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Are you a Vanguardista?

NHS England recently announced 29 “vanguard” areas that will take a national lead in the transformation of care for patients across England by developing new/innovative models of care in line with the NHS Five Year Forward View.

Roy Lilley entitled the participants Vanguardistas, they were “enthusiasts giving it a go.”  Vanguardistas reminded me not just of enthusiasts, but of the Sandinistas - the revolutionary Nicaraguans in the late 1970s and 1980s.  For it was they who revolutionised Nicaragua after over thirty years of dynastic rule and were at the forefront of economic, political and cultural change. And economic, political and cultural change is at the heart of these new models of care.

Samantha Jones, Director for New Care Models Programme, at NHS England, brilliantly explained in a recent article the context and creation of the new vanguard areas (split between Multispecialty Community Providers (MCPs), Primary Acute Systems (PACS), Care Homes and Small Viable Hospitals) and the ambition to address the widening gaps and inequality between health and well-being, care and quality and funding and efficiency.

The brilliance of this system is that it is led by the people, rather than top down; it’s empowering, as opposed to determining; it’s to be delivered with pace, rather than slowly; it’s tangible (you can even watch the Vanguard presentations on Youtube) and it is fluid. As Sam Jones admits, it’s unlikely that all the models will be successful and the vanguards can/will change.

Interestingly, there are some initial gaps. Noticeably, the Shelford Group (ten leading NHS multi-specialty academic healthcare organisations) are absent, and if you visualise where the initially successful vanguards are based, large parts of the country have no representation whatsoever. I would be interested to know who features in the list of ‘fast followers’ - those with strong bids that did not make the initial 29 areas. Does anyone know who they are? The governance models are yet to be put in place.  Does it matter?  Probably not at this stage - there were 269 applicants demonstrating significant interest. The aim of the programme, as I understand it, is Blitzkrieg rather than never ending planning. Pragmatic and fluid - this is how to get results quickly.  Some will disagree with me regarding the governance, and I would argue that it is very early days.

I believe Vanguards are the way forward if the NHS is to meet the challenge of the NHS Five Year Forward View. It is an intelligent and pragmatic way to instigate change widely, from dedicated professionals passionate about improving the quality of patient outcomes. Are you a Vanguardista?  I’d welcome your thoughts.

David Rason is the Consultant of Finance, Healthcare at Interim Partners.

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