The recent announcement of additional Vanguard funding for 2016/17 was greeted with all the normal emotions that come with any financial allocations in the NHS. Most people getting money don't get the total sum they asked for, and the rest of the service looks on jealously at the fact that those getting money are getting anything at all.
So, depending on where you are standing, the allocations of £112 million can be both clearly not enough and unfairly too much. Given the sums of money involved in the NHS, both judgements can be right. £112 million is one tenth of one per cent of the NHS budget – so isn't really very much to invest in the models that are to supposed to deliver the future. But in any other part of the real world, where millions of pounds count as big money, £112 million is a lot to spend in a year – try telling your local social care provider that a local allocation of £4 million is not very much money.
So why should the NHS invest anything in the Vanguards? The Five Year Forward View is one of those odd documents that everyone agrees with, but few believe to be a guide for action. It outlined that, by 2020, there would be substantial gaps in quality health care provision. These would be caused in part by an increase in demand and in part by new demand for health care. Since we have a system that is set up for episodic care, and most new demand is for coordinated long-term care, the health organisations we have are mostly set up to provide the wrong sort of care. So in October 2014 there was a need to explore new models to try and change the orientation of health and social care services.
Here we are, more than 18 months after the publication of the Forward View, and if anything the pressure for new forms of care has come earlier and more heavily than expected. GP surgeries trying to meet this increased demand with the old model of care are finding it very, very hard today – not in 2020. The Forward View argued that we needed the new in 2020, but the growing demand for comorbidity services is causing existing services real problems here and now.
So, as their name suggests, the Vanguards are out front in developing new models, but we also need them to expand to meet this new demand here and now – not in four years' time.
That's why the £112 million is so important. In most health economies this investment in new models of care represents just a few percentage points on the budget of the local health economy. Again, it's not much but it's also a very great deal in the current climate, and it allows the Vanguards to work through and test whether some of the straightforward issues in new care models actually work at scale. For example:
Can the employment of pharmacists within a primary care team actually release GP time?
Does the use of phone and email consultations simply increase demand, or can it increase the productivity that has been limited in the past to face-to-face consultation?
Can investment in the voluntary sector really provide assistance to primary care teams in developing new forms of local assets?
Can the unpleasantly named extensivists keep very sick people in their own home rather than being bounced in and out of hospital beds?
This £112 million has been invested in answering these and other questions – not hypothetically in a seminar – but with real staff and real people, in real services.
It's true that some of the answers to these questions will be 'no'. In which case, we need to stop investing in that question and move the investment to those where the answer is 'yes'.
In every public or private service, the three crucial aspects of innovation are to:
try new services to see whether they work
stop the ones that don't
scale the ones that do.
In the coming year there will need to be some ruthless decisions made about some Vanguards that have not created the basis for NHS and social care sustainability. There will then need to be some equally ruthless decisions made about how we scale the ones that do provide such a basis.
The ambition is that, by 2020, half the population will be receiving some care via a new model. For this to happen, we will need the investment this year in order to have tested these new realities properly – some to destruction and some to success.
The views presented in this blog are those of the author and do not necessarily represent the views of the Nuffield Trust.
Corrigan P (2016) ‘Vanguards: investing in the future today’. Nuffield Trust comment, 8 June 2016. https://www.nuffieldtrust.org.uk/news-item/vanguards-investing-in-the-future-today