Abstract
Following publication of a new vision for the English National Health Service (NHS) in 2014, known as the NHS Five-Year Forward View, a Vanguard programme was introduced by NHS England charged with the task of designing and delivering a range of new care models (NCMs) aimed at tackling deep-seated problems of a type facing all health systems to a greater or lesser degree. Drawing upon recent theoretical developments on the multilevel nature of context, we explore factors shaping the implementation of five NCM initiatives in the North East of England. Data collection was based on semi-structured interviews (66 in total) between December 2016 and May 2017 with key informants at each site and a detailed review of Trusts' internal documents and policies related to the implementation of each NCM. Our analysis explores factors shaping the implementation of five NCM pilot sites as they touched on the multiple levels of context ranging from the macro policy level to the micro-level setting of workforce redesign. It is far too early to conclude with any confidence that a successful outcome for the NCM programme will be forthcoming although the NHS Long-Term Plan seeks to build on the earlier vision set out in the Five-Year Forward View. Early indications show some signs of promise, especially where there is evidence of the ground having been prepared and changes already being put in place prior to the official launch of NCM initiatives. At the same time our findings demonstrate that all five pilot sites experienced, and were subject to, unrealistic pressure placed upon them to deliver outcomes. Our findings demonstrate the need for a deeper understanding of the multilevel nature of context by exploring factors shaping the implementation of five NCMs in the North East of England. Exploring the wider national policy context is desirable as well as understanding the perceptions of front-line staff and service users in order to establish the degree of alignment or, conversely, to identify where policy and practice are at risk of pushing and pulling against each other.
Highlights
With health systems globally facing new and complex challenges, transforming the way services are organised and provided to meet rapidly changing needs has become a major preoccupation of, and priority for, policy-makers with increasing attention being given to improving population health and strengthening integrated care (Hunter et al, 2015; WHO, 2016, 2018)
Drawing upon the multilevel nature of context, we explore factors shaping the implementation of five new care models (NCMs) initiatives in the North East region of England
This study was conducted within a limited time period during which there has been considerable and continuing policy churn, notably developments surrounding Sustainability and Transformation Partnerships (STPs) and ICSs, and more recently Integrated Care Partnerships (ICPs), accompanied by growing financial pressures on the National Health Service (NHS) despite an improved funding path for the NHS averaging 3.4 per cent over the five years compared with 2.2 per cent over the past five years
Summary
With health systems globally facing new and complex challenges, transforming the way services are organised and provided to meet rapidly changing needs has become a major preoccupation of, and priority for, policy-makers with increasing attention being given to improving population health and strengthening integrated care (Hunter et al, 2015; WHO, 2016, 2018). The NCMs include: managing rising demand on accident and emergency services, keeping people out of hospital, effecting rapid discharge for those no longer in need of acute care, integrating health and social care, reducing silo working and giving higher priority to prevention These new models of care proposed changes that are not concerned solely with structures or top-down reform edicts but are seeking new ways of achieving integrated care and joined up working across a whole system, driven by those on the front-line displaying new behaviours and leadership styles with an emphasis on collaboration rather than competition. The overall aim of the NCMs programme was to encourage the adoption of a whole system focus on health and well-being rather than ill-health and disease and to strengthen integration across health and social care
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