Sam Jones - The Vanguards - Progress to date - Wednesday 1 February 2017

“The Google definition of ‘vanguard’ is a group of people leading the way in new developments or ideas, or the foremost part of an advancing army,” Sam Jones told Care Conversation delegates. “Leaving aside the military analogy, this is not just abstract,” she said of the New Care Models programme. “This is real people doing real things.”

The 2014 NHS Five Year Forward View document had set out the health and wellbeing gap, the care and quality gap and the funding gap, and the challenge now was to properly address those issues. “We all know that if we don’t have the clinicians who are actually delivering the services involved, then things won’t happen,” she said, while patient involvement was just as integral and all of the arms-length bodies were fully on board. “There’s no point just trying to do this from Skipton House, Wellington House or Richmond House, because it will just get stuck in the mire.”

The programme was made up of a range of elements, she said, including integrated primary and acute care systems, multi-speciality community providers, enhanced health in care homes, urgent and emergency care, and acute care collaboration. “What happens in Northumbria should be no different to what happens in London. But let’s be frank, the NHS hasn’t always been very good at working like that.”

The programme was also supporting the development of further care models, she pointed out. “We asked the vanguards what gets in the way of care getting delivered – ‘What is it that you want to do, and why can’t you do it?’ We’re out there designing the care models in real time, and if it isn’t working for the vanguards then it isn’t working for the national bodies. This is about real policy change.” One of the biggest challenges was often getting the national bodies to move as fast as the change on the ground, she pointed out. “There’s a huge appetite for this.”

The New Care Models programme had also studied why previous policy initiatives had failed to take root, she explained. “There’s no point trying to design and deliver a new care model if the commissioning system and everything else works against it.”

The vanguards that were moving fastest were the ones focused on relationships, she stressed. “It can be frightening when you say to the workforce, ‘You need to change’. So it’s also about supporting people to do things differently and understanding why they’re reacting the way they are.
To be a vanguard you also have to be willing to talk about it, and willing to share. Change is about people – things can only work as fast as relationships and trust and behaviours.”

The last year had been about developing and delivering the new models, and signs of a positive impact were already there, she told the seminar. The vanguards were reducing pressure on the system by bringing health and social care teams together in the community, providing proactive care to patients with higher needs, keeping people well in the places where they most wanted to be, and improving outcomes across a range of measures.

Independent evaluation had been commissioned which included real time tracking, she stressed. “We’ve also been blown away by how the CQC has been actively supporting the care models, and re-designing how they can regulate them in the future.”

There was no ‘magic bullet,’ however. “This is about relationships between anyone who has an impact on the wider determinants of health, and taking the fundamentals and making them relevant wherever you are. It’s not longer a case of ‘That’s fine, but it’s not the way we do it in Yeovil’.

“This is happening at an NHS near you,” she stated. “My biggest frustration is that the good stuff doesn’t get the airtime, doesn’t get on the front pages – this stuff is making an impact. The next challenge is for there to no longer be a vanguards programme, because all of it is being done through the mainstream system.”