The new care models programme already appears at risk of becoming old news. Having first been signalled in 2014 in the Five year forward view, it is due to end in 2018. Plans for much larger place-based systems of care have developed in response to the squeeze on NHS finances and the growing complexity of health and care needs. The national spotlight is now firmly fixed on the creation of sustainability and transformation partnerships (STPs) and accountable care systems (ACSs).
Yet those seeking to drive the development of STPs and ACSs, at all levels of the NHS, can benefit from valuable learning from the vanguard sites of the new care models programme. These sites have worked through the complexities of bringing together professions and organisations to develop place-based models of better coordinated care for people with complex health and social care needs.
Shining a light on what can be learned from new care models
While the design and technical aspects of the new care models have been discussed by others, this report seeks to shine more light on how the sites have made changes. Based on first-hand accounts from clinicians and managers who developed and implemented new care models, this report describes an approach to change that emphasises local co-creation and testing of care models as an alternative to the traditional top-down structural approach to change in the NHS.
The report identifies 10 lessons to support providers and commissioners seeking to adopt this new approach.
1. Start by focusing on a specific population.
2. Involve primary care from the start.
3. Go where the energy is.
4. Spend time developing shared understanding of challenges.
5. Work through and thoroughly test assumptions about how activities will achieve results.
6. Find ways to learn from others and assess suitability of interventions.
7. Set up an ‘engine room’ for change.
8. Distribute decision-making roles.
9. Invest in workforce development at all levels.
10. Test, evaluate and adapt for continuous improvement.
Implications for the future: local and national principles
The report identifies additional implications of the new care models programme for local health and social care leaders embarking on cross-organisational change. Taking time to understand and adapt to the local context is essential for new care models. Sites should focus on care redesign and its intended aims, and reserve time for people to collaborate to support co-design. Finally, evaluation must be seen as a core component of any plan, and teams must be given the time and support to collect and analyse data.
Finding this time can be difficult, as the actions of national policymakers and regulators often create multiple pressures and competing priorities that local leaders struggle to balance. By contrast, the national new care models programme consciously set out to create an enabling environment and headspace for professionals to make change happen. While this report focuses on what local leaders can do, it also identifies three key ways national bodies can support cross-organisational change.
Support new and existing systems –further focus is needed on what the national performance and governance frameworks should look like – they must build in the time and headspace needed to carry out care redesign, allowing for experimentation and failure. This is important not just for the most advanced systems, but also for those at a more formative stage of developing new models.
Send the right message – national messaging should focus on the core aims of system change and not simply on restructuring. It should encourage sites to answer the question: ‘how can care be improved for patients in this area?’ as opposed to ‘how can this area become a new care model?’
Continue to build evaluation capability and capacity –investing in robust local and national evaluation will enable sites to understand if changes are improving care. This will make sure that what works and why is shared and that areas can learn from their mistakes.
History suggests that the acronyms linked to the new care models programme will soon fade from view. But wider application of the programme’s approach to supporting local change could have a substantial impact on the health of the population and, in particular, on the lives of people who fall through the gaps of service fragmentation.