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NHS 'vanguards' are not delivering as planned

National Audit Office says money intended for health and social care integration has been diverted to relieve health service's financial pressures

National Audit Office says money intended for health and social care integration has been diverted to relieve health service's financial pressures


Picture: Charles Milligan

An NHS scheme to join health and social care has not transformed services as planned, an official report found.

Much of the funding intended for the 'vanguard' programme was diverted to relieve short-term financial pressures, the National Audit Office (NAO) said.

As a result, the scheme has not been expanded across England as was initially hoped as a result, the report said.

NHS England selected 50 vanguard sites to pilot models of providing health and social care as part of its five-year plan, published in 2014.

The sites were asked to design care models – for example, integrating GP, hospital and community and mental health services – that could be replicated across the country.

Reduce hospital deficits

About £329 million has been invested in the sites since 2015, as well as an additional £60 million spent by NHS England on central support.

However, the NAO said much of the funding intended for the programme was used to reduce hospital deficits.

The report said: 'The vanguard programme is one in a series of attempts to transform the NHS to better meet patients' needs and to respond to the financial pressures it faces. However, short-term financial pressures led to the diversion of much of the transformation funding, weakening the programme's chances of success.

‘The vanguard programme’s progress has been mixed but there are some early signs of a positive impact… and hope NHS England can break out of previous cycles of missed opportunity’

Amyas Morse, National Audit Office

'An important objective was to design new care models that could be replicated quickly across the NHS, and services have not yet been transformed to the depth and scale that was hoped for at the beginning of the programme.'

Long-term plan

NHS England chief executive Simon Stevens confirmed vanguard care models will continue through a long-term plan. 

NAO head Amyas Morse said: 'The vanguard programme's progress has been mixed but there are some early signs of a positive impact.

'I am pleased the chief executive of the NHS has confirmed his commitment to sustaining and spreading vanguard new care models through a long-term plan, and hope NHS England can break out of previous cycles of missed opportunity.'

Some hospitals in vanguard areas have improvements in emergency admissions numbers but it is too soon to assess their impact, the report said.

An NHS England spokesperson said: 'The NAO rightly highlights the success of the vanguard sites, both in improved outcomes for patients through fewer emergency admissions, and value for money with an expected return of £2 for every £1 spent.

'It is now crucial to build on this progress as the NHS develops its 10-year plan.'


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