• Publication of the Five Year Forward View
  • Finalisation of the 2014-2019 PPRS agreement
  • CCGs now fully operational with significant and growing commissioning responsibilities

1More-to-doMore to do

  • Review of NICE processes to address accusations that it is no longer fit for purpose
  • Required efficiency savings to bridge the £30billion NHS deficit

1UnexpectedThe unexpected

  • Drastic changes to the Cancer Drugs Fund operating procedures
  • Barker report calling for ‘well-off retired’ to shoulder responsibility for bridging the £5bn gap in social care funding
  • Cancer and A&E waiting time scandals


  • An increasing emphasis on dementia and Alzheimer’s
  • Uncertainty and controversy around the funding of cancer drugs
  • Further NHS upheaval

2014 was a year of ups and downs for the NHS and the wider health and social care sector, with much change stemming from the appointment of ex-Labour adviser Simon Stevens as Chief Executive of NHS England.
His appointment demonstrates a continuing shift in responsibility away from the Department of Health.
Mr Stevens has spent his first seven months making waves both internally and externally; from scrapping and creating new directorates, to hiring old friends to head them up. There has been a middle management cull with a shift to regional leadership, potentially paving the way for his recent five-year plan.
The Five Year Forward View is being hailed as the definitive plan for the future of the NHS, with everything we can expect in the coming years alluded to in this sizeable document. The more exciting headlines include an emphasis on the role of technology; new care models; the rise of multispeciality providers and small hospitals; prevention, and empowering patients to take responsibility for their own care.
Arguably the plan’s key role is to outline the savings required to bridge the £30billion deficit the NHS is facing. However, what appears to be another statement of planned bureaucracy could be seen as the start of Mr Stevens’s ‘big revolution’, with the upheaval to come. We should expect a pro-competition stance to feature in coming years, despite no official mention of the ‘c-word’. Whatever happens, we know that pressures on NHS resources will only continue into 2015.
The 2014 Pharmaceutical Price Regulation Scheme (PPRS) has also been a source of controversy with the battle between NICE and the pharma industry raging on. There has been a clear split between those that believe rejecting new drugs on cost grounds is the right thing to do, and those that believe these decisions are stifling innovation. Whilst pharma insist that price should no longer play a part in NICE’s assessment of new drugs due to the hefty rebate system, NICE has continued to press on pricing, becoming increasingly vocal.
The Department of Health, meanwhile, announced controversial changes to the operating procedure for the Cancer Drugs Fund, effectively duplicating the role of NICE by introducing an assessment of drugs’suitability based on price. Patient groups and industry have been up in arms and we can expect an ongoing and robust dialogue on the issue. While it is clear that the CDF is one sticking plaster that can’t last for ever, it remains to be seen if an agreement can be reached on funding of future cancer care.

The long standing ‘problem’ issue of social care received its fair share of the limelight in 2014 following the Barker Report, which aimed to ‘confront the injustices of long term care’. The report unveiled plans to extend free care into social services, so that patients with long term conditions are not penalised by a fragmented system. It suggested raising the £5m estimated cost through measures aimed at wealthy older people, such as stopping winter fuel payments and free TV licenses for the ‘well-off retired’. The perceived burden on pensioners led to a mixed response, but there has been no clear statement of intent outlining whether or not the plans will come into effect. Pay and workforce issues have
also been in the news, with Labour calling for care staff to be paid the Living Wage, with a view to driving up better standards of care.Politically each party has begun aligning themselves with the NHS, and setting out their battle lines ahead of the election. Throughout 2014 Labour continued to champion the theme of integration and joined up services across both health and social care, whilst the Liberal Democrats have successfully driven the mental health agenda.The Conservatives have started pushing the ‘strong economy equals strong NHS’ line, which if communicated correctly has the potential to be a very compelling message as we move closer to the election. As for Jeremy Hunt, he will be raising a glass to the mild winter and praying for a smooth, NHS-crisis-free run-up to the election (or as crisis-free as can be achieved), when his record, and that of his boss, will be judged.
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