Implications for delivering the Forward View

Gordon Frame, Associate Director at Attain talks about the urgent and coherent response required to the recently issued ‘The Forward View into action’ planning guidance.

The Five Year Forward ViewThe publication of the Five Year Forward View (FYFV), October 2014, stressed that the time for transformational change within the NHS had arrived. It recognised that the demands being placed on the NHS could no longer be sustained, and set forth different approaches that encouraged healthcare organisations to explore and utilise new models of care to address the challenges. It made financial sustainability, innovation, and improved quality of care the priorities.

In December health leaders produced “The Forward View into action: planning for 2016/17 – 2020/21” – essentially the planning guidance for the next five years, supported by £1.98 billion of additional funding. This is the first time that the annual planning guidance has been jointly produced for the entire NHS, and jointly produced by NHS England, Public Heath England, NHS Improvement, (Monitor and the NHS Trust Development Authority), the Care Quality Commission and Health Education England.

The emphasis of the planning guidance remains focused on the principles of the Five Year Forward View, namely to restore and maintain financial balance, and the necessity to have greater integration and innovation to transform healthcare. There is, however, a clear expectation that the planning process will be fully collaborative and designed and delivered across local health economies by the leaders of systems. Those regions that can demonstrate positive change at a faster pace will benefit from having early access to central funding from 2017/18.

Ultimately, the success of the planning guidance will rest on the formulation and implementation of the two interdependent plans, a one-year Operational Plan and a five-year Sustainability & Transformation Plan (STP).

  • The Operational Plan will form the delivery plan for 16/17 and year one of the Sustainability & Transformation Plan
  • The Sustainability & Transformation Plan will be a system-wide plan to address the financial sustainability and service transformation of local health and care economies

Implications for health and social care organisations

1.     Urgency – transformation starts today

The release of the planning guidance denotes a heightening in the pace of change, and while integrated leadership, collaborative planning, and focused delivery will all be essential, rapidly responding and fully engaging in this planning process will be critical.

For 2016/17, there needs be an immediate focus on developing plans that address the nine “must do’s”, through engaging with system partners in order to establish a credible and shared open-book operational planning process. This process means commencing immediately and cannot wait for the wider system vision driven through the STP process to be agreed.

The timeframe is tight, and it is therefore essential, that within the defined footprint, there is a strong momentum engendered for developing and delivering these plans.

2.     Sustainability – it’s in the title!

The planning process has the fundamental objective of increasing the sustainability of local health economies, by improving health care services, while ensuring that financial probity is restored and retained. The concept that system leaders will, through robust planning and implementation, deliver better clinical and fiscal outcomes by promoting a culture of continuous sustainable improvement, is central to the envisaged transformation. The STP will reflect this intention, incorporating contingencies to withstand variation and challenge, with financial performance a consistent priority.

3.     Bringing people with you

While system leaders will proactively engage in an inclusive planning process, their ability to collate the extensive opinions of the broad range of stakeholders will require a comprehensive understanding and appreciation of many different perspectives. Ensuring that plans are reflective and incorporate the needs of the healthcare system, will be essential, particularly if leaders are to elicit the support that will engender widespread commitment and involvement. Extensive ongoing communication with all interested parties will be the only means of guaranteeing that the STP is embraced and delivered. The opportunity to engage with clinicians, patients, carers, voluntary sector and other community partners, should be encouraged and endorsed and the evidence collated form the basis of transformation outlined in the STP.

4.     Collaborative leadership for transformation

The requirement in the planning guidance is for strong integrated system leaders who can create momentum, determine the appropriate scope for “place-based planning” and formulate and execute plans accordingly. This will necessitate greater cross boundary collaboration by health and social care leaders, and will require those that are engaged in leading the planning process to champion a co-created shared vision. Their style of leadership, their interaction, communication and ability to develop trust and confidence and broker consensus will be critical, as will their collective ability to evaluate, analyse and develop fresh approaches to long seated problems.  A major test for them will be to exert influence and hold accountability for planning, specifically across activities and in areas that they have not previously held historic responsibility.

5.     Planning

To achieve the national priorities within the timelines, system leaders will need to be committed to developing plans that utilise effective organisational structures and allocate appropriate resources to support essential delivery activities. The planning process will be demanding and complex, with priorities and interdependencies that need to be clearly identified and assessed against risks and impact. The scale of resource required for this planning process should not be underestimated.

6.     Delivering sustainable transformation

To support the implementation and delivery, collaborative decisions will need to be made regarding ongoing programmes of work and how they align to the wider care economy vision. The decisions about what activities continue, what stops and what needs to be started will all require careful consideration and considered negotiation. The STP needs to be deliverable and lead to transformed, and ultimately sustainable, care economies. This might mean difficult and unpopular decision making, but leaders should not be afraid to have ambition and to see a new future for patients and services.


So, the challenge has been set…

The NHS Planning Guidance provides the continuity and supporting infrastructure to further promote and develop the Five Year Forward View. Undoubtedly, it presents an urgent challenge to the system leaders, promoting wider integration, more detailed plans, and high expectations of delivery, all within a relatively short time period. The fact that the planning guidance has been jointly produced for the whole NHS, provides a further insight into the rigor and intent now associated with delivering wide scale change through the planning process.

For system leaders to succeed, and to be recognised as having robust, credible plans, their plans will need to demonstrate visionary aspirations with evidence of ambition and delivery. They will need to reflect the unity of the local system and will require to be structured to inspire confidence in the ability of the system leadership to produce a sequential implementation of actions, supported by an achievable system wide financial sustainability plan.

The challenge has been set, and the importance of planning and delivery has never been more evident to the future of the NHS.


Attain supports organisations to improve people’s wellbeing and care, and on the basis of the planning guidance circulated, we have already been engaged by our clients to support them to develop their STPs and and contribute to the transformation of healthcare services that improve people’s quality of life.

If you would like to learn more about how Attain can assist you in the planning, design and delivery of healthcare services, please contact Helen Pyecroft, Head of Strategy