Moving from 50 vanguards to this kind of coverage represents a significant challenge for those working in health and social care - and you know what? That's where we come in........
Has the NHS ever set itself a bigger challenge? Probably not - but I think collectively we are up to the challenge = you prove it every week by your support, sharing and collaboration on FabNHSStuff.
It’s an exciting time (yes I know its challenging too) but we should all proud to be leading the way and supporting improvement and integration of services.
We can start by learning how other health services have successfully spread innovation. In TheBlondes humble opinion there is no better person to summarise that for us than Dr Mark Britnell, Partner and Chairman, KPMG - This video gives a fascinating insight into the need to think big if transformation is to be sustainable and its an informative must watch.
Of course there are barriers to spread:
Insufficient time and resources to transform -The pressures of the day job, and insufficient local capacity, mean that there is little room for transformation to take place at the same time.
Regulation that supports old models of care -Planning and regulation need to be aligned with the new care models and not just the maintenance of individual organisations. Arms-length bodies also need to clearly communicate what flexibility there is in terms of payment.
Too much focus on organisational form -Population health outcomes need to be the focus rather than focussing first, for example, on what an accountable care organisation is.
Lack of commissioner engagement -Local alignment needs commissioners to want to buy the new models of care using longer term contracts. Currently clinical commissioning groups tender contracts for shorter periods, and not on a population basis.
Information governance and IT systems -There is a strong perception that current information governance restrictions are a barrier to new care models. Existing IT systems reinforce organisational boundaries and practical experience of expensive failures has put some people off implementing changes.
Organisational self-interest -There is a lot of staff and public loyalty to maintain existing organisational forms. Larger organisations may find it the hardest to change. This is because their size gives them the belief that they run their local system. Everyone is trying to do ‘place-based work’ but in very different ways and do not always know what each other is doing.
Inconsistent national messaging and language -Recent years have seen many different ways of describing “the new” in the NHS. The language of change needs to be unified, simple and for the long term.
Not being part of the vanguard ‘club’ -The funding for vanguards will not be available everywhere so adopters know that they will have to do this with less resource. How can non-vanguard sites be given support and profile to help them implement new care models
But these barriers are not insurmountable.
Getting clinicians and frontline staff like you more involved in the change is paramount.
The Vanguards are committed to sharing early outcomes rather than wait until the ‘final’ lessons have been learned is also . International evidence shows that learning networks 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. I guess that's where we all come in.....
Its an exciting time, great changes in service delivery are happening and we will continue to share developments here.
You can read more about spread and transformation here https://www.england.nhs.uk/ourwork/futurenhs/new-care-models/updates/encourage/