In September 2015, NHS England and its national partners announced a new type of new care model vanguard.
There are 13 acute care collaboration vanguards which will link together local hospitals to improve their clinical and financial viability.
The vanguards were selected following a rigorous process, involving workshops and the engagement of key partners and patient representative groups.
- Salford and Wigan Foundation Chain
- Northumbria Foundation Group
- Royal Free London
- Foundation Healthcare Group (Dartford and Gravesham)
- National Orthopaedic Alliance
- The Neuro Network (The Walton Centre, Liverpool)
- MERIT (Mental Health Alliance for Excellence, Resilience, Innovation and Training) (West Midlands)
- Cheshire and Merseyside Women’s and Children Services
- Accountable Clinical Network for Cancer (ACNC)
- East Midlands Radiology Consortium (EMRAD)
- Developing One NHS in Dorset
- Working Together Partnership (South Yorkshire, Mid Yorkshire, North Derbyshire)
Patient population: 2 million
Salford Royal NHS Foundation Trust and Wrightington, Wigan & Leigh NHS Foundation Trust are working together with Devo Manc partners to create a new healthcare group. This will help them to increase the pace at which they are able to make improvements, which will result in better outcomes for their patients and increases in productivity.
They are working in partnership with commissioners and provider organisations across the region to create an integrated or accountable care type organisation and a single service model for elective and specialist services.
Northumbria Healthcare NHS Foundation Trust is planning to create a foundation group to widen the support and services it can provide to other organisations.
The trust is already supporting a number of organisations within the North East and across England (including North Cumbria University Hospitals NHS Trust for which it is the appointed acquisition partner and buddy), and will use the development of the foundation group as a vehicle to better coordinate and further develop this support.
Through the foundation group, the trust and its partners could support others more effectively in a range of ways. These include: acquiring and/or merging other hospital trusts; providing corporate services to other NHS organisations; and creating a standard operating model built on providing excellent clinical outcomes.
This will benefit patients by driving efficiency and clinical effectiveness across the NHS and ensuring that high quality patient care is sustainable over the longer term.
Patient population: Dependent on which partners are identified.
The Royal Free London NHS Foundation Trust plans to become the heart of a group that other organisations will want to collaborate with.
The trust is considering options including buddying, merging specific office functions and other innovative models such as joint clinical and corporate ventures.
The key benefits of this approach are that it would reduce the variation patients can experience in care, increase efficiency and could be delivered at reduced cost to the healthcare economy.
Potential partners will be identified as the proposal is developed but the trust plans to work with Salford Royal NHS Foundation Trust and Northumbria Healthcare NHS Foundation Trust to develop plans for a group model.
Patient population: 1.25 million
Dartford and Gravesham NHS Trust (DGT) and Guy’s and St Thomas’ NHS Foundation Trust are both stable and successful organisations. The two trusts are building upon their shared culture and values and their track record of collaboration to create sustainability in the hospital sector. Their aim is to undertake this work on a collaborative basis; so although DGT is the lead trust for the purposes of the vanguard, each organisation is committed to working together to assess a series of options that could bring them together in an appropriate governance arrangement or organisational form that avoids the distraction and cost of acquisition.
Guy’s and St Thomas’ NHS Foundation Trust wishes to become a system leader; providing strategic and operational clinical and management support to NHS organisations. Dartford and Gravesham NHS Trust sees itself very much as the local provider of care. Dartford and Gravesham NHS Trust wishes to be a self-determining and increasingly integrated service provider and has strong relationships with partner health, social care and voluntary sector organisations.
Both Dartford and Gravesham NHS Trust and Guy’s and St Thomas’ NHS Foundation Trust propose to come together into a ‘foundation healthcare group’, a new type of entity that builds upon the options identified in the Dalton Review and presents a range of opportunities that will enable the fulfilment of both trusts’ visions. This coming together will improve outcomes and access, reduce costs, and enable the challenges of increasing demand to be met through the application of clinical innovation and best practice.
Patient population: Depends on which partners are identified
Moorfields Eye Hospital NHS Foundation Trust already runs services in 22 locations in and around London in a variety of healthcare settings, but recognises that this model has grown in response to ad hoc requests. Therefore it aims to identify the best approach to establishing and sustaining a chain of services and to produce a toolkit which can be used to roll out service level chains regardless of the specialty to benefit patients in other parts of the NHS.
In addition to analysing the best approach for a successful chain of services, the trust will also explore the opportunities and risks associated with running an extended network of eye services, based on increasing the number of Moorfields satellite sites and widening the trust’s geographic reach.
Patient population: vanguard has national reach.
The National Orthopaedic Alliance vanguard aims to create a UK-wide franchise or chain of orthopaedic providers to deliver outstanding and consistent care in more areas. Partners include Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust in Oswestry; Royal National Orthopaedic Hospital NHS Trust in Stanmore and Royal Orthopaedic Hospital NHS Foundation Trust in Birmingham.
The vanguard partners will explore formal ways of collaborating more closely to explore how they could extend their model more widely across the country. This work builds on their already established base of collaboration and will formalise the way organisations work together on a clinical basis as well as through back office functions.
The vanguard will also explore the possibility of enabling exemplar orthopaedic services to be offered on a franchise model across England. Their work will include developing a single common model for NHS franchising that can be picked up by any speciality to implement best practice, to identify ways of expanding across a wider geography and to ensure that scale brings with it stronger local patient and community involvement.
For patients this could help deliver higher quality care more consistently across the country and also provide a new model for smaller hospitals and specialist providers.
44. The Neuro Network (The Walton Centre, Liverpool) (neurology and spinal multi-specialty franchise)
Patient population: 3 million
The Neuro Network aims to develop a high quality and cost effective neuroscience service chain. It is a partnership between the Walton Centre NHS Foundation Trust; Warrington and Halton Hospitals NHS Foundation Trust; Liverpool CCG; Warrington CCG and NHS England Specialised Services Commissioning Team (North).
The programme will build on partners’ extensive experience in developing the network models for neurology and spinal services in Cheshire and Merseyside. It will also strengthen the neurological support provided by the Walton Centre to local hospitals, GPs and patients, and look to extend the spinal model in partnership with The Royal Liverpool and Broadgreen University Hospitals and Aintree University Hospital. This approach enables patients to have rapid access, locally, to high quality care from a regional specialist centre.
45. MERIT (Mental Health Alliance for Excellence, Resilience, Innovation and Training) (West Midlands)
Patient population: 3.4 million
This vanguard aims to share best practice and create replicable models for long-term clinically and financially sustainable specialist mental health services. They will work together to solve efficiency, workforce, equality and policy implementation challenges.
It is a partnership between Birmingham and Solihull Mental Health NHS Foundation Trust, Black Country Partnership NHS Foundation Trust, Dudley and Walsall Mental Health Partnership NHS Trust and Coventry and Warwickshire Partnership NHS Trust.
MERIT will focus on three priority areas where the greatest challenges for urban mental health services exist. These are seven day working in acute services, crisis care and reduction of risk, and recovery and rehabilitation. In these areas better integration across organisations will aim to increase quality and improve efficiency rapidly while reducing variations and spreading best practice.
Service users will benefit from faster decision making, such as discharges seven days a week and a co-ordinated emergency response; a shared care plan, meaning one assessment and only having to tell their story once; more support for recovery in the community and less chance of a relapse or return to secondary care services; and less unnecessary time spent in A&E or police cells.
46. Cheshire and Merseyside Women and Children’s Services (maternity and paediatrics multi-specialty network)
Patient population: 2.4 million
This vanguard aims to develop a clinically managed network for women’s and children’s services (including maternity, gynaecology, neonatal and paediatric services) across Cheshire and Merseyside in order to further improve quality and ensure services are clinically and financially sustainable. It has the backing of all provider trusts, clinical commissioning groups and networks across Cheshire and Merseyside.
The vanguard will address the challenges facing services for women and children locally by creating a new approach between commissioners, clinicians and providers that goes beyond organisational boundaries. These challenges include a greater demand for services and an increase in patients with more complex needs as well as variation in quality of services. No single organisation, commissioner or provider can alone resolve the issues faced. This vanguard will also allow organisations to work together to tackle challenges around workforce like recruitment, retention, retirement and skills mix, as well as overall financial sustainability.
Working more closely together will also allow the vanguard to better engage with the people who use their services and create a more personalised offer for them.
Patient population: 10.7 million
Individual networks led by The Royal Marsden NHS Foundation Trust, The Christie NHS Foundation Trust and UCLH (University College London Hospitals NHS Foundation Trust) will work together to develop plans for implementing accountable clinical networks for cancer capable of being reproduced nationally. Working with a range of partners, including Devo Manc partners in Manchester, this approach will support integration across the entire cancer patient pathway (including public health, primary care and diagnostics), in order to secure improvements in delivering patient centred, quality and more financially sustainable cancer care.
Working together the networks will focus on a number of areas. These include improving early diagnosis and detection of cancer by taking advantage of the scale and pace working together will allow. The aim of this will be on driving improvements in clinical outcomes, particularly around patient survival rates through an alignment of objectives and focussed leadership across cancer services at a local level and less variation in access and outcomes across pathways.
Patients should also see an improvement in their experience across the whole pathway from diagnosis to living with and beyond cancer.
Patient population: 6 million
East Midlands Radiology Consortium (EMRAD) is a consortium of seven NHS trusts within the East Midlands working together, hosted by Nottingham University Hospitals NHS Trust. Together they aim to create a clinical network, providing timely and expert radiology care for patients across the East Midlands regardless of their location, which will be seen as a national benchmark for new models of clinical collaboration within NHS radiology services.
In order to achieve this vision they will deliver a number of improvements. They have already started work on purchasing a shared, technical system to allow access to patient radiology images at the point of clinical need. In order to maximise the benefits of this technical investment they will develop and implement new regional systems of governance, patient consent, commissioner support and education.
The vanguard also has plans to develop a collaborative network of services, aided by the shared technical system, to support true network-wide clinical care for patients. They hope to develop a mechanism for working regionally, bringing work back into the NHS which is currently being delivered in other sectors, providing expert trusted opinions within the NHS, and supporting both large and small trusts by creating cross-trust expert radiology networks.
Patient population: 850,000
The recent Dorset Clinical Services Review had a vision of sustainable models of care for in- and out-of-hospital care, to meet the needs of local people 24 hours a day, seven days a week. The three district hospital providers in Dorset (Dorset County Hospital NHS Foundation Trust; Poole Hospital NHS Foundation Trust; The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust) aim to use a multi-service joint venture to deliver this vision and ensure future sustainability of health services in Dorset.
Patients will benefit from a reduction in avoidable variations in care, the implementation of standardised best practice and the spread of service innovation. There will be a more equitable delivery of services to patients across the whole of Dorset, with the clinical network(s) organised to ensure that all patients have faster access to a consistent, high standard of care irrespective of where they live. It is envisaged that there will be movement to a single shared rota for some agreed clinical services across Dorset, which will ensure the best use of senior clinicians. The creation of job plans that allow for the recruitment and retention of high calibre clinicians will facilitate the development of sustainable clinical models.
Patient population: 2.3 million
The Provider Working Together Partnership is an existing partnership established in March 2013 between seven acute trusts in South Yorkshire, Mid Yorkshire and North Derbyshire. The programme aims to develop a clinical strategy involving different models highlighted in the Dalton Review. To deliver a seven day service and improve patient care, the partners plan to develop solutions and models for joint ventures on shared services and to work across organisational boundaries. Models will include greater use of networking, sharing of clinicians across sites and delivery of specialist and diagnostic services across a number of different providers. The focus will be on ensuring sustainable local services that are both clinically and financially viable.