The urgent and emergency care vanguards are the ‘battering ram of change’ and should quickly test new ideas to be replicated nationally, the director of NHS England’s new care models programme has said.

  • Vanguards should “get on and do it”, says director of new care models programme
  • Regular updates on vanguards’ progress in testing out new approaches will be published
  • New performance targets to sit alongside four hour target, focused on outcomes
  • Sites to pilot new payment models

In an interview with HSJ, Samantha Jones said the “fundamental principle” with the vanguards across all care settings is “get on and do it” to find out which models work.

The first eight urgent and emergency care vanguard sites were revealed last month.

The new care model leadership team will regularly publish updates on how successful the new approaches being tested have been. Ms Jones said this would show “the components that make things work for patients and population, as opposed to talking about the theory and the principles behind it”.

She added: “The NHS Five Year Forward View was very clear. It’s not a situation where we’re going to test this and in three years’ time we’re going to be looking for a pipeline of organisations [from now]. These are the care models of the future, which is why we have a responsibility to make sure we publish as we go.”

Samantha Jones

Samantha Jones said being a vanguard site was ‘quite scary in some respects’

Ms Jones said that as a former acute trust chief executive she found the vanguard approach “really exciting because it’s saying let’s go and do it, and show whether it works and works at scale to fundamentally change the way we deliver urgent and emergency care. Equally, it’s quite scary in some respects.”

It is “uncomfortable” being a vanguard because it requires trying new approaches quickly, Ms Jones said. She added: “I think they’re described as the battering ram of change. It’s uncomfortable being a vanguard, the existing vanguards would say we’re trying to go as fast as the fastest pace required… but that means it’s difficult as well.”

Russell Emeny, care model lead for the urgent and emergency vanguards, told HSJ the eight sites were chosen because they could “accelerate… to create prototypes for other parts of the country”.

He said: “They could experiment, see things which didn’t work as well and the learning could be fed back quickly to the NHS.”

HSJ asked how the national bodies will support local health systems that come up against political or public opposition when making changes to their emergency services.

Ms Jones said the vanguards could avoid a backlash because they have been engaging with the public over plans for urgent and emergency care in their area. “We know when that happens that minimises the risks [of opposition]”, she said.

Mr Emeny said there was an “opportunity” to “create something new in how we engage patients… so people don’t feel that any change means change for the worse”.

Vanguards to pilot multiple payment methods

NHS England and Monitor recently published the outcome of their consultation into a new payment system for urgent and emergency care.

This is a three tier model that includes a fixed payment to “keep the lights on”, a volume based payment to cover increased demand, and a payment based on performance.

Urgent and emergency services across a health economy will be encouraged to adopt the same payment approach and the vanguard sites will be testing this new model.

NHS England new care models director Samantha Jones said there is no proposal to change the payment system mid-financial year but where national policy is “getting in the way of the delivery of the network or the services being provided they will be addressed for the following year”.

More than one payment method will be piloted by the urgent and emergency care vanguard sites.

Russell Emeny, care model lead for the urgent and emergency vanguards, said: “There’s no intention to take a one size fits all approach… If a vanguard says it wants to move to a capitated model I don’t think there’s any reason for them not to do that.”

In June, NHS England chief executive Simon Stevens told HSJ emergency care would be “completely redesigned” within three years. Ms Jones said the vanguards will still be expected to meet performance targets during the redesign.

She said: “The fundamental requirements of quality, safety, national standards… have to be delivered… those aren’t being suspended for the vanguards but we have to develop tomorrow while we’re delivering today. One of the things that we were looking for from the vanguards is how do they demonstrate that they have the leadership capacity and capability to be able to do that.”

Mr Emeny said the new care model leadership team is designing dashboards for urgent and emergency care networks “so we can actually see where the heat is and where the flow is frustrated, and that will give networks an opportunity to do something about it”.

NHS England said earlier this year that these networks, involving a number of representatives from primary and secondary care, should be set up across the country to set and monitor standards of care and “designate urgent care facilities”.

The performance of urgent and emergency care networks will be judged under a new set of metrics, including care outcomes.

Mr Emeny said that while he is “fairly attached” to the target to see 95 per cent of patients within four hours, “it’s just one metric among others”.

Outcome metrics would be useful “so we can then look at the performance of whole systems as well as individual parts”, he said.

He added: “I suspect we’ll end up with a mix of longer term outcomes and some process metrics. Some process metrics are very good and they’re easier to use to establish how people are performing in the shorter term. Outcome metrics are all very well but if you look at an outcome that’s two-years-old it’s less easy to influence what’s happening now.”

Ms Jones added that the new metrics would be “designed by and with patients”.

Exclusive: Vanguards urged to quickly become ‘battering ram of change’