The search for new models of care, as proposed in the NHS Five Year Forward View, has previously entailed four types of vanguards:
- Integrated Primary and Acute Care Systems (PACS): which involve local integration of GP, hospital, community and mental health services.
- Multispecialty Community Providers (MCPs): which involve moving specialist care out of hospitals into the community.
- Enhanced Health in Care Homes: which involve offering older people joined-up health, care and rehabilitation services.
- Urgent and Emergency Care vanguards: which involve improving coordination of UEC services and reducing pressures on A&E departments.
Now, 13 new Acute Care Collaboration Vanguards are being created to explore improvements in collaboration between hospitals. The intention is to promote excellence in hospital services and management across wider areas (“multiple geographies”).
“The era of go-it-alone individual hospitals is now being superceded by more integrated care partnerships; both within local areas, and across different parts of the country”.
There are a number of different models:
Multihospital Chains: with NHS hospitals implementing NHS Foundation Groups to raise standards across hospital chains (the “hospital chains” model).
Multisite Specialty Franchises: with clinical services in local district general hospitals being run by specialists from regional centres of excellence in a given area of expertise (or “specialty”). Smaller trusts thereby benefit from the expertise in larger surrounding trusts, whether through networking or franchises.
Accountable Clinical Networks: which integrate care for key services across district general hospitals and teaching hospitals; for example in cancer care or mental health. (The independent Cancer Taskforce recommended cancer vanguards operating across sites to achieve earlier diagnosis, and better solutions for cancer surgery, radiotherapy and chemotherapy).
The new vanguards are listed below, by category:
Multisite Specialty Franchises
- Dartford and Gravesham NHS Trust (DGT) (a small District General Hospital making use of specialty franchises).
- Moorfields (Ophthalmology specialty franchise).
- National Orthopaedic Alliance (Orthopaedics specialty franchise).
- The Neuro Network (Walton Centre in Liverpool) (Neurology and spinal specialty franchise).
Accountable Clinical Networks
- Cheshire and Merseyside Women’s and Children Services (Maternity and Paediatrics Accountable Clinical Network).
- Developing ‘One NHS’ in Dorset (Multispecialty).
- East Midlands Radiology Consortium: EMRAD (Radiology).
- MERIT: Mental Health Alliance for Excellence, Resilience, Innovation and Training, West Midlands (Birmingham and Solihull) (Mental Health Accountable Clinical Network).
- Royal Marsden, Manchester Cancer and UCLH (Cancer).
- Working Together Partnership (South Yorkshire, North Derbyshire and Mid Yorkshire) (Multispecialty).
Millions of patients to benefit from radical new hospital collaboration drive. London: NHS England, September 25th 2015.
This relates to:
Acute care collaboration vanguard sites. London: NHS England, September 2015.
The overall vision, with a national map:
New care models – vanguard sites. London: NHS England, Updated September 2015.
Chalk and Cheese: Timely Reflections Based on Past Experience?
Perhaps only of tangential relevance in this new context, the King’s Fund has issued salutary independent observations which may or may not have any bearing on NHS England’s Vanguard programme.
Collins, B. (2015). Foundation trust and NHS trust mergers: 2010 to 2015. London: King’s Fund, September 23rd 2015.
New Care Models: NHS Improvement’s Support for Acute Care Collaboration (ACC) Vanguard Trust Buddying Schemes
NHS Improvement has accredited the first four foundation trusts to assist groups of NHS providers. The four trusts are all Acute Care Collaboration (ACC) vanguards. The aim of this “sharing excellent practice” scheme is to improve clinical viability and financial sustainability, yielding better / more sustainable services for patients. The accredited foundation trusts are:
- Guy’s and St Thomas’ NHS Foundation Trust.
- Northumbria Healthcare NHS Foundation Trust.
- Royal Free London NHS Foundation Trust.
- Salford Royal NHS Foundation Trust.
These vanguards are experimenting with different options; including informal buddying, partnerships and federations, through to formal mergers and acquisitions.
High-performing foundation trusts to support others in improving patient services. London: NHS Improvement, August 19th 2016.