Five Years

We’ve got five years, stuck on my eyes

We’ve got five years, what a surprise

We’ve got five years, my brain hurts a lot

We’ve got five years, that’s all we’ve got

David Bowie

As a student of politics in the early 1980’s I had occasion to study the workings of the Soviet Union, and as such became familiar with the term Five Year Plan.

If memory serves me there were thirteen Five Year Plans in total. The final one in 1990 ran for just one year when the Soviet Union dissolved.

It is to be hoped that the Simon Stevens version — the Five Year Forward View — will make it beyond 2015. Frankly it has to, because the stakes couldn’t be higher.

Okay so the document released on 23rd October isn’t strictly a Plan. It’s a View, but whatever the difference my first observation is that of the many planning documents that I have trawled through since I first engaged with the NHS back in 1983, this one resonates most.

It has much to commend it, not least its brevity. Why use four hundred and forty pages to tell a story when forty will do?

Whilst a keen student of politics, a student of mathematics I wasn’t. Nonetheless even I can spot a big number when I see one, and £30 billion qualifies as quite large.

Put simply the days of business as usual in healthcare are over. There needs to be a paradigm shift in the way things get done and to borrow a well-worn cliché, if you’re not part of the solution, then you’re part of the problem.

I was particularly taken by the statement that one size does not fit all (a further distinguishing feature perhaps between a Stalin ‘Plan’ and a Stevens ‘View’).

Anyone that has worked as long as I have with the NHS will understand that the service is not so much a single entity as a collection of fiefdoms. Stevens made a similar point in an interview last week when he spoke of the ‘N’ in NHS also standing for neighbourhood. To this end one of the most powerful messages for me in the forward view document is, “Different local health communities will instead be supported by the NHS national leadership to choose from amongst a small number of radical new care delivery options.”

I just love the word radical. Tellingly it appears nine times in the document. Moreover, the word partner – or a form of it – appears 28 times.

In terms of partnering, Sollis stands ready to serve. We have an immediate role to play in delivering a clinically based intelligence platform that supports key decision makers in making informed decisions about future investment.

In terms of these investment decisions I am persuaded that some of the solutions exist in new and often radically different care models, supported by new and imaginative payment mechanisms. Care models that are centred on the patient and which are designed and delivered close to home. Care models where we measure outcomes and not processes; where we measure things that are important to patients, not institutions.

This is the time to innovate.

It is a time for leaders.

It is a time to be bold and brave.

“I have a view” is perhaps less memorable than “I have a dream”… but it’s a start.