Don't judge vanguards on what they weren't designed to do

Many years ago I took an introductory course in computer skills. I learned a number of helpful things from using email to build websites, and each week I duly completed course work to show I’d made progress.

The final mark for the course was determined, not by this weekly course work, but by a presentation to be made using PowerPoint. You might think “well that’s fine, surely PowerPoint was taught on the course”, but as I’m sure you’ve guessed, it wasn’t.

I was stumped, not by the regular objectives, but because I was measured against something else.

Following the publication of the NHS Five Year Forward View last year, 37 NHS sites have been selected to become vanguards.

They are charged with testing new models of care to improve the way that services are provided by the NHS in England.

With some different approaches, the new models all focus on providing more care out of hospital, through improved services from your GPs and in the community. This will allow the NHS to identify the best approaches to meet the needs for the population in the most cost effective way.

• New care models: To keep up, the NHS must shift focus in three ways
• First eight urgent and emergency care vanguards revealed
• First wedge of £200m transformation funding allocated to vanguards

A well thought out plan

Because we don’t yet know what these best models are, NHS England is not attempting a full roll-out of an untested idea.

Instead, vanguard sites are being run as a series of trials, covering just over a tenth of the English population. Those trials that aren’t making progress will be stopped, while models that genuinely improve the quality of care can be rolled out across the whole NHS, improving the service provided to everyone.

‘Progress in supporting the vanguards is looking good’

The evaluation will be real time, so that progress can be assessed, much like my weekly course work.

This is excellent - a well thought out plan to move care away from hospitals and towards people’s homes, with sensible timings and real focus on good proposals and evaluation.

The Health Foundation have argued for a similar approach with the King’s Fund, in what we referred to as the “development strand” in our joint report on a transformation fund for the NHS. And I’m pleased to say that progress in supporting the vanguards is looking good.

Vanguards won’t fill the gap

However, the NHS is currently facing financial issues. NHS providers recorded a deficit in 2014-15 of over £800m, and the most optimistic estimate for this year is a deficit of £2bn. The NHS needs a plan to save money, and it needs it now.

The vanguard sites are not this plan.

They have been set up to address the medium to long term issue of increasing the quality and sustainability of the English NHS.

‘Vanguards won’t achieve results at the speed and scale required to close the financial gap’

The current issues highlight why the success of the vanguards is so crucial for the future. But they will not achieve results at the speed and scale that is required to close the financial gap this year, or even in five years’ time. Even in the most optimistic scenario in the forward view, they don’t provide any benefits until 2018-19.

The budget for the NHS in England will rise by £8bn by 2020-21, but demand and costs for services are rising faster. £8bn will only be enough if the savings of £22bn can be achieved by then, plus an extra £2bn to cover this year’s expected deficit.

Lord Carter’s interim report suggested potential savings of up to £5bn, leaving another £17bn to find. The Care Quality Commission will start measuring trusts’ use of resources, but not until next year.

The only other obvious plan is the vanguards. But if the success of the vanguards is measured against their contribution to this financial crisis, they will fail.

Think efficiency

This is why we’ve argued that the transformation fund also needs an “efficiency strand”.

This would be a national programme, in addition to vanguards, to support staff to learn how to identify waste in the services they currently provide, and give them time to work as a team to remove this waste.

‘It’s crucial we don’t allow vanguards to fail because they don’t achieve something they aren’t designed to do’

It would have a clear objective to achieve efficiency growth of at least 2 per cent a year, with a clear goal. Crucially, its performance would be measured against that clear goal.

Many people on my IT course failed, not because they hadn’t achieved the tasks they were set, but because they were measured against their ability to do something else.

It’s crucial that we don’t allow the vanguards to fail because they don’t achieve something they aren’t designed to do.

Adam Roberts is a senior economics fellow at the Health Foundation