Health Service Focus

Vanguards: from set-up to delivery

At this year’s Health+Care Show, NHS England’s national lead for primary and acute care systems (PACS) in the New Care Models programme, Jacob West, updated attendees on the recent progress of the up-and-coming Vanguards. Luana Salles reports.

One of the first things attendees heard at this year’s Health+Care conference was that this was the year of implementation: after a period of blue skies, we’ve now reached the “walk the walk” phase, where healthcare plans will finally have to crystallise into practice. 

The same applies to Vanguards: whilst mostly focusing on mobilisation and set-up during last year, 2016-17 is when they will turn their attention to full-scale delivery.

These were the words of Jacob West, NHS England’s national lead for PACS in the New Care Models programme, who updated a jam-packed audience at this year’s exhibition on the recent examples of progress taking place across Vanguard sites. 

Pushing forward on delivery 

“This is a three-year national programme. This year, we’ll really be pushing forward on delivery and, next year, particularly through the sustainability and transformation plans (STPs), will be about how we try to mainstream the approach to new care models,” said West. 

“And whilst we talk about Vanguards, they are, in a way, a means to an end; it’s about the wider adoption and uptake of the new care models more generally. 

“The real radical expression of the care models is that they are doing all these different things in a co-ordinated way, and doing it together. They’re doing it at scale, not just in a small pocket, and they’re doing it in a sustainable way, clinically but also financially. That, I think, is a really important point to hold on to.” 

The New Care Models programme kicked off in January 2015, when NHS England invited organisations to apply to become a ‘Vanguard’ site – considered one of the first steps towards delivering the Five Year Forward View (FYFV). Fast-forward to September the same year and 50 sites had already been chosen: 29 as either PACS, multispecialty community providers (MCPs), or models of enhanced health in care homes; eight as urgent and emergency vanguards (UCEs); and 13 as acute care collaborations. 

The golden thread of replicable population health 

West noted that the goal of all new care models is to “start to define the common ingredients” that describe them.  “All of them are seeking to achieve the same three goals: addressing the three gaps in the FYFV, in relation to health and wellbeing, variation in care quality, and finance and sustainability,” he said. 

“Whenever I talk about what we’re trying to achieve, it’s framed within that overarching set of objectives. Although they are different, there is a golden thread that runs through all of them, which is around more integrated care, focused on population health.” 

West added it was important to acknowledge large-scale change of this kind is both about the ‘what’ but also about the ‘how’. “These values run through everything we do: it has to be about local ownership which is clinically led and patient and service user engaged and involved. If you don’t get that right, then really, everything else is of little consequence,” he continued. 

“The second thing is about the technical side of change. [Contracting and procurement] matter, but large-scale change has to be about the human side as well, fundamentally. Through all of the work the Vanguards are doing, that’s a common theme. 

“Thirdly, sometimes with national programmes there have been amazingly brilliant, individual, isolated examples of what’s working well: a care pathway here, a system intervention there. But what we’re trying to do is break the model where we just get the idiosyncratic examples of what works, and really think about the replicability and the transferability of these care models.” 

Latest achievements 

West highlighted different examples of innovations being taken forward by all types of Vanguards, such as Symphony Programme’s enhanced primary care model using health coaches and creating parity of esteem between GPs and other partners; Morecambe Bay’s grassroots Millom campaign, aimed to help recruit GPs to the geographically isolated town; and the acceleration of data and IT in care homes, with Airedale & Partners, for example, developing a secure video link that connects care home staff to specialist hospital nurses. 

There’s also “intensive work” going on to develop a new MCP voluntary contract that would give GPs flexible options to help develop these models, which should hopefully be available in the next financial year. 

Addressing all barriers early on 

Despite these promising signs, West remained realistic: “The caveat is that this is large-scale, complex change. We need years, probably, to see the true results of this; these are sort of green shoots of what some Vanguards are doing. It’s not just about getting the care model right: it’s also about addressing local and national barriers.” 

Vanguards can also now benefit from a programme created to address early issues that were holding them back from delivering change, including contracting, technology, workforce redesign and patient engagement. 

So what lies ahead? “Over the course of this year, we’ll be really focused on supporting the Vanguards to accelerate their delivery. We have a number of toolkits and guidance and there will be policy changes,” said West.

“We are also working closely with NHS Improvement and the CQC to think about how you start to regulate these new models in a different fashion – building, for example, on what the CQC is doing in terms of thematic inspections. We’re not going to move away entirely from organisational-based inspections, but actually, to support these new care models, we need to do what I would call system re-wiring.” 

The mark of success for the programme as a whole, West argued, will be two things: that they can succeed in their own terms, which they have already started to do; and that there can be widespread adoption and adaption of these models countrywide by 2020-21. 

“The STPs are going to be a huge vehicle to help mainstream that, but, ultimately, I think the test is something simpler: it will be when these new care models become the new normal that staff really want to work in them and that patients start to demand access to them,” he concluded.

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