shortly after he became CEO of  NHS England . At first sight, the FYFV might come across as fairly NHS-friendly: it sings the praises of the NHS and the values that underpin it. However, it suggests that the NHS can't continue without fundamental change leading to; cutting demand, new models of care and changing the workforce. Specific proposals include:

  • Improve the  prevention  of ill-health.
  • Turn the NHS into a more active agent of health-related social change (encouraging people take greater responsibility for their own health and health care).
  • Harness the potential of new technologies.
  • Develop new ways of delivering care, including new care models such as  integrated care .
  • A shift in investment, from acute settings such as hospitals, to primary and community services.
  • Restructuring the NHS workforce.
  • Implement a  7-day NHS .
  • Save £7.5 billion by selling NHS assets.
  • Reduce the NHS budget by £22-billion over the five years of the plan.

The FYFV is carefully written so that the extent of the radical changes it proposes are hidden in plain sight. The FYFV demonstrates the implications of the  2012 Health and Social Care Act . Before the Act, significant changes to the NHS would have needed to be introduced through primary legislation, but because the Act gave control of the NHS to NHS England, sweeping change can be rapidly introduced without even a hint of democratic mandate.

The cornerstone of the FYFV is the new models of care also known as integrated care, and these share many of the features of  Accountable Care Organisations (ACOs)  developed in other health care systems. The structure of ACOs, including their financial independence, makes it easier for ACOs to be run or controlled by private insurance companies. (Specifically the FYFV proposes multi-speciality community providers and primary and acute care systems that are akin to Accountable Care Organisations in Spain and the US).

Throughout the FYFV there is an emphasis on health promotion and prevention as an argument for the viability of cutting front-line hospital services.

Although the FYFV talks a lot about integration it does not mention the market system that has dis-integrated our health services. A return to real integration is only possible through publicly owned and provided health services. The FYFV begins the process of 'market integration' in readiness for wholesale privatisation. The FYFV can be seen as a logical next step in the long-term strategy originating in the 1980s to transform the NHS into an insurance-based system. It sets out proposals for integrated care which led to the development of  Sustainability and Transformation Plans . As of 2019 the Five Year Forward View has been superseded by the  NHS Long Term Plan .