Tracking everything that’s new in care models and progress of the Five Year Forward View. By integration reporter David Williams.

The week in new care models

There’s no main feature this week because my colleagues Alastair, Dave and I have penned a special joint leader article on new care model delivery, in which we question where the intrepid Simon Stevens may be leading the service.

  • A couple of weeks ago I raised the issue of whether vanguards had enough money to invest in their new models of care, and whether any would be seeking funding from elsewhere. Robert Harris of Lakeside, who I doubt will be offended by being described as a bit of a renegade, is exploring some sort of joint venture involving the Far East. Tease that he is, no more details have yet been revealed, but I don’t think he means Norfolk or Suffolk. He’s planning to double Lakeside’s registered list to 250,000 – sounds like the sort of thing that might need a bit of capital upfront.
  • On new care models delivery, this slightly prickly Twitter exchange between Professor Harris and national director Sam Jones is worth a look too.
  • NHS Providers made a lot of headlines last week for saying openly what its members cannot about the impossibility of the situation facing many trusts this autumn. But chief executive Chris Hopson also had plenty to say about new care models. This presentation slide lists the nice things and the not so nice things providers have learned from the vanguards. In the green column: new relationships; clinicians enthused; “clear evidence on ability to rapidly improve patient outcomes” (publish it!). In the red column: will take five to 15 years to deliver, not three to five; more complicated and difficult than we thought; little evidence of rapid and significant savings. And, he has suggested that the current operational pressures are sucking up the management capacity needed for transformation.
  • Hull Clinical Commissioning Group has proposed a 10-plus year alternative provider medical services contract, my colleague Rebecca Thomas has spotted. With STPs yet to be signed off, it seems a strange time for a CCG to be looking to bind itself into a new generation of contracts affecting the part of the system most likely to be radically formed in the coming years.
  • Sir Howard Bernstein, the Sir Leonard Fenwick of Manchester (in terms of the incredible length of his service), is to retire. This is a big moment for devolution, as Sir Howard is known to be an extremely influential figure locally, and his leadership has been key in bringing the various parties together enough for devolution not to seem like a crackpot idea – no mean feat. It’s hard to know whether his departure is simply a case of “my work here is done” or if he’s reacting to a change in the weather in Westminster.
  • The UnitingCare contract fallout keeps on falling out. Falling out this week are the various players in the local health economy, who are now having a row about whether enough information was shared while the disastrous Cambridgeshire deal was being set up. There is also a second row going on about whether the winning (failed) provider “low balled” its competitors by putting in a bid it knew was unrealistic.
  • Meanwhile, Simon Stevens has suggested that some good may yet come out of Brexit: extracting the UK from the EU may allow the creation of a “smarter version” of the EU procurement regulations the NHS has such a hard time not making a horrible hash of. Giving evidence to the Commons public accounts committee, he also detailed a new assurance regime to stop UnitingCare style horror shows happening in future.
  • Fancy watching a video about a primary and acute care system? Morecambe Bay has made one. It starts with some nice scenic helicopter shots and features a surprising amount of arm waving.
  • Finally – a really significant development from Frimley Health’s bespoke STP: it is planning to extend its PACS vanguard across the whole patch, tripling the scope of the new care model to a population of 750,000. It will be built up out of hubs of 30,000-50,000, as per the forthcoming PACS policy framework – which may well also suggest a PACS could one day span an entire STP patch. According to board minutes published by the trust, Frimley Health chief executive Sir Andrew Morris said the initial vanguard work “had arguably been on too small a scale”.