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.
The NHS is facing one of the most challenging periods in its history, with a funding gap of more than £22 billion over the coming years. And the pressure on the social care system is more acute than ever, with many councils raising eligibility thresholds and making cuts to social care budgets.
Sustainability and Transformation Plans (STPs) – which are local health and care reform plans, authored jointly by NHS and local government leaders to improve outcomes and drive greater efficiency in their local area – are one of the government’s main responses to this problem. These plans rightly focus on decentralising power within the NHS, investing in leadership and relationships to drive improvements, and on local health and care organisations coming together to overcome the silos created by the 2012 Health and Care Act.
This report looks at the most promising reform solutions that have been identified by STPs, and also sets out the range of challenges that stand in the way of them realising their vision for improved health and efficiency.
The Better Care Fund will provide financial support for councils and NHS organisations to jointly plan and work together to deliver local services.
This document sets out the story of integration of health, social care and other public services, and provides an overview of related policy initiatives and legislation.
It is intended for use by those responsible for delivering the Better Care Fund at a local level (such as clinical commissioning groups, local authorities, health and wellbeing boards) and NHS England.
It includes the policy framework for the implementation of the statutory Better Care Fund in 2017 to 2019, which was first announced in the government’s Spending Review of 2013 and established in the Care Act 2014.
It also sets out proposals for going beyond the Fund towards further integration by 2020.
This paper reveals how integration of the fields of health and social care will require organisations to break down traditional barriers in how care is provided. | Skills for Health
Long-term chronic conditions and preventable illnesses such as diabetes are on the rise and can require multiple interventions from a complex range of organisations.
These population changes mean that health and social care providers must work together to pool their skills, knowledge and resources to increase efficiency and quality of care, delivering a system of health and social care shaped around the needs of the patient.
This working paper details how workforce development plays a crucial role in successful integration.
The Department of Health has published Social work: essential to integration. This document is intended to support and inform local and regional health and social care integration initiatives. It explains the contribution that social workers make to integrated services; how social work is essential to the whole system; and the necessity of support to ensure integration succeeds in providing the services people need.
It also includes ‘top tips’ for directors of adult social services and for principal social workers to assist in progressing the integration agenda.
It was developed in collaboration with the Association of Directors of Adult Social Services, the Principal Social Workers’ Network and the Department of Health.
Devo-health: where next? | Institute for Public Policy Research
This report provides a comprehensive overview of the devolution of health policy to date, and the directions it could take in future. It presents the evidence for how ‘devo-health’ could allow integration within and beyond the NHS, and act as a catalyst to much-needed reform.
NHS Employers has published details of a case study from Norfolk and Norwich University Hospitals NHS Foundation Trust who working with social care partners, have developed an integrated apprenticeship designed to provide a broad understanding of the different roles and responsibilities that exist in both health and social care.
Piloted over a year, the aim of the programme was to support those wishing to pursue a career across a range of care organisations. Starting with a two week clinical induction, the apprentices went on to undertake two six month placements, offered in a community care setting and on a hospital ward.
By experiencing the different systems and cultures, the apprenticeship enabled the apprentices to gain both knowledge and transferable skills while keeping a person-centred approach to care at its heart.