Through a series of round table discussions, the people in the room gave their views and feedback on how the new care models could be spread. Ten messages came through strongly.
1. Clear and consistent messaging from the national bodies
National bodies should be clear about the goal of the new care models covering the majority of the country. They should avoid layering new language, initiatives and processes on top of this already ambitious goal.
There should be clearer information and communications about new care models. A public platform where resources and other information about them would be a good place to start.
2. Using public and patient demand to support the spread of the new care models
Innovation in other sectors is often driven by users and consumers. So we need to be much more imaginative about how we get local people involved in driving this change.
Individual patient stories need to demonstrate the outcomes of change with before and after examples. In making the case for change, and all the way through the process of change, we need to show how this is about patients and not systems. How can we create a social movement around the new care models?
3. Getting clinicians more involved in the change
Engaging with clinical staff and ensuring they are enthusiastic about the new vision of integrated care and workforce is vital. Given how important ‘specialism’ is to staff and their view of their success, this is not straightforward and will need national as well as local work. This approach to clinicians should be tailored as different aspects of the new care model outcomes will engage different audiences. Pulling in international experts would help. The Buurtzog example from Holland is a good one of a staff-led new care model.
4. Invest heavily in different ways of sharing learning
Share early outcomes from the vanguards rather than wait until the ‘final’ lessons have been learned. International evidence shows that learning networks (or are one of the most powerful ways to spread innovation. One way of doing that would be for vanguards to become involved in buddying with others in a ‘community of interest’. We need to find multiple ways in which other health and care systems can become involved in the new care models, and avoid the sense that there is a vanguard ‘club’. Learn how to develop continuous improvement cycles and make a social movement, rather than just a learning set, by involving patients and their organisations.
5. Describing the local case for change
Adoption will happen if new care models can support local transformation to solve today’s problems and not just promise change in two to five years’ time. The national case for change needs to be adapted and adopted to fit and engage with local areas.
6. Building shared goals in local health and care systems
Local health care leaders need to agree and be clear that the success of a vanguard is not the same as maintaining organisational control. To make this work more discussions need to take place between the boards of local organisations to help facilitate a shared understanding of what needs to change, and encourage shared ownership so that it all becomes a shared problem. Making this work relies on trust between organisations and developing shared values.
7. Generating hope that the new care models can be successfully delivered
At the moment developing new care models looks like an exam that you could well fail in. We need to reduce the anxiety that comes with this feeling and encourage many more to have a go. Some will fail and it is vital to learn from that and be more explicit about supporting failure and lessons learnt from it. Develop ambassadors of change who clearly argue both for it and how to do it. Vanguards need to be more actively sharing the learning across their localities. We need to describe clear options for the non-vanguard organisations describing how they can work towards implementing new care models.
8. Aligning the national arms-length bodies as a driver for new care models
The national messages from the regulators and the arm’s length bodies needs to argue for the development of new care models and not the old. Regulation needs to make new models of care easier to do than not to do. The values are already there but the behaviours are not. Developing national constructive and supportive behaviour across the system will be crucial. National support to clarify procurement and competition rules is also needed.
9. A can-do approach to information governance and technology solutions
Local information solutions are being developed that overcome real or perceived legal and technical challenges. National bodies could help codify this learning and support local systems to implement these approaches.
10. Create the time, space and resources for change of this scale
Time and space is needed for people and organisations to effect change at this scale and have enough energy to implement new care models. How can the national bodies create some headroom over the next three to five years to support this?