Health policy expert Professor Paul Corrigan sheds light on why soaking up the learning from the vanguards will leave sustainability and transformation partnerships (STPs) in good stead.
Twenty-first century medicine is one of the most dynamic set of ideas in our society. Every fortnight or so, the broadsheets announce new breakthroughs either in medicines, kit or new ways of working. Many of them offer new hope to people in pain and distress.
And for some members of the public, the new is actually there to help straightaway; for most, it takes a long time to reach them. One estimate is that it takes about 15 years for a new activity to reach every part of the NHS. We are very good at starting new activity, but just not very good at seeing it through to everybody who needs it.
There is a library of literature that explains why this is so hard in the NHS, but there are ways in which we can speed up this 15-year cycle in the wider implementation of new care models.
There is some responsibility on those who are creating the new. New care models must be prepared to not just develop their own ways of working but must come to the aid of today’s challenges. With an NHS currently under great pressure from new forms of demand, what are new care models doing to help that crisis today and not just tomorrow? How can they help this winter? And how can they help to a greater extent next winter?
Spreading new care models needs more than simply making a case for how change can help current orthodoxy. Most of us who are doing something new have developed our new with some idiosyncrasy. We like to be different. But giving in to being different everywhere means that the NHS is very bad at creating a prototype that can be picked up in other places.
New care models are meant to achieve three things. They’ve got to be new, they’ve got to care, and they have to be a model. It’s the third of these that has proved to be the most difficult. How do you shape a number of very different activities in a number of very different locations into a single model of new care?
Knocking the different edges off and saying this is the core activity that we need to spread is something that the NHS has to learn a lot more about. But there has been some progress towards what a model will look like.
Alongside this, sustainable and transformation partnerships (STPs) and their advanced guard, accountable care systems, are developing partnerships which should at base create new care models.
Sustainability will only happen if there is transformation and transformation needs a very new approach to developing pathways of care. This is not to say that existing new care models meet all the needs of every transformation in the country, but it is to say that the vanguards have concrete real experiences of how to create new care models.
The content of the care models that STPs, across their footprint, come up with may be different, but the form of change that creates them will contain the same very difficult issues of joint working, new workforce skills and changed accountabilities. How the vanguards tackled them provides important lesson for STPs.
At the moment, there are very different relationships between existing vanguards and the STPs they are a part of. Some have placed the vanguard leaders on their executive and are plugging them into all the possibilities they can within their footprint. Vanguards are being asked to provide STP sponsored presentations across their area and localities are being strongly encouraged to not only make sense of what they are hearing, but start the hard work of implementation.
In these footprints they know that they have – next door – a set of real people who have been through some of the hard work and most of the pitfalls of implementation.
But in other areas, the very fact of being ‘next door’ is the problem. I worked for nearly a decade in London local government and I quickly found that if I wanted my colleagues, who were rightly very proud of their borough, to implement something new, the thing I must not do is say that it came from our neighbouring borough. If the good practice had come from another city, and not a neighbour, it got a better hearing.
It’s not so much a problem of not invented here, but a very specific issue of not invented in places that are nearby. That may sound odd, but in all my experience of locality working, it seems to be a real human issue.
So, sometimes an STP membership will want to spread good practice from within their footprint and sometimes it will need to use the national best practice to help teach some lessons.
However it’s carried out, STPs, if they want to live up to their name, have to develop some transformative new care models. They will carry this out with more pace and confidence if they take the opportunity to learn from existing new care models.
Professor Paul Corrigan is working with NHS England to help develop new models of care, with a particular focus on multispecialty community providers. He is a non-executive director at the Care Quality Commission and adjunct professor of public health at the Chinese University of Hong Kong and of health policy at Imperial College London. Follow him on Twitter @Paul_Corrigan
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Sharing the learning
The NHS Confederation is working with NHS Clinical Commissioners, NHS Providers and the Local Government Association to help spread the learning from the vanguard programme across the health and care sector.
As part of this, we are holding an event on 28 November in London
which will offer insight into the outcomes and lessons from the vanguards, and explore how they can inform broader transformation work around the development of sustainability and transformation partnerships and accountable care systems.