Thirteen bids have been chosen to take forward NHS England’s vanguard for future models of acute care.

  • Hospital chains, shared clinicians and accountable clinical networks for cancer and mental health among winning bids
  • National orthopaedic programme will seek to set up franchise model
  • Simon Stevens says era of “go it alone” hospitals is being “superseded” by partnerships

The successful bids include hospital chains, now known as “foundation groups”; clinical services at district general hospitals run by specialists from regional centres; and accountable clinical networks for cancer, mental health and across multiple specialties.

There were 65 bids put forward to join the vanguard programme.

The winners also include plans to share senior clinicians across organisations; set up specialist nationwide franchises; share back office functions; and to establish a regional centre for radiology to bring work that has been outsourced back to the NHS.

The Royal Marsden, University College London Hospitals and The Christie foundation trusts all submitted separate vanguard bids and have been teamed up into one accountable clinical network to improve cancer diagnosis and outcomes.

The network may work towards taking accountability of a population budget but this could vary depending on the site. Geoff Bellingham, medical director for surgery and cancer at University College London, said the trust may use its budget differently to the Royal Marsden, for instance.

He said: “[Royal Marsden] may be looking very strongly at an accountable care organisation; we may be working in different ways in that we may have an ACO that’s not just cancer. We may achieve all of the cancer aims but not ringfence the cancer funds within that because we might work in other ways with our partners”.

He added: “I don’t think you need 100 per cent the same solution otherwise you lose the point of the vibrancy of what a vanguard is about. We will drive the cost of delivering cancer care down. In the long run that’s what this is all about, how we do that in each area is open to interpretation.”

The winning bids

Multi-hospital chains

  • Salford Royal and Wrightington, Wigan and Leigh foundation group
  • Northumbria Healthcare foundation group
  • Royal Free London FT

Multi-site specialty franchises

  • Dartford and Gravesham and Guy’s and St Thomas’ foundation group
  • Moorfields Eye Hospital FT
  • National Orthopaedic Alliance
  • Neuro Network

Accountable clinical networks

  • MERIT – Mental health accountable clinical network
  • Cheshire and Merseyside maternity and paediatrics accountable clinical network
  • Royal Marsden, The Christie, University College London Hospitals cancer accountable clinical network
  • East Midlands Radiology Consortium
  • Multispecialty Dorset accountable clinical network
  • Multispecialty Yorkshire and Derbyshire accountable clinical network

In a speech to the Confederation of British Industry in London this afternoon, Simon Stevens will say: “The era of go it alone individual hospitals is now being superseded by more integrated care partnerships – both within local areas, and across different parts of the country. The scale of the interest in these new vanguards from across the health service shows the NHS is up for radical reform.

“Our new approach to hospital partnerships will help sustain the viability of local hospitals, share clinical and management expertise across geographies, and drive efficiency beyond the walls of individual institutions.

“We’ve got some of the world’s best hospitals and specialists in this country, and it’s right they should be able to extend their reach more widely.”

Ed Smith, chair of Monitor and the chair-designate of NHS Improvement, said: “Today’s new vanguards represent the evolution from the era of standalone hospitals, begun in the 1962 Hospital Plan for England, and reinforced by the creation of foundation trusts in the early 2000s. These were right at the time, but the economic and clinical circumstances facing the NHS are now different, and our response needs to evolve.”

Royal National Orthopaedic Hospital Trust, Royal Orthopaedic Hospital FT and Robert Jones and Agnes Hunt Hospital FT have formed the National Orthopaedic Alliance. This will seek to provide orthopaedic services across the country through a franchise model.

Moorfields Eye Hospital FT already runs 22 clinics in and around London but this has been on an “ad hoc” basis. The trust will identify the best approach to setting up a chain of services and will produce a toolkit that can be used to roll out service chains in any specialty.

The Neuro Network is a partnership between the Walton Centre and Warrington and Halton Hospitals FTs, Liverpool and Warrington clinical commissioning groups, and NHS England’s specialised services team in the North. It will build on the providers’ experience in developing network models for neurology and spinal services in Cheshire and Merseyside. The intention is to set up a regional specialist centre for patients.

Salford Royal and Wrightington, Wigan and Leigh FTs are working with Greater Manchester devolution partners to set up an accountable care type organisation and a single service model for elective and specialist services.

Northumbria Healthcare FT will set up a foundation group and acquire or merge with other trusts, provide corporate services to other organisations and create a standard operating model.

Seven trusts in the East Midlands will set up a radiology consortium, hosted by Nottingham University Hospitals Trust. The trusts have already jointly purchased a shared technical system to allow access to patient radiology images when clinicians need them. They hope to set up a regional service that can bring work back into the NHS that is being outsourced.

A mental health accountable care network has been set up by four providers in the West Midlands.

Birmingham and Solihull Mental Health, and Black Country Partnership FTs, Dudley and Walsall Mental Health Trust, and Coventry and Warwickshire Partnership Trust will focus on seven day working in acute services, crisis care and reduction of risk and recovery and rehabilitation.

Royal Free hopes to lead a chain that will include buddying with other trusts, merging specific office functions and trying new models such as joint clinical and corporate ventures. No potential partners have been announced but the trust plans to work with Salford Royal and Northumbria Healthcare FTs to form a group, as revealed last month by HSJ.

Guy’s and St Thomas’ FT will work with Dartford and Gravesham Trust to become a foundation group. The trusts will share corporate services and Guy’s will provide some specialist services at Dartford and Gravesham.

Mapped: Acute care vanguards revealed