Third wave of acute Vanguards to test three new ‘radical’ joined-up models

NHS England boss Simon Stevens is set to announce today (25 September) three “radical” new options for the future of local hospitals developed by 13 new acute care Vanguards.

In a speech to the Confederation of British Industry in London this afternoon, Stevens will outline three approaches ready to be tested in response to ideas for reform proposed by frontline clinicians and managers.

The ideas were devised by a third wave of Vanguards – comprised of 13 of the best-run hospitals nationwide, known as ‘acute care collaborations’ – joined to link local hospitals together in an effort to improve their clinical and financial viability.

The “radical” approaches include individual NHS hospitals with an excellent track record being able to form NHS Foundation Groups to raise standards across a chain of hospitals, a model frequently used in other countries.

Individual clinical services at local district general hospitals will be run on site by specialists from regional centres of excellence, such as orthopaedics, ophthalmology and neurosciences. This model hopes to ensure a smaller trust will draw expertise from larger and surrounding trusts through a mixture of networking and franchising.

Lastly, Stevens will announce the creation of ‘accountable clinical networks’ integrating care across district general hospitals and teaching hospitals for vital services, such as cancer and mental health. Drawing on recommendations from the independent Cancer Taskforce, the new cancer Vanguards will strive to ensure accountability for a population budget for cancer care. They will be able to operate across sites, move investment into faster earlier diagnosis, and optimising combinations of cancer surgery, radiotherapy and chemotherapy.

Stevens is set to say this afternoon: “The era of go-it-alone individual hospitals is now being superseded by more integrated care partnerships – both within local areas, and across different parts of the country. The scale of the interest in these new Vanguards from across the health service shows the NHS is up for radical reform.

“Our new approach to hospital partnerships will help sustain the viability of local hospitals, share clinical and management expertise across geographies, and drive efficiency beyond the walls of individual institutions.

“We’ve got some of the world’s best hospitals an specialists in this country, and it’s right they should be able to extend their reach more widely, as the Vanguard programme will now allow them to do.”

The ‘acute care collaboration’ Vanguards will devise new arrangements between hospitals including sharing staff, services and resources in a bid to improve the quality of patient care, the clinical viability of smaller providers, and the productivity of each participating hospital.

They will receive financial and practical support from a joint programme led by NHS England and NHS Improvement with other NHS Five Year Forward View partners, such as NICE. The hope is that lessons learnt from their experience will be implemented in other areas in coming years.

The 13 Vanguards, chosen from 65 bids, will be:

Multihospital chains

  • Salford and Wigan Foundation Chain
  • Northumbria Foundation Group
  • Royal Free London

Multisite specialty franchises

  • Dartford and Gravesham (small District General Hospital making use of specialty franchises)
  • Moorfields (Ophthalmology)
  • National Orthopaedic Alliance (Orthopaedics)
  • The Neuro Network (The Walton, Liverpool) (Neurology and spinal specialty)

Accountable clinical networks

  • MERIT (Birmingham and Solihull) (Mental Health Accountable Clinical Network);
  • Cheshire and Merseyside Women’s and Children Services (Maternity and Paediatrics Accountable Clinical Network);
  • Royal Marsden, Manchester Cancer and UCLH (Cancer)
  • East Midlands Radiology Consortium (Radiology)
  • Developing ‘One NHS’ in Dorset (Multispecialty)
  • Working Together Partnership (South Yorkshire, North Derbyshire and Mid Yorkshire) (multispecialty)

Ed Smith, chair of Monitor and the new chair-designate of recently-merged NHS Improvement, said: “Today’s Vanguards represent the evolution from the era of standalone hospitals, begun in the 1962 hospital plan for England, and reinforced by the creation of foundation trusts in the early 2000s. These were right at the time, but the economic and clinical circumstances facing the NHS are now different, and our response needs to evolve.”

The new Vanguards were selected after a “rigorous” process involving workshops and the engagement of national and regional partners and clinical and patient representative groups.

For a list of the 13 hospitals selected to form part of the new wave of Vanguards, access NHS England’s list.

One of the new cancer partnerships comprises The Royal Marsden NHS Foundation Trust, The Christie NHS Foundation Trust and UCLH (University College London Hospitals NHS Foundation Trust). They will work together to develop plans to implement ‘accountable clinical networks for cancer’ that could be echoed nationally.

The partners will work with a range of providers, including Devo Manc, to support integration across the entire cancer patient pathway, including public health, primary care and diagnostics.

Roger Spencer, chief executive of The Christie, said: “A strong and cohesive leadership of the cancer pathway is vital for effective service delivery.

“By aligning and unifying our efforts, we can create a future model that will reduce the variations that exist in cancer services and drive improvements in both clinical outcomes and patient experience.”

Previous types of Vanguards included integrated primary and acute care systems, multispecialty community providers, care homes and urgent and emergency care – all of which aimed to integrate different services to improve performance.

They vary from the new wave of Vanguards will by mostly focusing on integrating care between GPs, social and community care, mental health and hospital services within their local area, while the acute care collaborations will share services across multiple geographies.


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