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Vanguards: Stevens pledges 10-year plan, original aims failed due to trust deficits

An NHS scheme aimed at integrating health and social care has failed due to much of the funding being diverted to combat short-term financial pressures rather than poured into transformation, the National Audit Office (NAO) has said.

NHS England’s chose 50 sites to act as vanguards in 2015 to lead the development of five new care models as part of the Five Year Forward View.

A total of £329m was invested into the vanguard programme to support them in testing their proposed care models, where providers would, for example, create acute care collaborations connecting hospitals to improve their clinical and financial viability and reduce variations in care and efficiency.

Yet the original intention to expand the programme was not realised “because funding was reallocated to reducing trusts’ financial deficits,” the NAO said in today’s report. This echoes the findings of its review of sustainability and transformation partnership (STPs) from earlier this year, which concluded that long-term STP funding had been swallowed up by short-term demand to “just keep the show on the road.”

The vanguard programme was modelled on having six waves of care providers, with an early planning assumption of around £2.2bn in funding for new care models between 2016-17 and 2020-21. But much of this cash was used to tackle hospital deficits, meaning actual direct vanguard funding was just £329m over three years from 2015-16, with another £60m spent on central support. As a result, the original aim to expand the programme was not realised.

The timeframe for vanguard funding was three years, but many consider that such a high level of transformation often takes more than a decade to be delivered successfully. “The NAO has seen a pattern of initiatives being continually folded into a successor initiative, sometimes before their objectives are fully achieved,” the report explained.

The auditor also blasted NHS England for not setting clear national objectives or stating how new care models would be spread around the UK.

“Because of uncertainties about future funding and its design principle not to prescribe the initial approach from the centre, NHS England did not produce a national business case, a clear statement of national objectives and intended outcomes, or details of how new care models were to be spread,” the NAO said.

It continued: “The vanguard programme is one in a series of attempts to transform the NHS to better meet patients’ needs and to respond to the financial pressures it faces. However, short-term financial pressures led to the diversion of much of the transformation funding, weakening the programme’s chances of success.

“An important objective of the programme was to design new care models that could be replicated quickly across the NHS, and services have not yet been transformed to the depth and scale that was hoped for at the beginning of the programme.”

Upcoming 10-year plan

However, the parliamentary watchdog did note that NHS England CEO Simon Stevens has confirmed his commitment to sustain and spread the new vanguard care models through a long-term plan.

A spokesman for NHS England said: “The NAO rightly highlights the success of the vanguard sites, both in improved outcomes for patients through fewer emergency admissions, and value for money with an expected return of £2 for every £1 spent.

“It is now crucial to build upon this progress as the NHS develops its 10-year plan.”

Head of policy at NHS Providers, Amber Jabbal, said: “We welcome the commitment from the chief executive of NHS England to sustain and help to spread learning from the vanguards within the upcoming 10-year plan, but we must ensure this builds on the progress made so far.

“Continuing the journey towards more integrated care will be a key pillar of the plan and funding settlement. But we must be realistic about what this funding can do alone without a clear longer-term strategy for transformation and support from national and local leaders.”

NAO boss Amyas Morse also welcomed Stevens’ commitment to a long-term plan, and said he hoped that NHS England can “break out of previous cycles of missed opportunity.”

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Image credit: rajurahman85, iStock images


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