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Next steps on FYFV: what about transparency?

Awaited more eagerly than the arrival of musical Hamilton in the West End or the new season of Game of Thrones, the  Next Steps on the Five Year Forward View (5YFV) was published on Friday, just in time to see out the financial year.

At a time when public satisfaction in the NHS is at a high, the paper outlines much to celebrate in NHS England’s strategy to dismantle the health and social care act and the purchaser provider split: cancer survival at a record high; better access to mental health care; and evidence the vanguard programme yields fewer emergency admissions (although the geeks amongst us would like to see error bars on that graph).

And of course at ZPB we are pleased to read about technological advancements, including online 111, e-referrals and the use of apps (we are very proud of the small piece of work we did on this). This will no doubt reduce demand and increase access at times that suit citizens, not the NHS.

But it is this section this gives us some concern. The focus has been narrowed to technology only. In the 5YFV we were promised the NHS would harness the information revolution, now it seems the delivery plan is only going to harness one part of this – technology. There’s nothing about better use of data, no information governance, little tangible deliverables about how we can develop new ways of measuring quality, and not much about transparency above rhetoric on how open the NHS has become.

The original committed to “comprehensive transparency of performance data” but this plotline hasn’t been developed in the sequel. How can we evolve consultant level outcomes to move away from the (erroneous) measures of mortality only, how will PROMs move to other specialities, and how can we grow the success of the Friends and Family Test to also capture outcomes more relevant to individuals, are just some of the topics championed in 5YFV I that seem to have been forgotten in 5YFV II.

Importantly, the wider need for transparency and moving to a position where information and intelligence means patients and clinicians have equal power has been missed.  Sir Robert Francis recently warned us that “the NHS wasn’t immune to another Mid Staffs”, and better information in the public domain is the best way we know to prevent this. The mishandling of implementation doesn’t mean the idea was wrong, but whilst data for data for genomics and GP clinical research does get a mention, this kind of programme does not.

There is no doubt the technology revolution will fundamentally change health and care, but participation without transparency doesn’t work.  Let’s hope 5YFV III begins to address this.

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