Lessons from new models of care / Vanguards

Featured article - 09 February 2018
By Jane Harris, Senior Consultant, Cordis Bright consultancy, advice and research

Head-shot of the author, Jane Harris, Senior Consultant, Cordis Bright consultancy, advice and research

‘Blueprints for the NHS moving forward.’ That’s how NHS England describes the Vanguard sites that aim to improve the care of millions across England. Through the New Care Models programme, complete redesign of whole health and care systems are being considered. This means, for instance, fewer trips to hospitals with cancer and dementia specialists holding clinics in local surgeries, having one point of call for family doctors, community nurses, social and mental health services, or access to blood tests, dialysis or even chemotherapy closer to home.

But how is this sizing up? Over the last two years we’ve evaluated seven NHS Vanguard projects across the range of models. As the programme moves into a new phase of trying to scale and replicate successes, have the Vanguards succeeded in demonstrating better ways of working? Here are our top five lessons from the Vanguards that we’ve been supporting.

A better experience for patients

Multi-disciplinary teams have resulted in a much better experience for patients. Not surprisingly, when professionals have a structured means to talk to one another and agree action plans, there is less risk of an individual falling through the safety net and more opportunity to treat people rather than symptoms.

A better experience for staff

For the most part, staff have grasped the opportunity to share information and learn from one another. As a nurse working in a community integrated team told us: ‘This is absolutely the best change I’ve seen in the NHS in the 30 years I’ve been working as a nurse. It must carry on.’

Benefits may be longer term

Much has been made of the potential of new care models to reduce hospital admissions, but the policy consensus is that the way to ease pressures on the NHS in the long run is to keep people healthier for longer. MCPs have kick started initiatives to involve citizens and voluntary groups in keeping themselves and their neighbours well.

Data sharing can still be a challenge

The Vanguards would have worked far more efficiently and we would know so much more about them if the systems had been in place to share data across health and social care and between NHS organisations. Surely this can’t be so difficult?

Short-term cashable savings

New care models probably aren’t going to result in hospital beds closing in the near future. The impact of these projects is too small, while it’s been very hard to prove that any reduction in, for example, non-elective admissions happened because of these initiatives and not for other reasons. Local partners would need to sign up to the principle of taking costs out of the system on the basis of an economic case – and at the moment this just seems too risky for most.

So there are promising signs and also challenges with the Vanguards. But let's hope that they can encourage the rest of the health and care system so that the NHS and social care move forward to improving more lives.

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