• Vanguards allocated just a third of the transformation funding they requested
  • Sites will relax timescales for implementation or prioritise only “core” workstreams

Vanguard sites have told HSJ they have had to scale back their work developing new care models after receiving less than a third of the transformation funding they said they needed this year.

HSJ analysis of more than half of the vanguards’ investment cases, which were produced in early 2016, shows that vanguards requesting a combined £216m were only allocated £70m between them (see table below).

This 2016-17 £112m transformation fund was allocated to vanguards earlier this year, and in 2015-16, and is specifically to support the development of new models of care. Another round of funding is expected in 2017-18. After then, any further central funding to support new care models will be allocated to sustainability and transformation plan areas, rather than vanguard sites.

Gaps between requested and approved vanguard funding

Vanguard site (and type)Approved funding, 2016-17 £mRequested funding, 2016-17 £mShortfall £m
Morecambe Bay (PACS) 4.7 17.5 12.8
Southern Hampshire (MCP) 4.3 16.7 12.4
Royal Free (acute care collaboration) 8 20 12
Dorset (acute care collaboration) 0.2 10 9.8
Cheshire and Merseyside (acute care collaboration) 0.2 9.2 9
Guy’s and St Thomas’ (acute care collaboration) 2.5 11.2 8.7
Barking and Dagenham, Havering and Redbridge (urgent care) 1.3 9.9 8.6
West Cheshire Way (MCP) 0.8 8.3 7.5
Accountable Care Network for Cancer (acute care collaboration) 7 14.2 7.2
Principia/Rushcliffe (MCP) 3.5 10.6 7.1
Harrogate and Rural District (PACS) 1.6 8.6 7
Cambridge and Peterborough (urgent care) 1.3 8 6.7
South Devon and Torbay (acute care collaboration) 1.3 6.8 5.5
Solihull (urgent care) 1.3 6.7 5.4
Fylde Coast (MCP) 4.3 9.6 5.3
Sunderland (MCP) 4.8 10.1 5.3
Dudley (MCP) 4.4 8.8 4.4
Encompass/Whitstable (MCP) 2 3.9 1.9
MERIT (acute care collaboration) 1.8 3.4 1.6
Moorfields (acute care collaboration) 0.5 2 1.5
East and North Hertfordshire (care homes) 1.8 3.1 1.3
Mid Nottinghamshire Better Together (PACS) 6.6 7.8 1.2
Airedale (care homes) 0.5 1.5 1
North East Hampshire and Farnham (PACS) 4.9 5.8 0.9
Nottingham City (care homes) 0.3 1 0.7
Sutton (care homes) 0.5 1.2 0.7
Total 69.6 215.9 146.3

Vanguard leaders have told HSJ that as a result of the shortfall in funding, they have had to prioritise which reforms to press ahead with while delaying others. Their comments are shown below.


Moorfields Eye Hospital Foundation Trust, which is developing an acute care collaboration around its specialist services, said it would have to review its timescales for delivery. While a toolkit setting out best practice in networked care, and establishing the need for it, would be delivered by March, a second piece of work on how networked care can be extended will be delivered at an unspecified “later date”.


Airedale, which is seeking to improve access to health services in care homes, said the “core” parts of its work have progressed, but other elements which “would potentially have widened and diversified the scope of our work”, such as remote monitoring of patients’ vital signs and new e-prescribing services, have been postponed.

Southern Health

Paul Streat, director of provider development for Southern Health, which is developing a multispecialty community provider in Hampshire, said: “Whilst we would ideally have wished to receive the full funding for which we bid, we understand the financial pressures the NHS is under and are grateful for the support received.

“We have adapted our programme of work to reflect this and have adjusted our view on how quickly benefits can be achieved, whilst maintaining our desire to work at scale and pace.”

He added that where possible the vanguard has secured extra funding from local NHS providers and commissioners.

Fylde Coast

Fylde Coast’s MCP said vanguards were informed early on that the total requested nationally exceeded the amount available, “therefore we were already reviewing plans for the likelihood of receiving a lesser amount than requested. This review of plans has mainly centred on our phasing and mix of the recruitment of additional staff and changing the roles of existing staff.”


Dudley CCG, which is leading the development of an MCP, said there are some aspects of its development that are continuing at the original pace of change, and there are some where the milestones have been pushed back. “We have had to reassess our plans and some proposed investments have been deferred to a later period rather than scaled back.”

North East Hampshire and Farnham

However, North East Hampshire and Farnham primary and acute care system, which received 85 per cent of its requested funding, said it was on track to deliver the “overwhelming majority” of its plan.


Salford PACS will also be able to deliver most of its planned transformation. Greater Manchester devolution leaders have granted the vanguard almost all of the £24m it asked for – but spread the allocation across four years, rather than the requested three. A spokesman said this partly reflects “a better understanding of the practical steps required”.

NHS England has been approached for comment.