ISQUA17-2500HEALTH SYSTEM TRANSFORMATION IN THE UK: MAKING IT HAPPEN

Abstract

Objectives: Following publication of the United Kingdom National Healt h Service (NHS) Five Year Forward View in 2014, 50 Vanguards have been established across England charged with the task of designing and del ivering a range of new care models (NCMs) aimed at tackling deep-seate d problems of a type facing all health systems to a greater or lesser degree. They include: managing rising demand on accident and emergency services, keeping people out of hospital, effecting rapid discharge f or those no longer in need of acute care, integrating health and socia l care, reducing silo working, and giving higher priority to preventio n. The principal objective at the heart of the transformation agenda i s achieving the Triple Aim: improving the patient experience of care; improving the health of populations; reducing the cost of health care. The NHS Vanguards are being evaluated and this paper presents the fin dings from an initial scoping exercise as part of an ongoing evaluatio n of 5 Vanguards in the North East region of England. The NCMs embodie d by these Vanguards span urgent and emergency, acute hospital, primar y, community and social care services. Drawing upon the ‘receptive con texts for change’ framework developed by Pettigrew et al., the study a ims to provide a mapping of the implementation arrangements in each of the 5 Vanguards. The objectives of the evaluation are to: identify th e organisational and cultural facilitators and barriers in the impleme ntation of each of the Vanguards; explore the role and nature of multi disciplinary team working in the delivery of each Vanguard’s aims and objectives; explore the role of technology and digital solutions in th e delivery of each Vanguard’s aims and objectives; assess the costs an d costconsequences as part of an economic evaluation which will provid e information on the sustainability of each programme; identify key as pects that can be shared across all 5 Vanguards in the region and draw out any lessons learned from the implementation in order to inform fu ture transformational change underway in the NHS. Methods: The study h as adopted a mixed-methods design combining qualitative and quantitati ve methods to provide contextual understanding of the complex mix of o rganisational, technological and economic factors shaping the implemen tation of the Vanguard programmes. It is being conducted in 3 stages o ver a period of 8 months: (1) in-depth review of local documentation, semistructured interviews with key stakeholders involved in the implem entation of each Vanguard to identify organisational and technological enablers and barriers; (2) economic evaluation; (3) overarching analy sis and emerging key messages for shared learning. Results: The paper reports on the key findings under each of the three themes. It also re flects on the challenges facing academic researchers of conducting res earch in ‘real time’ in complex, messy dynamic contexts shaped by powe rful political forces. Conclusion: The evaluation study’s findings are being used by the 5 Vanguards to inform the next stage of their trans formation journey. They are also being picked up at a national level b y NHS England in order to share the lessons with other Vanguards. Refe rence 1. Pettigrew A. et al. Shaping Strategic Change. London: Sage, 1 992.