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With the first anniversary of the NHS five year forward view approaching rapidly, how are new care models developing, and what are the prospects for the future?
Even at this early stage, it is clear that the new care models programme has unleashed a good deal of energy and welcome variety in the approaches adopted. Five types of vanguard are now in development, encompassing multispecialty community providers (MCPs), primary and acute care systems (PACS), enhanced health in care homes, urgent and emergency vanguards, and acute care collaborations. It is encouraging too that the programme is sponsored by seven national bodies who are working together to support innovations in care.
While it is far too soon to assess the impact of the vanguards, it is clear that they face some common challenges. These include creating time to implement new care models when the NHS is faced with growing financial and operational pressures, and extending involvement from a small number of enthusiastic champions to frontline staff and others who will be critical in ensuring that patients really do experience improvements in care. Another challenge is overcoming legislative and regulatory barriers to collaborative working.
The history of pilot programmes in the NHS demonstrates the need to allow time for the vanguards to demonstrate results and to avoid a rush to judgement. It also points to the need for dedicated programme management support as plans move from the drawing board into practice. With most of the vanguards seeking to achieve closer integration of care, it is particularly important that there is deep and genuine engagement by doctors, nurses and other staff since evidence shows that clinical integration rather than organisational integration is what delivers benefits.
One of the biggest risks facing the programme is that dealing with financial and operational pressures will crowd out the time needed to design and implement new care models. The trick here is to see the models as part of the solution to these pressures rather than an unhelpful distraction. Dealing with rising demand for hospital care cannot be achieved through ‘more of the same’ and the work being done in many of the vanguards to tackle avoidable hospital admissions through better co-ordinated care holds out the hope that ‘doing things differently’ will be more effective.
Our work at the Fund on high-performing health care systems has shown that improving the delivery of care involves a long march in which benefits result from ‘the aggregation of marginal gains’ rather than a major breakthrough. These gains occur when frontline staff are supported to improve care and have the space to do so. The challenge for national and organisational leaders is to protect the time of key staff involved in the vanguards and to provide the support they need to put in place sustainable solutions.
Our work has described the journey from fragmented care to integrated care and on to population health as the path that needs to be followed in implementing the Forward View. Devo Manc is an ambitious example of an attempt to do this by improving health and wellbeing through action across a range of services and sectors. Population health improvement is the prize on offer where NHS organisations and their partners can find common cause in working together to deal with the unprecedented challenges facing public services in this parliament.