Vanguards: Truly at the Forefront?

The NHS Expo 2015 saw much attention and enthusiasm for the new Vanguard sites for the NHS. NHS England and the Department of Health have put a lot of trust in these sites to deliver better connected care and improved efficiency. One of the phrases repeated was “care without walls” and there is clear intent to break up organisational barriers as part of this process.

The NHS as a whole is often accused of having a defensive mind-set and of deliberately obstructing change. This is undoubtedly true, but the counterargument runs that this insulates the NHS against the worst of knee-jerk political decision making. This has meant that as policy makers have become more frustrated at the resistance of the NHS to change, they have resorted to more deliberately disruptive approaches to change management. Some of the earlier incarnations of this arguably gained momentum under New Labour in the 2000s with the promotion of increased competition and a marketplace for healthcare as a policy lever for change, and was followed up by perhaps one of the most deliberately disruptive pieces of legislation in healthcare, the 2012 Health and Social Care Act, described by Sir David Nicholson as “so big you can see it from space”.[1]

Undoubtedly these Vanguards could be truly innovative and efficient and this continues a policy move towards greater integration between health and social care as seen in the devolution of healthcare to Manchester and other regions. The mandate to be disruptive could deliver real ground-breaking change, except that no exemption has been given on the myriad of performance targets that all of these organisations face and the additional finance is very limited due to the current spending plans. So perhaps the mandate for change is more towards Eleanor Clift’s summary that “People want change but not too much change. Finding that balance is tricky for every politician”.[2]

So to the root of these new models of care: what is a Vanguard? Well, interestingly, one Chief Executive was brave enough to admit that despite being underway with the process, he was not really sure what it would ultimately look like, but that staff response to greater integration had been enthusiastic. Another described the process of being a Vanguard as making changes that they would have made anyway, but that the additional funding was allowing them to do it more quickly. The range of projects and integrations being undertaken under the Vanguard banner is very broad, which is laudable and ambitious, but the evaluation of the changes and proof of causality will be challenging with such a complex and inter-related and multi-provider environment. The launch documents for Vanguards spoke of “intensive evaluation” and many CLAHRCS and Academic Health Science Networks will be involved in trying to deliver the ‘logic model’ based evaluations.[3] It will be interesting to see the initial outputs from these evaluations.

— Paul Bird, CLAHRC Head of Programme Delivery (Engagement)


  1. Timmins N. Never Again? The Story of the Health and Social Care Act 2012. London: The King’s Fund. 2012
  2. Clift E & Brazaitis T. War Without Bloodshed – the Art of Politics. New York, NY: Touchstone. 1997.
  3. NHS England. The Forward View into Action: New Care Models: Update and Initial Support. 2015.

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