Evolution of care: where will the vanguards be in five years’ time?

There has been great celebration surrounding the newly selected ‘vanguards’, the 29 areas touted as the beacons of hope in delivering the NHS Five Year Forward View. The vanguards have emerged from the Dragons Den-like selection process with great enthusiasm and a sense of urgency.

This was abundantly clear at the vanguard kick-off event – the first time that representatives from all successful sites (primary and acute care systems, multispeciality community providers and models of enhanced health in care homes) had come together. Along with leaders of the support programme and other organisations, the agenda was to discuss how best to support the sites and tailor the programme to their needs.

However, among all the buzz and excitement, we must take care to not overlook the fundamental reason for the vanguards in the first place – to develop new care models which will act as blueprints for the NHS moving forward and inspire the rest of the health and care system. So it's never too soon to ask ourselves: what position will the vanguards be in when the reign of the Five Year Forward View ends in 2020?

While clearly this is open to much speculation, there were three key themes that loudly resonated throughout the launch event that are likely to determine the long-term success of the vanguards: failure, peer support, and headspace.

Failure

The fear of failure – so often the elephant in the room – was a key topic of discussion at the event. The ability to fail and learn lessons from failure is often cited as something that the NHS does not do well, so it was refreshing to hear failure put forward as a realistic potential outcome for some of the vanguards. Don Berwick stated that some failure was to be expected and embraced.

This may come as a shock to some, however to others it may appear that, without failure, the vanguards will not have pushed themselves hard enough. These areas should not be ‘safe innovators’ – something of an oxymoron. Vanguards should be given free licence to fail openly and allow themselves and others to learn from their mistakes.

Peer support

Despite April’s event marking the official launch of the vanguard programme, it was great to see that sites were already connecting with their peers, particularly the six sites focused on enhancing health in care homes. Don Berwick suggested that the key determinants of success were collaboration, cooperation and peer-to-peer learning – sites must not operate in isolation.

There was also talk of twinning sites, potentially pairing one vanguard identified as possessing strength in a certain area with another that would benefit from support. Likened to a dating agency, there was a call for the programme to create a web-based platform to facilitate a constant exchange of information between the sites, drawing on previous learning.

Headspace

Crucially, there needs to be recognition that neither of the two previous points for success are possible without the capacity and time for change. There was a request from the vanguards to be cut some slack and allowed freedom (to some extent) from performance targets and inspection regimes.

But what will this actually mean in practice?

Coherence and understanding between supporting national bodies and the vanguards is essential so that sites can select their own priorities and have the time to implement local transformational change. One overheard exchange exemplified this: 'We just need additional time on top of the day job.' 'But this is the day job!' The national bodies can play a powerful role in facilitating this.

During the launch event Simon Stevens spoke about the three different emotions around the vanguard programme – pride, pressure and passion. The sense of pride in the NHS; the stress on frontline staff from the health system making so many asks; and the ambition and enthusiasm of the vanguards.

Looking to the future, no one can predict where we will be with new models of care in five years’ time. However, we can say with absolute certainty that transforming the way the NHS delivers care will be extremely challenging. It’s therefore important to be realistic with our expectations of the vanguards, especially since the sites cover only a small part of the population. Sustainable transformational change in the NHS will take far longer than five years, but we need to start somewhere and as soon as possible. We should place our confidence and support in the vanguards. 

Isobelle is a Policy Intern at the Health Foundation