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Joining up services
NHS England has implemented one of the first components of its five year improvement plan, published in October 2014. This first step is the establishing of 'vanguard sites' which will develop new ways of partnership and integrated working between health and social care services. 29 areas have been selected to receive support and funding from a £200 million transformation fund: later phases of the program will include more vanguard sites, utilising lessons and principles which have been developed as the scheme progresses.
The vanguard sites fall into three models of operating - integrating GP, hospital, community and mental health services; providing specialist health services locally in the community; and in care homes, improved health, care and rehabilitation services.
Will it work?
The five year forward report outlined partnership working, preventive services and participation by service users as priorities for development. Partnership working certainly figures highly in the presentations and aims of the vanguard sites. Prevention has a less high profile, although easier community access to services, and improved care home services will no doubt provide a measure of prevention. Participation by service users? It is difficult to trace how service users have been involved, if at all, in the planning or future evaluation of this scheme.
The Bubb report of last year repeated the need to urgently close large, centralised hospital provision for people with learning disability , in the light of the Winterbourne View scandal. It also called for people to have more say in how their care service was provided, and advocated pooling of budgets and better, more localised and integrated support services. The last of these is certainly aimed at in most of the vanguard sites.
But the need expressed in the report to urgently begin a closure program for these large institutions may have taken a back seat; now the focus seems to be on reducing pressure on primary health care trusts. This is valuable in itself, but may obscure the recognised need to reform specialist care for some people with learning disabilities and autism.
Innovative or reactive?
It is difficult to avoid the conclusion that the vanguard site scheme is reactive rather than innovative, aimed at reducing existing problems of supply rather than answering the demand for true personalised care as a goal and objective. There are already services which are small scale and local, and we might have wished for these exemplars to be identified and supported as models. This might have been just as effective as providing funding for large organisations to perhaps become even larger.
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