CH: So Sam it is one year on since the five year forward view and the Vanguards are making
some progress. What are you seeing out there?
SJ: What is really interesting with all of the Vanguards is that the appetite for change
and the appetite for delivery of a different type of care model is consistent across all
of them. Every single one of them is up for and having some very significantly different
types of conversations across the population that they are covering. So I think a few months
on, so whatever it is, six months on from when the care models started my reality is
very different around the focus that they are taking on the population health.
CH: So if we come down to the patient or the person receiving care, what do you think this
is going to mean where it works well?
SJ: Norman who is the 89 year old, actually my father in law which I speak with his permission,
is somebody that has had involvement with different parts of the health and social care
system consistently over the last five years. And what we are starting to see whether it
is Norman or whether it is a younger person, because the Vanguards are approaching things
from a population health perspective is they are starting to be able to identify not just
the top 1% of their population but the type and the need of their population and individuals
like Norman and how care should be wrapped around them across all of the different institutions.
So if I use Cumbria or Millom as an example, one of the Vanguards, they have engaged their
local population in a very different way for different types of conversation and have shaped
the care around people like Norman in a very different way.
CH: And what are the challenges that you have seen? I know it is early days. But are there
some barriers to overcome to make a reality of this sort of joined up person centred care?
SJ: Yes. So what the Vanguards have told us and we visited all of the Vanguards and then
we played back through the thematic reviews what it is that they said. So some of the
challenges are really people not necessarily understanding how long change takes and a
real wish to see results very quickly, so those are two challenges. There are some very
practical challenges around whether it is technology, whether it is around the system
leadership discussions that have been had, whether it is around supporting existing workforce
to work in a different way and also recognising changes for the future, or whether it is some
of the more technical needing to support the national contract to be developed in a different
way so that it supports and incentivises a longer term approach to population health.
CH: There are some barriers at a national level aren’t there that could get in the
way of us seeing progress on the ground? How are you working with your national partners
on that?
SJ: So although I am employed by NHS England the care model programme and the care models
themselves are sponsored by all of the arm’s length bodies. So what that means in practice
is that I have tried to develop a blended team through the care models. So we have people
from Monitor TDA, we have people from Health Education England actually working within
the care model team to support the delivery through the Vanguards, because it is the Vanguards
that are delivering not us. What we are doing is identifying which of the appropriate arm’s
length body needs to be involved in addressing, whether it is pricing, whether it is around
collaboration, procurement, workforce, and making sure that the Vanguards and the wider
care models are supported by all of them playing their part in practice.
CH: Part of the challenge is commissions are very busy dealing with the day job, freeing
up some of their time to get involved in designing some of these new care models. How encouraged
are you by the depth of real clinical engagement in this work?
SJ: So I think there are a number of answers to that. The values of the programme and indeed
for the care models generally are around patient engagement and clinical involvement, local
delivery through the national team and the national bodies sorting to deliver the change
that is very easy to say. But on every interaction we have with the Vanguards and including everything
to do with the care models whether it is people from my team or whether it is actually out
and about, we have patients and we have clinicians involved in those discussions all the way
through to really truly pull out whether what is happening in practice is really what is
written on the tin.
The hardest challenge is doing today at the same time as thinking about tomorrow. But
if I use a really practical example, I was kindly invited to Wessex LMC last week, there
were about 125 GPs in the room and other people from the multi professional team all thinking
through...it was about 270 people in total actually, all thinking through how they could
in their areas support the delivery of the care models.
CH: If we fast forward three or four years, what will success look like for you?
SJ: So success from a care model perspective will be the majority of the country covered
by some form of a “new” care model. Not necessarily a PACS, not a primary and acute
care system, not an MCP, but what is right for the local population. Not all of them
will be delivering but everybody will be focused on the need of their population. And I think
that we will have been able to demonstrate through the Vanguards and wider because it
is not just the Vanguards that are delivering the care models of the future. Those bits
that are the fundamental building blocks that have to be in place to enable the delivery.
CH: So let’s finally talk about what this means for leaders and leadership. We are talking
here about something that is different very often from what we have had before, working
across organisational and service boundaries. What do we need of our leaders whether they
are in chief executive roles or in clinical roles to make a reality of the Vanguards?
SJ: So I think it is like a reality of the care models actually rather than just the
Vanguards. So I was trained to be a leader of an institution, I am a nurse by background.
Actually you need to keep the nursing as a background but focus on the population. That
is the leadership challenge of the future. And I think that the leadership of the future
needs to be comfortable in working in a network of accountability for the population that
is served and institution second. So we have spent a lot of time understanding from the
Vanguards and wider what is the leadership support that is needed to be able to break
down those conversations and break down the narrative so that people are focused on the
delivery of population health consistently.
CH: And that is true at the clinical level as well as at the organisational level?
SJ: More importantly in fact. We need to learn from the clinicians. So the clinical model
isn’t about institutional boundaries. The clinical model people don’t get ill. When
my son is ill he doesn’t get ill just in the GP practice, he uses every single part
of the system. And we all know that and we all go yes that is absolutely right, but that
is not how the NHS or care systems have been set up.
CH: So very last question. There have been lots of pilots in the NHS before, some people
say more pilots in the NHS than in BA, you also talked about the importance of patients
and staying the course, how confident are you that national leaders will do that?
SJ: I am optimistic that people understand the need for it. I am optimistic that people
understand that change doesn’t happen sitting in Whitehall is the expression. I am also
optimistic that...and this is the important point, the Vanguards or the care models have
to show delivery.
CH: Sam thank you very much.
SJ: Thank you.