11. We accept this recommendation in principle. NHS England are establishing
Vanguard sites to explore how new models of care can address the challenges faced
by services that are rural, geographically isolated or difficult to recruit to.
12. The Investigation highlighted some of the problems that can affect services
provided in remote or isolated areas, where poor practice becomes entrenched and
low staff turnover and low numbers of procedures can lead to a lack of clinical
experience and reduced opportunities for learning.
13. The NHS Five Year Forward View11 set out a way forward for the NHS that
includes new and different care models to meet the health needs of the population in
the future. Through these new care models, care will often be focused more in
community settings than in hospitals, will be more joined up to recognise the need of
people with multiple conditions, and will be more patient-focussed.
For example,
integrated community teams will be community based (including in rural districts) and
where clinically appropriate will utilise tele-health to support effective, safe and
quality care.
14. One of the main areas of focus for the new model of acute care collaboration
will be on the question of how to maintain local access to a range of safe, clinically
and financially sustainable acute services - in particular for services with low
volumes of patients or where there are national or local staff shortages.
15. Changing how care is provided is an ambitious and lengthy task. To start this
process NHS England has established some Vanguard sites which will test whether
these models work for patients. NHS England has selected areas that address
these challenges in both rural and urban settings. Lancashire North, which covers
the population of Morecambe Bay, is one of the nine Primary and Acute Care
Systems Vanguard sites that will receive national, regional and local support to
develop new care models joining up GPs, hospitals, community and mental health
services.
11 NHS Five year Forward View (October 2014)
16. Examples of best practice and shared learning from these Vanguard sites will
be made available to the wider NHS as soon as possible.
17. NHS England, Monitor and the NHS Trust Development Authority have also
recently announced the first locations to enter into the Success Regime, in which the
tripartite partners will jointly oversee a package of challenge and support for some of
the most challenged health economies. The regime will be tailored to local
circumstances, building upon existing interventions and working with providers,
commissioners and other local stakeholders to diagnose key underlying issues and
develop and implement the solutions to address both short-term performance and
long-term strategic issues.
18. The aim of the Success Regime is to create the conditions within health
economies to enable them to become high performing in the future. It will differ from
other interventions in that it will focus on identifying and addressing issues across
whole health systems as opposed to simply dealing with individual providers or
commissioners