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Executive Summary

Filtering out the background noise, NHS England's chief executive tends to give a straightforward account of the state and the needs of the national health care provider. He did just that in a mid-term update of the NHS Five Year Forward View on March 31.

The UK National Health Service is on the verge of its toughest two years ever in terms of funding and demand for services. (Also see "UK’s Underlying Healthcare Model Is On Borrowed Time" - Medtech Insight, 10 Jun, 2016.) Happily, it has Simon Stevens as chief executive.


Each time he takes to the platform, speaks on air or addresses delegates, a calm begins to settle. His is amongst the most testing of tasks – a vital national role carried out in the gaze of a critical public and with insufficient funding to meet rising demand. Many of the messages he brings are hard, and yet he makes them sound pragmatic, forward-viewed and sustainable. Doable, in short.


Today, he released a 2017 update of his original 2014 Five Year Forward View. (Also see "UK medtech industry sees opportunities in NHS’s ‘forward view’" - Medtech Insight, 31 Oct, 2014.) Next Steps On The Five Year Forward View sets out the NHS’ main national service improvement priorities over the next two years, with an eye on achieving financial balance. Its new tasks include taking the strain off emergency departments (A&E) (specifically, moving 1.5-3 million A&E consultations to general practitioners), training up more GPs, and reversing funding declines in the primary-care sector.

The cash saved will be allocated to priority areas, such as mental health care, primary health care services, and cancer care. In cancer care, the plan is to improve diagnosis, increasing current capacity by opening 10 new Rapid Diagnostic and Assessment Centres by March 2018, giving patients access to upgraded linear accelerators (LINACs). Molecular diagnostic test volumes are targeted to grow from 55,000 at present, to 70,000.

The largest radiotherapy upgrade program in 15 years will take place between now and October 2018 – more than 50 new radiotherapy machines will be rolled out in at least 34 hospitals. In addition, a National Cancer Diagnostics Capacity Fund, to support early diagnosis, will be set up; a new bowel cancer screening test will be introduced to cover four million people from April 2018; and a new primary human papillomavirus testing service for cervical screening will cover three million women and could prevent 600 cancers per year.

Stevens reports that the early findings in the "Vanguard" areas – localities where primary, community secondary, mental and home care are integrated, are showing that emergency hospitalizations and time spent in hospital are lower than in comparator localities. (Also see "Is The UK Still Open For Medtech Innovation And Reimbursement?" - In Vivo, 20 Nov, 2016.) The Sustainability and Transformation Partnerships (STPs) are promoting this integrated approach, and the next stage is their development into Accountable Care Systems – locally integrated health systems that combine services and financing.

New Urgent Treatment Centres (UTCs), with clinician-staffed diagnostic facilities, including X-ray machines, will be made available to patients who don't need hospital services. 150 UTCs are expected to be opened by spring 2018.

Elsewhere, the new NHS Innovation and Technology Tariff is designed to expedite uptake of innovations as of April 2017. The first group of products will benefit 160,000 people suffering from episiotomy-related injuries and ventilator-associated pneumonia. A new antibiotic-free treatment of C. difficile is among the products. The NHS Innovation Accelerator will select a new batch of innovations to target population-based health challenges, and the Academic Health Science Networks (AHSNs) and "Test Beds" will be responsible for driving uptake of already proven innovations.

However, waiting times for non-urgent treatments are likely to lengthen, Stevens acknowledged – the average wait for an operation is currently 10 weeks. The overall target is 18 weeks, but this has not been abandoned, he told BBC radio today.

Association of British Healthcare Industries CEO Peter Ellingworth said in a statement that current pressures on the NHS are unprecedented. "We welcome the approaches being adopted to drive further transformation. The medtech sector has the necessary solutions to help the NHS tackle issues such as waiting times, through technologies that reduce procedure time and length of stay."

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