The vanguard programme, one of NHS England’s attempts to better meet patients’ needs and deliver savings by developing new care models to integrate health and social care services, has not delivered the depth and scale of transformed services it aimed for at the beginning of the programme, according to this report by the National Audit Office.
A key objective of the programme was to design new care models that could be quickly replicated across England. NHS England selected 50 sites to act as ‘vanguards’ which might entail, for example, joining up GP, hospital and community and mental health services in an integrated network or single organisation in one area to improve healthcare for patients.
NHS England’s early planning assumption was £2.2 billion of funding for new care models between 2016-17 and 2020-21, but it used much of the funding to reduce deficits faced by hospitals. Actual direct funding of vanguards was £329 million over three years from 2015-16, with another £60 million spent by NHS England on central support for vanguards. Consequently, with less funding for transformation, the original intention to expand the programme was not realised.
Despite not meeting its original intention to expand the models across the country, vanguards have made progress in developing new care models. NHS England forecasts that vanguards will make net savings. As at April 2018, it estimated that vanguards would secure £324 million net savings annually by 2020-21, which is 90% of the £360 million that had been expected.
Full report: Developing new care models through NHS vanguards
See also: National Audit Office press release
Supporting Change In Your NHS: The Non-Executive Community In Transformational Change | NHS Clinical Commissoners | NHS England | NHS Improvement
This joint publication with NHS England and NHS Improvement summarises discussions held at two events earlier this year that brought together more than 200 CCG lay members and trust non-executive directors. These events focused on how lay members and NEDs can contribute to the integration and transformation of their local health communities.
Full document available here
Rishi Mandavia, Nishchay Mehta, Anne Schilder and Elias Mossialos. Effectiveness of UK provider financial incentives on quality of care: a systematic review. Br J Gen Pract 9 October 2017; bjgp17X693149. DOI: https://doi.org/10.3399/bjgp17X693149
Provider financial incentives are being increasingly adopted to help improve standards of care while promoting efficiency.
Aim To review the UK evidence on whether provider financial incentives are an effective way of improving the quality of health care.
Design and setting Systematic review of UK evidence, undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations.
Method MEDLINE and Embase databases were searched in August 2016. Original articles that assessed the relationship between UK provider financial incentives and a quantitative measure of quality of health care were included. Studies showing improvement for all measures of quality of care were defined as ‘positive’, those that were ‘intermediate’ showed improvement in some measures, and those classified as ‘negative’ showed a worsening of measures. Studies showing no effect were documented as such. Quality was assessed using the Downs and Black quality checklist.
Results Of the 232 published articles identified by the systematic search, 28 were included. Of these, nine reported positive effects of incentives on quality of care, 16 reported intermediate effects, two reported no effect, and one reported a negative effect. Quality assessment scores for included articles ranged from 15 to 19, out of a maximum of 22 points.
Conclusion The effects of UK provider financial incentives on healthcare quality are unclear. Owing to this uncertainty and their significant costs, use of them may be counterproductive to their goal of improving healthcare quality and efficiency. UK policymakers should be cautious when implementing these incentives — if used, they should be subject to careful long-term monitoring and evaluation. Further research is needed to assess whether provider financial incentives represent a cost-effective intervention to improve the quality of care delivered in the UK.
Supporting providers: STPs and accountable care | NHS Providers
NHS Providers are working to develop a programme of support that helps provider organisations adapt to the challenges and opportunities presented by the move to accountable care.
The programme, Supporting Providers: STPs and accountable care, will be developed in close collaboration with NHS trusts over the next six weeks. The programme aims to ensure there is the right support and a strong advocate making the case for NHS trusts as they move to accountable care structures that deliver more integrated care for the public.
Elements to support trusts will include:
- Developing new and effective relationships with local authorities, primary care and commissioners
- Responding to specific challenges such as moving care closer to home, prioritising mental health, workforce strategy and getting the most out of the NHS estate
- Exploring new ways to support change, identifying “enablers” including new approaches to contracting, different financial flows, adopting risk stratification and whole population health management approaches, and developing STP level governance arrangements.
More detail at NHS Providers
Department of Health, 2017
- Source: Department of Health
The Quality Matters initiative is co-led by partners from across adult social care sector. This publication sets out a single view of quality and a commitment to improvement. The summary action plan sets out 6 priority areas to make progress on improving quality in first year. These initial priorities have been identified by people who use services, their families and carers, providers, commissioners, and organisations that support and oversee adult social care services.
This action plan summarises, for each of our priorities:
- What this priority means in practice
- Who is responsible for making it happen
- Where we will focus in the first year.