ACUTE CARE collaboration vanguards may not be a catchy title, but they could well hold the key to creating a hospital system fit for the 21st century – or at least this is the hope of NHS England. The 13 vanguards are the next wave of NHS England chief executive Simon Stevens’s Five Year Forward View programme. It brings the total number of vanguard sites to 50 but, while the previous pilots announced earlier this year were focused on community-based services, these are all hospital related. Three basic models are being tested: ■ Multi-hospital chains allowing leading trusts to run other hospitals. ■ Multi-site franchises so that individual specialist services at local district general hospitals are run on site by experts from regional centres of excellence. ■ Accountable clinical networks to integrate care across groups of hospitals and other providers. Details of the support and the share of the £200 million transformation fund they will each receive will be announced in the autumn and Mr Stevens predicts they will revolutionise how the hospital system runs. He says the ‘era of go-it-alone individual hospitals’ is over. ‘Our new approach will help sustain the viability of local hospitals, share clinical and management expertise across geographies and drive efficiency beyond the walls of individual institutions.’ NHS Providers chief executive Chris Hopson is a little more circumspect, describing them as ‘interesting but hardly revolutionary’. He adds: ‘We need to be realistic about how long it will take. This is not a twoto three-year project. It’s more like a fiveto ten-year timeline to get this right. This doesn’t mean we shouldn’t London, and tapping into their specialist service and corporate expertise, it will allow it to develop its community services; or, as its chief executive Susan Acott says, to become a ‘hospital without walls’. Elsewhere, the three district hospitals in Dorset are exploring how shared rotas for senior nurses and doctors can be established to help improve services across a range of specialities. Meanwhile, four trusts in the Birmingham and Solihull area are focusing on acute mental health services, crisis care and recovery and rehabilitation as part of an accountable clinical network. In the East Midlands, seven trusts, led by Nottingham University Hospitals NHS Trust, are collaborating on radiology services. They have already started work on purchasing a common technical system to share access to radiology images. So what is the role of senior nurses in all this? RCN policy officer Mark Platt hopes they will be ‘given prominence’ in the vanguards. ‘They can play a part in setting their direction and their oversight, as well as ensuring that vital issues, such as safe staffing and the delivery of person-centred care, are realised.’ He worries, however, that the decline in senior nurse posts may make that difficult. ‘Those that are left are being stretched, often leaving them with little time to engage in the strategic elements of such programmes.’