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New care models – the case for change
As the New Care Models Programme marks its first anniversary, healthcare commentator, Professor Paul Corrigan reflects on a year of change and examines the progress the vanguards have been making.
A year ago several hundred NHS and local government leaders turned up at London’s Oval to make their case to become vanguards. Over three days eager local leaders enthusiastically argued why they should be the ones that would lead the charge for change.
Six months before that, in October 2014, Simon Stevens, Chief Executive of the NHS, had made it clear that without developing new models of care, the NHS would not close the necessary gaps in health resources and quality that will have widened by 2020. If the Five Year Forward View was the road map for the NHS then new models of care was the vehicle that would get us to the sunnier uplands of health and health care sustainability.
So there was a big focus on those selected as the vanguards to develop the innovations that would transform the NHS experience.
A year on, how are the vanguards doing? Being a simple soul there are three tests that something called a new model of care has to pass before it can be said to be working:
- Is it new?
- Does it care?
- And, is it a model?
Obvious questions but difficult to answer.
Firstly, is there anything in health and social care that is totally new? How novel do you have to be to be really new? And, is it a good idea to be an original one off? The challenge with ‘new’ in the NHS is not that we lack the capability of doing something completely novel. Given the number of professionals with some aspect of training in science in the NHS people are trying out new things all the time.
No – often the challenge with the category ‘new’ in the NHS, is seeing that shiny innovation through to many more people. I think new models of care don’t have to be completely original but they do need to bring something ‘new’ to the many, not the few. So a year on the new care models are reaching many more people than at the start BUT the next two years will be crucial as they will need to spread the new to millions.
Secondly, do the new care models care? The main care challenge that runs through the NHS at the moment is not a lack of compassion on the part of NHS staff. The problem for patients is that the care comes at the patient in bits that are fragmented by very different organisations. An 85-year-old with three long-term conditions will not be short of caring and professional staff, but that care will not be delivered in a single experience of support. Tens of different drugs collide with very many different staff into – my new collective noun – a bewilder of confused care.
We need strong interlocking pathways providing person centred coordinated care for patients. Are the new care models doing this? My experience is that many of them are.
And thirdly, are they a model? This is the most difficult question – creating real models from this new care will be the really original activity for the NHS. Then encouraging people to follow these models will also be new.
But if we don’t get the creation of models right all the new care will not develop at the scale that is needed to really move on from the old models of care.