Three years on from the Forward view, what can we learn from the vanguards?

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19 September 2017

Chris Hopson
Chief executive


As we approach the third anniversary of the publication of the NHS Five year forward view it feels like a good opportunity to take stock of how far we’ve got in realising the ambitions of the 2014 strategy. The Forward view warned that, in the face of changing health needs, developments in treatments and technologies, and an unprecedented financial challenge, short term strategies would not be enough to preserve existing services and standards. What’s more, short term fixes would ultimately lead to a widening of the three ‘gaps’: health and wellbeing, care and quality, and funding and efficiency. Instead, the Forward View proposed that we need to fundamentally re-shape the way care is delivered.

The new care models described in the Forward View seek to dissolve traditional divides in health and care services. They are integrating services around the needs of patients, focussing their efforts on promoting wellbeing and preventing ill-health and innovating to make more efficient use of resources. From our work in partnership with the NHS Confederation, NHS Clinical Commissioners and the Local Government Association to share the learning from the vanguards – local areas pioneering the introduction of new care models – we know impressive progress is being made, and believe there is considerable cause for optimism.


Beginning to show results

The Forward view and subsequent new care models programme rightly recognised that large scale transformation in health care requires funding, implementation support, time, and the permission to make mistakes and learn from them. This approach is beginning to show results; nearly all the vanguards estimate that they will have saved more than has been spent on them by the end of 2018-19. Early findings from NHS England suggest primary and acute care systems (PACS) and multispecialty community provider (MCP) vanguards are already seeing lower growth in the population rate of emergency admissions than the rest of England.

The Forward view and subsequent new care models programme rightly recognised that large scale transformation in health care requires funding, implementation support, time, and the permission to make mistakes and learn from them.

Chris Hopson    chief executive

These early outcomes are underpinned by the vanguards’ efforts to simplify services and the way people interact with them, which in turn is supporting people to maintain their independence and wellbeing. As part of the vanguard project in Mid Nottinghamshire people are increasingly being supported to manage their own conditions at home and share information with their clinicians through an automated telehealth tool using text messages. Meanwhile, Salford Together vanguard is tackling the enormous challenge of joining up primary, secondary and social care services, and is seeking to make more efficient use of the workforce spanning these traditional divides. As part of Salford’s work to develop an Integrated Care Organisation 450 adult social care staff have transferred across from the city council to Salford Royal Hospital, creating a new team of health and adult social care workers. Underpinning this is work to integrate data across these services. This could be a real turning point in the use of data to assess patients’ levels of risk and prevent ill-health at population level.


Leadership capacity is at its peak 

Let’s be careful, however, not to interpret these successes to mean that health and social care services can be expected to maintain, or accelerate, the speed at which they are delivering new models of care. An incredible amount is being achieved by committed NHS staff to develop new models while also keep existing services running. But leadership and management capacity in the NHS is at its absolute peak. Likewise, while there is much anticipation about the scope and spread of NCMs, the reality is that most PACS and MCPS have a long way to go before they fully meet all the key elements set out in contract frameworks. We cannot underestimate the scale of the change the vanguards are delivering - recent data showing that delayed transfers of care (DTOCs) for patients who are medically fit to move on after treatment remain stubbornly high demonstrates just how challenging it is to deliver joined up services across the health and care system. So we need to continue to be clear about what can realistically be achieved.

An incredible amount is being achieved by committed NHS staff to develop new models while also keep existing services running. But leadership and management capacity in the NHS is at its absolute peak.

Chris Hopson    chief executive


Event

In November, health and social care leaders will come together at an event to discuss what we can learn from the vanguard journey, and where it is headed next. The reality is that we are at just the beginning of the journey for these new care models, which will take 7-10 years to become fully implemented. However, we do now have a clear direction of travel in a number of areas. As we continue to support the vanguards to deliver changes locally, we should also now look at how change can be supported in areas that aren’t vanguards. Likewise, the good practice, successes and failures from the vanguards should inform the development of further new models of care, STPs and accountable care systems. While positive differences are being made by the vanguards, applying the learning to transformation at a much larger scale presents another challenge.

 

Read more about our work to share the learning from the vanguards.

NHS Providers, the NHS Confederation, NHS Clinical Commissioners and the Local Government Association are working together to help spread the learning from the new care models programme. Together, we aim to create greater understanding, involvement and ownership of the vanguard vision, showcasing new ways that health and care economies can help establish a sustainable health service now and in the future.

 

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