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This Lords Library briefing provides a broad overview of the challenges and pressures on the NHS in England and the proposals presented by NHS England and the Government to address these issues. It also briefly sets out the objectives and ambitions of the NHS. This briefing has been prepared to support the debate in the House of Lords on the ability of the NHS to meet present and future demands on 14 January 2016.

NHS Objectives

The NHS Constitution, which sets out the principles and values of the NHS in England, states that the health service is there to “improve our health and wellbeing, supporting us to keep mentally and physically well, to get better when we are ill and, when we cannot fully recover, to stay as well as we can to the end of our lives”. The Department of Health also publishes an annual mandate for the NHS, which outlines the Government’s objectives. The most recent mandate, published in December 2015, set out seven key areas where the Government expected the NHS to make progress, including the improvement of local and national health outcomes; helping to create the safest, highest quality health and care services seven days a week; and balancing the NHS budget.

NHS England’s Five Year Forward View

In October 2014, NHS England published the report, Five Year Forward View, which set out its vision for the future direction of the NHS; how it would evolve to meet current and future demands; and presented proposals for new models of care. The NHS stated that there were three main facets to its vision for the future direction of the health service. Firstly, it argued that “the future health of millions of children, the sustainability of the NHS, and the economic prosperity” of Britain depended on “a radical upgrade in prevention and public health”. Secondly, it promised that patients would have greater control of their own care, and the third strand of its proposals was for the NHS to take steps to break down the traditional barriers in how care was provided. The NHS argued in the report that an integrated approach to providing NHS services could both improve the quality of care for patients and improve productivity. The document also addressed the estimate that was quoted in the 2013 Monitor report, Closing the NHS Funding Gap, that there could be a funding gap of £30 billion by 2020/21. NHS England considered several scenarios which combined efficiency and funding options, and suggested that £8 billion of additional funding and £22 billion of efficiencies by 2020/21 could meet the gap.

Government Policies

Following the general election in May 2015, the Government set out its “vision for a modern, efficient and sustainable NHS” that provides “high quality for patients seven days a week” by 2020. It has also provided details on the proposals for a new voluntary contract for GPs to deliver seven-day care for all patients by 2020. In the Spending Review and Autumn Statement 2015, the Government announced that between 2014/15 and 2020/21, health spending would increase by £10 billion in real terms.


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