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NEW CARE MODELS: Vanguards - developing a blueprint for the future of NHS and care serviceswww.england.nhs.uk/vanguards#futureNHS1NEW CARE MODELS:Vanguards - developing a blueprint forthe future of NHS and care servicesSEPTEMBER 2016#futureNHS
CONTENTSWhat is the new care modelsprogramme?3New care models - the vanguards6The vanguards: integratedprimary and acute care systems8The vanguards: multispecialtycommunity providers18The vanguards: enhanced healthin care homes33The vanguards: urgent andemergency care40The vanguards: acute utureNHS#futureNHS
NEW CARE MODELS: Vanguards - developing a blueprint for the future of NHS and care services3WHAT IS THE NEW CARE MODELS PROGRAMME?In January 2015, the NHS invited individual organisations and partnerships to applyto become ‘vanguards’ for the new care models programme, one of the first stepstowards delivering the NHS Five Year Forward View (published October 2014) andsupporting improvement and integration of services.In March 2015, the first 29 vanguardswere chosen. There were three vanguardtypes – integrated primary and acute caresystems; enhanced health in care homes; andmultispecialty community providers.Integrated primary and acute care systems joinup GP, hospital, community and mental healthservices, whilst multispecialty communityproviders move specialist care out of hospitalsinto the community. Enhanced health in carehomes offer older people better, joined uphealth, care and rehabilitation services.In late July 2015, eight additional vanguardswere announced. Urgent and emergency carevanguards are developing new approachesto improve the coordination of services andreduce pressure on A&E departments.A further 13 vanguards were announcedin September 2015 – known as acute carecollaborations, they aim to link hospitalstogether to improve their clinical and financialviability, reducing variation in care andefficiency.All 50 vanguards were selected following arigorous process, involving workshops andthe engagement of key partners and patientrepresentative groups.Each vanguard is taking a lead on thedevelopment of new care models which willact as the blueprints for the NHS movingforward and the inspiration to the rest of thehealth and care system.#futureNHS
NEW CARE MODELS: Vanguards - developing a blueprint for the future of NHS and care services4What does it mean for patients?The vanguards are improving the care receivedby millions of people across England.Through the new care models programme,complete redesign of whole health and caresystems are being considered. This meansfewer trips to hospitals with cancer anddementia specialists holding clinics in localsurgeries, having one point of call for familydoctors, community nurses, social and mentalhealth services, or access to blood tests,dialysis or even chemotherapy closer to home.They are also joining up the often confusingarray of A&E, GP out of hours, minor injuriesclinics, ambulance services and 111 so thatpatients know where they can get urgent helpeasily and effectively, seven days a week.The partnersThe new care model vanguards are a keyelement within the NHS Five Year ForwardView which is a partnership between NHSEngland, the Care Quality Commission, HealthEducation England, NHS Improvement, PublicHealth England and the National Institute forHealth and Care Excellence.Supporting the vanguardsThe NHS Five Year Forward View partnerspublished an updated national supportpackage for all 50 vanguards in December2015.This followed an initial support package,which was published in July 2015 for the first29 vanguards.The revised package reflects the needs ofthe eight urgent and emergency care and 13acute care collaboration vanguards selected inJuly and September 2015. It includes learningto date from the first 29 vanguards.Extensive engagement with the vanguardswas carried out including site visits,workshops and discussions.The nine areas of support are:1. Designing new care models – workingwith the vanguards to develop their localmodel of care, maximising the greatestimpact and value for patients;2. Evaluation and metrics – supportingthe vanguards to understand – on anongoing basis – the impact their changesare having on patients, staff and the widerpopulation;3. Integrated commissioning andprovision – assisting the vanguards tobreak down the barriers which preventtheir local health system from developingintegrated commissioning;
NEW CARE MODELS: Vanguards - developing a blueprint for the future of NHS and care services54. Governance, accountability andprovider regulation – helping thevanguards develop the right organisationalform and governance model, as well asunderstand the impact on how they areregulated;5. Empowering patients andcommunities – working with thevanguards to enhance the way in whichthey work with patients, local people andcommunities to develop services;6. Harnessing technology – supporting thevanguards to rethink how care is delivered,given the potential of digital technology todeliver care in radically different ways. Itwill also help organisations to more easilyshare patient information;7. Workforce redesign – supporting thevanguards to develop a modern, flexibleworkforce which is organised aroundpatients and their local populations;8. Local leadership and delivery – workingwith the vanguards to develop leadershipcapability and learn from internationalexperts; and9. Communications and engagement –supporting the vanguards to demonstratebest practice in the way they engage withstaff, patients and local people.The national package has been developed toenable the vanguards to make the changesthey want effectively and at pace. It is alsoaims to maximise the sharing of learningacross the vanguards and spread goodpractice nationally across the wider NHS andcare system.In addition to the support outlined in thesupport package the 50 vanguards wereallocated total funding of almost 114 millionin 2015/16 and more than 112 million in2016/17.#futureNHS
NEW CARE MODELS: Vanguards - developing a blueprint for the future of NHS and care services6NEW CARE MODELS - the vanguardsIntegrated primary and acute care systems joining up GP, hospital, community and mentalhealth servicesUrgent and emergency care - new approachesto improve the coordination of services andreduce pressure on A&E departments12345630 Greater Nottingham System Resilience Group31 Cambridgeshire and Peterborough ClinicalCommissioning Group32 North East Urgent Care Network33 Barking and Dagenham, Havering and RedbridgeSystem Resilience Group34 West Yorkshire Urgent and Emergency CareNetwork35 Leicester, Leicestershire & Rutland SystemResilience Group36 Solihull Together for Better Lives37 South Devon and Torbay System Resilience Group789Wirral PartnersMid Nottinghamshire Better TogetherSouth Somerset Symphony ProgrammeNorthumberland Accountable Care OrganisationSalford TogetherBetter Care Together (Morecambe Bay HealthCommunity)North East Hampshire and FarnhamHarrogate and Rural District ClinicalCommissioning GroupMy Life a Full Life (Isle of Wight)Multispecialty community providers - movingspecialist care out of hospitals into thecommunity1011121314151617181920212223Calderdale Health and Social Care EconomyWellbeing ErewashFylde Coast Local Health EconomyModality Birmingham and SandwellWest Wakefield Health and Wellbeing LtdAll Together Better SunderlandDudley Multispecialty Community ProviderEncompass (Whitstable, Faversham andCanterbury)Stockport TogetherTower Hamlets TogetherBetter Local Care (Hampshire)West Cheshire WayLakeside Healthcare (Northamptonshire)Principia Partners in Health (SouthernNottinghamshire)Enhanced health in care homes - offeringolder people better, joined up health, care andrehabilitation services24 Connecting Care - Wakefield District25 Gateshead Care Home Project26 East and North Hertfordshire ClinicalCommissioning Group27 Nottingham City Clinical Commissioning Group28 Sutton Homes of Care29 Airedale & PartnersAcute care collaborations - linking hospitalstogether to improve their clinical and d and Wigan Foundation ChainNorthumbria Foundation GroupRoyal Free LondonFoundation Healthcare Group (Dartford andGravesham)MoorfieldsNational Orthopaedic AllianceThe Neuro Network (The Walton Centre,Liverpool)MERIT (The Mental Health Alliance for Excellence,Resilience, Innovation and Training) (WestMidlands)Cheshire and Merseyside Women’s andChildren’s ServicesAccountable Cancer Network (ACN)EMRAD - East Midlands Radiology ConsortiumDeveloping One NHS in DorsetWorking Together Partnership (South Yorkshire,Mid Yorkshire, North Derbyshire)
NEW CARE MODELS: Vanguards - developing a blueprint for the future of NHS and care services7#futureNHS
NEW CARE MODELS: Vanguards - developing a blueprint for the future of NHS and care services8The vanguards: integrated primaryand acute care systems#futureNHS
NEW CARE MODELS: Vanguards - developing a blueprint for the future of NHS and care services91. Wirral PartnersWorking together without boundaries toimprove healthHealthy Wirral is all about supporting andempowering people to live happy, fulfilling lives,wherever they live in the community, and whatevertheir situation; and providing the environment forthe diverse workforce to deliver outstanding careand support to the population, whatever their role.The vanguard and the people it servesHealthy Wirral is a partnership between theorganisations that deliver health and social care inthe local community, including NHS Wirral ClinicalCommissioning Group; Wirral Council; WirralUniversity Teaching Hospital NHS Foundation Trust;Wirral Community NHS Trust; Cheshire and WirralPartnership NHS Foundation Trust and the localprofessional committees (medical, optometry,pharmacy, dentistry). The core partnership alsoreceives important support from Community ActionWirral and other third sector partners, HealthwatchWirral and the Cerner Corporation.The vanguard is using support from the nationalnew care models programme for working withnew technologies to develop Europe’s first‘population health management digitalinfrastructure’ – a new system where electronicpatient records are shared across all healthproviders.The information that can be gained from thesystem – such as the numbers of people with certainhealth conditions and any trends or patterns in whobecomes unwell – can be used to better plan theservices that the population needs and improve theefficiency of the health and care system.Key benefits Improving health and wellbeing outcomes Improving patients’ and service users’ experience Providing efficient, well organised and value formoney health and social care services.Together they serve a population of 330,000 people.Website: www.healthywirral.org.ukTwitter: @healthy wirralContact: jon.develing@nhs.netWhat is changing?The partners are focused on shaping local servicesaround what really matters to everyone in Wirral.To do this, the organisations are working muchmore closely together, commissioning (buying)services jointly, supporting joined-up local services,and working in partnership with the large anddiverse local communities and voluntary sector.#futureNHS
NEW CARE MODELS: Vanguards - developing a blueprint for the future of NHS and care services102. Mid Nottinghamshire Better TogetherA ‘bold vision’ for high quality, sustainableservicesBetter Together’s aim is to ensure that people acrossmid-Nottinghamshire receive the best possible carein the community and in hospital, with high quality,sustainable services.The vanguard has set out a bold vision for the wayhealth and care services will look over the nextfive years, based on population needs and public,stakeholder and staff feedback about currentservices.The vanguard and the people it servesThe vanguard partners are Nottingham EmergencyMedical Services; East Midlands Ambulance ServiceNHS Trust; Nottinghamshire County Council;Nottinghamshire Healthcare NHS Foundation Trust(including County Health Partnerships); NottinghamUniversity Hospitals NHS Trust; Sherwood ForestHospitals NHS Foundation Trust; United LincolnshireHospitals NHS Trust and Together EveryoneAchieves More.Together they serve a population of around310,000.Website: www.bettertogethermidnotts.org.ukTwitter: @bettermidnottsContact: nshccg.bettertogether@nhs.netWhat is changing?The vanguard is receiving support from the nationalnew care models team to support its work toempower patients and communities to bettersupport their own health, and in its work towardsgreater integration of health and care services.#futureNHSThis means getting doctors, nurses, other healthprofessionals and social care staff to work moreclosely together to support the needs of patients,their families and carers.The vanguard is focusing on several important areas: Urgent and proactive care (e.g. long termconditions and frail older people); and Early and planned care (e.g. surgery for hips,knees or cataracts).The benefits of working more closely togetherinclude better, more co-ordinated care for patients,better working relationships and clearer processesfor staff.An example of the changes being made is thecreation of new integrated care teams. Theintegrated care team includes GPs, specialistnurses (e.g. diabetes, cardiac), social workers anda voluntary sector worker. They work closely withother community teams to provide better, joinedup care for patients who are at high risk of beingadmitted to hospital.A new process called ‘transfer of care’ now allowspatients to be discharged from hospital as soon asthey are medically fit, with wide-ranging health andsocial care support already put in place.Key benefits Reduce pressure on hospitals by helping patientsleave hospital sooner Patients receive more and better care closer tohome.
NEW CARE MODELS: Vanguards - developing a blueprint for the future of NHS and care services113. South Somerset Symphony ProgrammeComing together to look after people’s healthand wellbeing as a wholeThis vanguard is developing a new system fordelivering health and social care in south Somersetwhich allows staff from a range of organisationsto work together, providing the population withquicker and easier access to services and support.This will be delivered through a new organisationthat is jointly managed by health and social careprofessionals.The vanguard and the people it servesThe vanguard partners are Yeovil District HospitalNHS Foundation Trust; the Somerset GP Federation(a group of GPs); Somerset Clinical CommissioningGroup and Somerset County Council.Together they serve a population of omTwitter: @SymphonyProjContact: lisa.pyrke@ydh.nhs.ukWhat is changing?The Symphony project is developing new ways ofcaring for patients that either help to prevent illhealth or address any potential problems as early aspossible.Services will be available closer to where peoplelive and patients – particularly those with complexconditions – will be supported to stay independentand healthier for longer and avoid unnecessaryhospital admissions.GPs, hospital clinicians, therapists, social workersand patients will work together to develop packagesof care which cover all of an individual’s care andlifestyle needs.Symphony is also exploring new ways of working tomake some routine clinical work – such as certainday surgery procedures – easier for patients toaccess and more efficient.Key benefits By working together in a proactive way, thepartners will help prevent ill health and reducethe reliance on health and care services Patients will receive care earlier and quickerthanks to a more efficient use of resources.#futureNHS
NEW CARE MODELS: Vanguards - developing a blueprint for the future of NHS and care services124. Northumberland AccountableCare OrganisationConsistent care and a seamless patientexperienceThe collective vision of health and social carepartners in Northumberland is to create a systemwhich consistently delivers the highest quality ofcare and a seamless patient experience for peopleliving across the county.This vision is supported by plans to develop a singleaccountable care organisation: this is an overarchingorganisation that sits above a joined up healthand social care system made up of a number ofdifferent providers, from health services to the localcouncil. The aim is to help teams across differentorganisations to work more effectively together,with the same shared goals.The vanguard and the people it servesThe vanguard partners are Northumbria HealthcareNHS Foundation Trust; NHS NorthumberlandClinical Commissioning Group and NorthumberlandCounty Council working together with local GPs,mental health services, the ambulance service, localpatients, Healthwatch and the Health and WellbeingBoard.The NHS organisations jointly serve a population ofmore than 320,000 people across Northumberland– one of the largest and most rural areas ofEngland.Website: www.northumberland.nhs.ukTwitter: @N LandNHSContact: andrea.stoker@northumbria.nhs.ukWhat is changing?Urgent and emergency care has already beentransformed, with the opening of the NorthumbriaSpecialist Emergency Care Hospital in June 2015.This new hospital, the first purpose-built of its kindin England, provides specialist consultant-led care,seven days a week, for all serious emergencies.Urgent care centres for walk-in patients with lessserious problems are now available 24/7 at generalhospital sites.Development is now focused on improving accessto GP advice during the normal working week andexploring the potential for new networks of GPpractices to work together to offer extended access,based on patient need, across the county.To support this, new locality based multi-disciplinaryteams are piloting new ways of working toproactively look after patients who are mostvulnerable, as close to home as possible. Thisincludes an acute home visiting service usingpharmacists and the wider community nursing teamto support GPs in managing home visit requests aswell as working with colleagues from mental healthand other specialists to proactively support peoplewith long term health problems to stay healthy andwell.Key benefits Improved outcomes for seriously ill patientsrequiring emergency hospital care Increase same day access to GP advice and reduceout-of-hours activity Reduce reliance on emergency care and hospitaladmissions Create more time for GPs to plan and care forthose with long term or complex needs Supports the future efficiency and financialstability of the health and social care system as awhole.
NEW CARE MODELS: Vanguards - developing a blueprint for the future of NHS and care services135. Salford TogetherImproving health and care for older peopleSalford Together aims to improve health and socialcare for older people through better links betweenGPs, district nurses, social workers, mental healthprofessionals, care homes, voluntary organisationsand local hospitals.The vanguard and the people it servesThe partners include Salford City Council; NHSSalford Clinical Commissioning Group; Salford RoyalNHS Foundation Trust and Greater Manchester WestMental Health NHS Foundation Trust.A new contact centre will act as a central health andsocial care ‘hub’, supporting the multidisciplinarygroups of staff and co-ordinating the use of telecare(modern technology that helps keep patients safe athome). Staff in the centre will also help local peoplefind and access community support to help themremain independent and develop greater confidenceto manage their own care.Patients will no longer have to tell their story todifferent professionals many times, as staff involvedin their care will share information and ensure thatcare is designed to meet their individual needs.Salford has a population of 230,000.Website: www.salfordtogether.comTwitter: @SalfordTogetherContact: rob.pett@nhs.netWhat is changing?The vanguard is developing groups of staff,including a range of health and care professionals,who will work together to provide targeted supportto the most vulnerable people.There is also a new focus on preventing ill healththrough increased screening for health conditionsand helping people find support available locally toimprove their health and wellbeing.Better communication and planning betweenprofessionals and services involved in an individual’scare will also help staff deliver a high quality of careeffectively and efficiently.Key benefits Sharing expertise and resources will allow staff tocreate more effective and efficient personalisedservices Patients will be kept safely at home for longerand receive care closer to home instead of inhospital.#futureNHS
NEW CARE MODELS: Vanguards - developing a blueprint for the future of NHS and care services146. Better Care Together (MorecambeBay Health Community)Empowering communities to deliver their ownhealthy futuresThe aim of Better Care Together is to enable thecommunities around Morecambe Bay to be ashealthy as they can be.This will involve delivering the ’triple aim’ – betterpopulation health, better quality services, deliveredat a lower cost and with higher staff morale.The vanguard and the people it servesThe Bay Health Partners are University Hospitals ofMorecambe Bay NHS Foundation Trust; CumbriaPartnership NHS Foundation Trust; North WestAmbulance Service; Blackpool Teaching HospitalsNHS Foundation Trust; Lancashire Care NHSFoundation Trust; Lancashire County Council;Cumbria County Council; NHS Lancashire NorthClinical Commissioning Group; NHS CumbriaClinical Commissioning Group; North LancashireMedical Services and South Cumbria Primary CareCollaborative.The vanguard partners serve a population of365,000 people in an area that is geographicallyspread out, financially challenged and withsignificant deprivation and health inequality.Website: www.bettercaretogether.co.ukTwitter: @BCTMorecambeBayContact: paul.wood@mbht.nhs.ukWhat is changing?Twelve new health and care teams are beingcreated, including professionals (nurses, doctors,social workers) from across primary, secondaryand community care. These teams have a mix ofdifferent health and care skills. They will be based inlocal areas and called ‘integrated care communities’.These professionals will work together, across thearea, in three clinical networks.The aim is to deliver consistent care for individualsbut with priorities localised (for example thepriorities for the people of Kendal will be differentto those for the people of Barrow-in-Furness). Carewill be provided as close to home as it can be withpeople going to hospital only when they need thespecialist care that only a hospital can provide.Key to success is that whole communities becomemuch more involved in better managing their ownhealth and wellbeing, as improved populationhealth cannot be achieved just through servicedelivery.Key benefits Improved consistency and quality of care, both inand out of hospital People to be cared for as close to home asthey can be, with hospitals concentrating onthose patients who need specialist treatment oremergency care A health system with exciting and innovativeteams working together.
NEW CARE MODELS: Vanguards - developing a blueprint for the future of NHS and care services157. North East Hampshire and FarnhamHappy, healthy, at homeThe vanguard is aiming to keep people happy,healthy and at home by motivating and supportinglocal people to improve their own health and byensuring a seamless health and care service whenthey are ill or need support.The vanguard and the people it servesThe partners include NHS North East Hampshire andFarnham Clinical Commissioning Group; FrimleyHealth NHS Foundation Trust; Southern Health NHSFoundation Trust; Surrey and Borders PartnershipNHS Foundation Trust; Virgin Care; South East CoastAmbulance NHS Foundation Trust; North HampshireUrgent Care; and Hampshire and Surrey countycouncils.It serves a population of more than 220,000.Website: www.happyhealthyathome.orgContact: nehfvanguard@nhs.netWhat is changing?The aim of the Happy, Healthy, at Home vanguardis to keep patients as well as possible and out ofhospital where appropriate.The teams will include community nurses,occupational therapists, physiotherapists, socialworkers, a psychiatric nurse, a lead psychiatrist,a pharmacist, a geriatrician (doctor specialising incare for older people), GPs, the voluntary sector,specialists for people who are terminally ill and theirfamilies, and home carers.Improved services will be available in people’sown homes, in GP surgeries and local communityhospitals and specialist inpatient care will beavailable in community hospitals such as in Farnhamand Fleet as well as Frimley Park Hospital.The programme will also focus on preventing illhealth, helping people better manage their ownhealth and wellbeing, and ensuring the rightservices are available to all.Key benefits The better value for money delivered throughnew ways of working will help close the gapbetween the available resources and the costs ofproviding services to meet needs Supporting a happy, healthier population to liveindependently will reduce demand and relianceon health and care services.Becoming a vanguard has given the partners a‘turbo boost’ to accelerate their plans to reshapethe ways health and care providers are set upand paid to work together. This will include newintegrated teams of specialist health and social careprofessionals who will ensure joined up care forpatients, especially those who are vulnerable or havecomplex needs.#futureNHS
NEW CARE MODELS: Vanguards - developing a blueprint for the future of NHS and care services168. Harrogate and Rural DistrictClinical Commissioning GroupTaking a new look at team workingThis vanguard aims to transform the way care isprovided locally with GPs, community services,hospitals, mental health and social care staffworking together to support people to remainindependent, safe and well at home.Where possible, care will be provided by the samepeople each time, so that patients and their familiescan get to know and trust their team. Their careplan will set out their goals and the support theywill receive to achieve them, pre-empting need andplanning better in advance.The vanguard and the people it servesThe vanguard partners include Harrogate andDistrict NHS Foundation Trust; Harrogate andRural District Clinical Commissioning Group; NorthYorkshire County Council; Tees Esk and Wear ValleyFoundation Trust; Harrogate Borough Council andYorkshire Health Network (representing the 17general practices in the District).Boundaries between primary, community, acute,mental health and social care are being removedand hospital beds will be used only when they aretruly needed. A response and overnight servicewill provide rapid support and social care staff willwork with A&E, both helping to avoid admissionsto hospital. Community beds are available for thosewho need a little more support.The vanguard covers a population of approximately160,000.The vanguard also focuses on early intervention,prevention and promoting self-care. Servicessupporting health and wellbeing will be bettercoordinated and include voluntary and communitysector services, local council services, the police andfire and rescue services. Prevention will focus onfalls, mental health and strokes.Website: www.whatmatterstous.orgTwitter: @WMTU HarrogateContact: hardccg.ncm@nhs.netWhat is changing?The ‘What matters to us’ vanguard’s work is built onwhat local people said is important to them. Serviceswill be provided by an integrated (joined-up) careteam including GPs, community nurses, adult socialcare, occupational therapy, physiotherapy, mentalhealth, geriatricians and the voluntary sector.Key benefits A focus on prevention and self-care will helpsupport independence and reduce the need forinterventions from health or social care services High quality and sustainable services will offervalue for money and be clinically and financiallysustainable Local and personal support will help reduceunnecessary hospital admissions.
NEW CARE MODELS: Vanguards - developing a blueprint for the future of NHS and care services179. My Life a Full Life (Isle of Wight)Working together to support an islandcommunityThe Isle of Wight vanguard is enhancing the care itoffers by delivering more services in people’s ownhomes and in the community, and by working inways that are sustainable over the long term as theyoffer better value for money for the NHS.The vanguard and the people it servesThe partners include Isle of Wight ClinicalCommissioning Group; Isle of Wight NHS Trust (aunique provider of ambulance, community, hospital,learning disability and mental health services); Isle ofWight Council; One Wight Health (a group of GPs);the voluntary and independent sectors and otherpublic sector organisations.The partners jointly serve a population of 140,000residents as well as thousands of tourists.Website: www.mylifeafulllife.comTwitter: @MyLifeAFullLifeContact: mlafl@iow.gov.ukWhat is changing?‘My Life a Full Life’ aims to prevent ill health bypromoting health and wellbeing and supportingself-care and empowered communities. Healthand care services for individuals is coordinatedby dedicated staff including community andcare navigators and local area coordinators, whohelp patients access the right service, reduce anyconfusion by simplifying how the system works andincrease awareness of the services available.New locality teams are also being introduced todeliver care and support in the community, with GPclinical leadership and teams of staff with a mix ofskills and specialisms.Services will work together to jointly assess people’sneeds and provide the right service, in the rightplace at the right time, avoiding unnecessaryhospital admissions and reducing inappropriatereferrals to services.At the same time, the partners are breaking
The vanguard is receiving support from the national new care models team to support its work to empower patients and communities to better support their own health, and in its work towards greater integration of health and care services. #futureNHS. This means getting doctors, nurses, other health professionals and social care staff to work more closely together to support the needs of .
