The Raven's Blog

29.05.18

The work of the vanguards can help overcome the challenges of integrated care

Following the announcement of the second wave of integrated care systems (ICSs), NHS Providers, the NHS Confederation, NHS Clinical Commissioners (NHSCC) and the LGA reflect on how lessons learnt by members from across the four organisations – that have designed and worked together as part of the vanguards – will support the journey to integrated care. Here, Chris Hopson (chief executive of NHS Providers), Niall Dickson (chief executive of NHS Confederation), Julie Wood (chief executive of NHSCC) and Cllr Izzi Seccombe (chair of the LGA Community Wellbeing Board) discuss why it is vital that the legacy of the vanguards is shared.

 

The national New Care Models (NCM) programme was seen by some as a ‘game-changer’ when it was launched by NHS England in 2015 – setting the template for patient care in the 21st century. Its vision was to deliver lasting change in the way that people access and use local health and care services in line with the ambitions set out in the Five Year Forward View.

Niall Dickson, of the NHS Confederation, described this challenge as “enormous,” with the health and care system needing to recognise “that unless we manage demand by providing the right support at the right time, the system cannot be sustained, even with more staff and more funding.”

Chris Hopson, of NHS Providers, added that the programme itself needed to recognise “that large-scale transformation in healthcare requires funding, implementation support, time, and the permission to make mistakes and learn from them.”

The vanguard sites across England have made strides towards realising those ambitions and setting out a blueprint towards integrated care. Many have introduced innovative approaches to delivering care that can be shared and spread at scale, while also building strong partnerships across traditional boundaries, overcoming complex governance challenges, and involving staff, patients and the public in service change.

Three years on, it is time to consider the legacy of the vanguards and to ensure that the lessons learned by those involved will make a positive contribution to health and care in the future.

What have the vanguards achieved?

At the end of the first year of the NCM programme, there were 50 vanguard areas working to improve care for more than five million people, around 9% of the national population.

Across these sites, there were five vanguard types set up:

  • Multispecialty community providers (MCP), combining primary care and community-based health and care services;
  • Integrated primary and acute care systems (PACS), joining up primary care, community and mental health services and also incorporating hospital services;
  • Enhanced health in care homes, bringing together NHS services in partnership with care home providers and local authority services;
  • Acute care collaborations, testing new ways for acute providers to work together to improve care quality, financial efficiency and workforce sustainability;
  • Urgent and emergency care, coordinating urgent and emergency care services across whole systems and ensuring people can access the most appropriate service, first time.

Julie Wood, of NHSCC, is positive about the changes that the programme has delivered: “Over the three years of the vanguards and NCM programme, we have witnessed many of our members leading and delivering truly innovative work that has radically changed the way that people receive care – resulting in a more coordinated approach and improving outcomes for patients and the wider population.”

Dickson added that the programme has “demonstrated an array of initiatives that have created new relationships, removed barriers, harnessed technology, empowered staff, patients and communities and connected up services.”

Partnership working has been at the heart of these successes. Cllr Izzi Seccombe, of the LGA, noted that for new models of care to be successful they must be based on “partnerships of equals between councils, the NHS and the community, based on a strong vision co-produced with all stakeholders including the public.”

Vanguards, such as Tower Hamlets Together and My Life A Full Life on the Isle of Wight, have demonstrated the power of different parts of the public and voluntary sector coming together to support population health and wellbeing in their broadest sense. Through their focus on multi-disciplinary team (MDT) working, sharing information across services and using technology to support self-care, many vanguards are starting to truly design care around the needs of people who use services. 

The All Together Better vanguard in Dudley has reported that implementing GP practice-based MDTs involving social care, mental health and voluntary sector workers has led to a reduction in patients’ length of stay. MDT working has also had a positive impact on staff levels of job satisfaction.

Whilst considering the next steps to integrated care, NHS England is also undertaking work to evaluate the impact of these reconfigured services and how they have improved the experiences of people who use them. This evaluation will also seek to set out the measurable impact on the local health and care economies.

The latest data shows that growth in emergency admissions has slowed in vanguards areas compared to other parts of the country.  For the 12 months to January 2018, compared to the base year 2014-15, emergency admissions growth was 1.4% in the MCP vanguards and 1.7% in the PACS vanguards, against 5.7% growth across the rest of England. For the enhanced care homes vanguards, emergency admissions for residents dropped by 1.4% while admissions for the rest of the England went up by 6.7%.

The programme has demonstrated the value of bringing people together to network and share learning. The spread of the ‘Red Bag’ initiative developed by the Sutton Homes of Care vanguard to other parts of the country including Wakefield and Hertfordshire is a perfect example of why the national commitment to supporting spread and scale has been so important and must continue.

The ‘Red Bag’ keeps important information about a care home resident’s health in one place so that it is easily accessible to ambulance and hospital staff if the resident needs to go to hospital in an emergency. It also has room for personal belongings (such as clothes for day of discharge, glasses, hearing aids, dentures) and it stays with the patient while they are in hospital. When the resident is ready to go home, a copy of their discharge summary is placed in the red bag so that care home staff have access to this information when their resident arrives back home.

Where do we go next?

The wider system is now taking broad steps towards more joined up care through ICSs and sustainability and transformation partnerships (STPs).

Hopson warned that we as we begin this journey, we must not interpret the successes of the vanguards “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.”

He acknowledged that “an incredible amount is being achieved by committed health and care staff, from right across our respective memberships, to develop new models, while also keep existing services running.” However, “leadership and management capacity in the health and care systems is at full stretch.”

Dickson agreed, adding: “Our members tell us trying to bring about transformational change, with little or no extra money, while trying to sustain the existing services is exceptionally difficult.”

He suggested that the real value of the NCM programme can be seen in the lessons shared from those involved in the vanguards, now supporting this journey. “If we can continue to share the lessons learned from the vanguard sites across the health and care system, there will be real and lasting value,” said the NHS Confederation boss.

Wood also argued that these “lessons must be embedded and not lost as work across the system scales up, ensuring the patient benefits from the transformation agenda are realised.”

Time to build on the experiences of the vanguards

Looking to the immediate future, it is evident that STPs and ICSs are the vehicles to put the lessons from the vanguards into practice. The next wave of ICSs represent an opportunity to build on the experiences of the vanguards and capitalise on the enthusiasm and leadership of vanguard partners and their local communities.

Dickson argued that it is critical that we “maintain momentum and capture the energy and enthusiasm from the clinicians and staff from across the NHS and local authorities that have shaped and led these innovations.” One element of this will be to “establish an innovative culture which fosters and supports these new models of care.”

Wood suggested that “now is the time to build on new partnerships, make the most of opportunities to bridge the gaps between different areas of the country and across clinical disciplines, and share best practice to scale up and deliver long-lasting change.”

At the heart of this, Seccombe stated that we must continue to place importance on “shifting the centre of gravity towards joined-up primary, community and social care – as these frontrunners have shown – to support people to stay well, independent, safe and happy.”

There is much to be learnt from the work of the vanguards, from how they have engaged local communities to help people stay well at home, and supported staff to deliver service change on the ground. While it is evident that this has produced positive changes, as Hopson explained, we need to be realistic about the challenges of scaling up and spreading these models. “Applying this learning to transformation on a much larger scale will present us with new set of challenges,” he concluded.

NHS Providers, NHS Confederation, NHSCC and the LGA have produced a briefing series to help share learning from the vanguards.

Comments

There are no comments. Why not be the first?

Add your comment

 

public sector executive tv

more videos >

latest public sector news

‘Bodies may be uncollected’: No-deal Brexit chaos could see council staff work from home for months

10/12/2018‘Bodies may be uncollected’: No-deal Brexit chaos could see council staff work from home for months

Bodies will remain uncollected and council staff may be forced to work from home for six months due to gridlocked roads in the event of a no-deal... more >
Major public services contractor seeking second rescue deal to avoid Carillion-style collapse

10/12/2018Major public services contractor seeking second rescue deal to avoid Carillion-style collapse

Interserve, one of the government’s largest outsourcing companies and provider of public services, has announced it is seeking a rescue dea... more >
Councils must set out rough sleeping strategies by 2019 or face government action, Brokenshire warns

10/12/2018Councils must set out rough sleeping strategies by 2019 or face government action, Brokenshire warns

All councils must publish detailed rough sleeping and homelessness strategies by winter 2019 or face government intervention if they fail to do s... more >

editor's comment

25/10/2017Take a moment to celebrate

Devolution, restructuring and widespread service reform: from a journalist’s perspective, it’s never been a more exciting time to report on the public sector. That’s why I could not be more thrilled to be taking over the reins at PSE at this key juncture. There could not be a feature that more perfectly encapsulates this... read more >

last word

The importance of openness after Grenfell

The importance of openness after Grenfell

Following the recent Grenfell Tower tragedy, Lord Porter, chairman of the LGA, argues that if the public are going to have faith in the safety testing process then everything must be out in the o... more > more last word articles >

the raven's daily blog

Re-energising citizen engagement

10/12/2018Re-energising citizen engagement

Could smart cities and social media be the perfect match? Simon Dennis, director of artificial intelligence and analytics innovation at SAS UK, reports.  Politics is a divisive issue and not simply from a philosophical standpoint. Engagement levels are highly polarised across different sections of society. We could postulate man... more >
read more blog posts from 'the raven' >

comment

The digital buying community is live

12/11/2018The digital buying community is live

Many of the requirements from buyers posted on the Digital Marketplace were either non-compliant or poorly worded, which resulted in challenges f... more >
A force to be reckoned with

12/11/2018A force to be reckoned with

The South Bank plan, which refers to a number of investments and proposed activities across a massive plot of land south of the River Aire, is on... more >
Less for less: the risk of 'core offers'

12/11/2018Less for less: the risk of 'core offers'

As councils across England struggle with their finances in the face of massive cuts from central government, Simon Edwards, director of the Count... more >
A two-speed England

05/11/2018A two-speed England

Central government needs to change its approach to local transport planning and investment, including by consolidating funding and maximising dev... more >

interviews

New Dorset Councils CEO on the creation of a new unitary: ‘This is going to be the right decision for Dorset’

05/11/2018New Dorset Councils CEO on the creation of a new unitary: ‘This is going to be the right decision for Dorset’

The new chief executive of one of the new unitary authorities in Dorset has outlined his approach to culture and work with employees, arguing tha... more >
Keeping the momentum of the Northern Powerhouse

15/10/2018Keeping the momentum of the Northern Powerhouse

On 6 September, the biggest decision-makers of the north joined forces to celebrate and debate how to drive innovation and improvement through th... more >
Cllr Cutts on dealing with children’s services pressures: ‘I can’t magic money out of the air’

26/09/2018Cllr Cutts on dealing with children’s services pressures: ‘I can’t magic money out of the air’

The leader of Nottinghamshire County Council has outlined her priorities for dealing with soaring demand of children’s services and social ... more >
Nottinghamshire considers unitary shake-up proposals in a bid to balance books

05/09/2018Nottinghamshire considers unitary shake-up proposals in a bid to balance books

Nottinghamshire County Council is considering proposals to scrap its current two-tier structure for a new unitary system in order to save on... more >

public sector focus

View all News