NHS vanguards – one year on

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I have witnessed at first hand the enthusiasm and commitment of staff involved in the new care model vanguards. Clinicians and managers from across the NHS, together with colleagues from local government and the third sector, are making real strides in establishing new care models. Progress is faster in some areas than others, but everywhere there is recognition of the need to do things differently and not just deliver more of the same.

Many of the new models are focusing on care being integrated more effectively around the needs of populations and patients. Among the integrated primary and acute care systems (PACS) vanguards, examples include work in Somerset, Salford, Northumbria, Morecambe Bay, and on the Isle of Wight to join up budgets and services with the aim of delivering better outcomes.

A high priority in all areas is to strengthen links between general practices and other health and care services. This means working with individual practices and with emerging federations of practices to provide care more seamlessly, as is now happening in the South Somerset Symphony programme. Collaboration between NHS organisations and local authorities is also receiving attention, as is work in the Isle of Wight’s programme My life, a full life.

Many of the PACS are exploring innovations in contracting and payment systems to support new care models. These innovations include accountable care systems and capitated budgets as in the Better care together (Morecambe Bay Health Community) vanguard. They are also investing in the development of shared leadership through health and wellbeing boards and other governance arrangements.

As the vanguards enter their second year, it is essential that the work of staff directly involved is visibly supported by top leaders in NHS organisations. Many of these leaders are preoccupied with operational performance in their own organisations as regulators tighten their grip over the NHS. They now need to pay as much attention to working with partner organisations to make a reality of place-based systems of care.

The challenge is how to do so when regulators are focused on organisational performance rather than the performance of place-based systems of care. The urge to collaborate may also be frustrated by the market-oriented provisions of the Health and Social Care Act 2012 and the persistence of competitive behaviours between organisations.

In this context, leaders face a choice between adopting a fortress mentality in which the needs of their own organisation come first, or reaching out to other organisations in the spirit of ‘we are all in this together’.

Leaders will need support from national bodies to overcome the barriers that inhibit collaboration. They will also need to commit to the lengthy and often slow process of building bridges between their own organisation and others to move from fragmented care to integrated care.

The involvement of local authority leaders is often helpful in this process as local government has considerable experience of working across organisational and service boundaries and has already proved to be beneficial in a number of the PACS vanguards.

The prize on offer is for organisations to go beyond efforts to integrate care and use their resources to improve the health of their populations. A worthy and powerful legacy of the new care models programme would be to act as a catalyst for the development of population health systems focused on health and wellbeing.


Simon Dodds

System Designer and Surgeon,
Comment date
02 May 2016
Moving from a fragmented / competitive system design to an integrated / collaborative system design will require health care systems engineering (HCSE) capability that appear to be in short supply. Why? One reason is that there are no training courses in complex adaptive system design applied to healthcare. But there is innovation happening ... http://www.thephoenixprogramme.org

Ed Macalister-Smith

NED; Chair,
Comment date
17 March 2016
I applaud the energy and enthusiasm, we need it!

We also need to ensure that Nolan principles, patient benefit and whole system gain are the drivers for change, not individual organisation cudos and budgets.


training consultant,
training institute
Comment date
16 March 2016
It is the great news.I am very happy to read this information and is easy to understanding.

Krishna Kodavali

Comment date
12 March 2016
I entirely agree with will sopwith's comment - this is the ground reality at large, there would be pockets of good practice.

will sopwith

Comment date
11 March 2016
Lots of challenges and calls to commitment here - inspiring or disheartening i wonder? The tension of 'fortress mentality' versus 'building bridges' in the current context of performance pressure is real. It's not a scenario that feels very amenable to just making a choice.

Where the relationships across organisational boundaries are not already effective and mutually supporting, trying to operate in partnership constantly trips up on 'fortress' issues of misguided assumption on motives and poorly developed mechanisms of collaboration. Without help to build better relationships, its no wonder organisations retreat to fight their own fires again.

Completely agree on the prize, but unless the systems get the technical support to integrate not only systems but also their relationships, we risk never progressing beyond that stage - population health then remains the mirage on the horizon that we never quite reach.

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