The NHS has today (Tuesday 10 March) chosen the first 29 ‘vanguard’ geographies  that will take the national lead on transforming care for patients in towns, cities and counties across England.


269 groups of nurses, doctors and other health and social care staff from across the country put forward their ideas for how they want to redesign care in their areas, and then helped choose the first 29 of the most innovative plans.


Drawing on a new £200 million transformation fund and tailored national support, from April the vanguards will develop local health and care services to keep people well, and bring home care, mental health and community nursing, GP services and hospitals together for the first time since 1948.


For patients, this will lead to a significant improve in their experience of health services. It is estimated more than five million patients will benefit, just from this first wave. For example, this could mean: fewer trips to hospitals as cancer and dementia specialists and GPs work in new teams; a single point of access for family doctors, community nurses, social and mental health services; and access to tests, dialysis or chemotherapy much closer to home.


Speaking ahead of NHS Change Day (Wednesday 11 March), Simon Stevens, the Chief Executive of NHS England, said: “The NHS now has its own long term plan, backed by just about everybody, and today we’re firing the starting gun. Instead of the usual top-down administrative tinkering, we’re backing radical care redesign by frontline nurses, doctors and other staff - in partnership with their patients and local communities. From Wakefield to Whitstable, and Yeovil to Harrogate, we’re going to see distinctive solutions to shared challenges, which the whole of the NHS will be able to learn from. ”


David Bennett, Chief Executive of Monitor, said: “The first wave of vanguard sites represents a practical start to transforming the NHS. We will use our expertise in areas such as pricing and system economics, alongside our oversight of foundation trusts, to help local areas develop the new models of care that are essential for the NHS and the people who use it.”


David Flory, Chief Executive of the NHS Trust Development Authority, said: “This is positive news for patients. The Five Year Forward View recognised the challenges that lie ahead for the NHS. There are some genuinely innovative plans to help us meet those challenges and with the support announced today there is an opportunity to develop better health and care services that will be built to thrive long into the future.”


Samantha Jones, Director of the New Care Models Programme at NHS England, said: “This is one of the most exciting opportunities to support change to how health and care services are delivered for patients for a long time. The health and social care systems that have been chosen to be vanguards in this cohort embody the forward-thinking and collaborative approach to improving patient care that the NHS Five Year Forward View called for last year. NHS England and partner national and local bodies will now work with those sites to accelerate the improvements that they are making and ensure this is replicated nationally.”


Sir Sam Everington, National GP Advisor, said: “The New Care Models programme is already highlighting just how much innovative and important work is going on in dozens of local areas already. I am confident that the 29 exceptional systems which have been chosen to be vanguards in this cohort will help revolutionise both the quality of care, and patients’ experience of it, over the coming years – not just for the patients in those areas, but for every patient in England.”


The vanguards will take the national lead on the development of game-changing care models:

  • multispecialty community providers (MCPs) – moving specialist care out of hospitals into the community;
  • integrated primary and acute care systems (PACS) – joining up GP, hospital, community and mental health services, and;
  • models of enhanced health in care homes – offering older people better, joined up health, care and rehabilitation services.

From April 2015, the national NHS will work with local vanguard sites to develop dedicated support packages to enable and accelerate change, and an intensive evaluation programme will seek evidence on what works so that this can be spread to other parts of the country.


Support will be tailored to the needs of each area, but could be a combination of peer learning and expertise in areas such as patient empowerment and community engagement, leadership, clinical workforce redesign, using digital technology to redesign care, devising new legal forms and new contractual models; and joined up procurement. 


All areas will benefit from a wider support and learning package which will be rolled out later this year, based on the learning from the vanguard sites. Additionally, as a result of the many examples of excellent models up and down the country, a wider programme of support is being put in place for some of the health and social care systems that applied to be part of the programme. This is being supported by the Kings Fund.


The NHS Five Year Forward View, published in October 2014 by NHS England, Monitor, the NHS Trust Development Authority, the Care Quality Commission, Public Health England and Health Education England, set out the health, quality of care, and funding gaps that will open up if the NHS does not change. 




  • The list of successful sites it as follows; pen portraits will follow:



Wirral Health and Social Care Economy

Northumbria Healthcare NHS Trust

Salford Royal Foundation Trust

Harrogate and Rural District CCG


Fylde Coast Local Health Economy

Calderdale Health and Social Care Economy

West Wakefield and Wellbeing Ltd

Sunderland CCG and Sunderland City Council

Stockport Together

NHS West Cheshire CCG/Primary Care Cheshire

Care Homes

Airedale NHS FT

NHS Wakefield CCG

NHS Gateshead CCG


Midlands and East


Mid Nottinghamshire CCGs (Mansfield and Ashfield and Newark and Sherwood CCGs)


Erewash clinical commissioning group and primary and community care providers

Vitality (Birmingham)

Dudley CCG

Lakeside Healthcare (Northamptonshire)

Principia (Rushcliffe)

Care Homes

Nottingham City CCG




Tower Hamlets Integrated Provider Partnership

Care Homes

Sutton CCG




Yeovil District Hospital NHS FT

North East Hampshire and Farnham CCG

Isle of Wight


Whitstable Medical Practice, Northgate Medical Practice & Saddleton Road & Seasalter

Southern Health NHS Foundation Trust

Care Homes

East and North Hertfordshire Clinical Commissioning Group

  • Further quotes from NHS leaders as follows:

Duncan Selbie, Chief Executive Public Health England, said: “I am delighted with the announcement of the Vanguard sites today. We all know we need to develop new ways of delivering care. New services that are about health and not just illness, and are about people not organisations and silos. The Vanguards will help us develop these new ways of working, and take a step towards the vision we outlined together in the NHS 5 Year Forward View.”


Professor Ian Cumming, Chief Executive of Health Education England, said: “It is extremely gratifying that our vanguard sites recognise that it is people not organisations who ultimately deliver care. Equipping staff, carers, and patients themselves with the skills and flexibility to deliver the new models of care, or to work in these new roles, is one of our key challenges.


“Health Education England, as part of the package of support available, looks forward to working with all vanguard areas to help successful implementation of their plans and to ensure that the learning from these sites is then shared with the NHS as a whole through our local LETB networks.


“The values of the NHS are core to the Forward View and are also core to the staff who make the NHS work. We need the right people with the right skills, values and behaviours now and in the future so that patients know that NHS staff will always be there for them.”


David Behan, Chief Executive of the Care Quality Commission said: “Health and adult social care should be designed around a person’s individual needs and not focused on organisational structures, as these do not represent the reality of experience. As the regulator for health and adult social care, we support this vision for improvement.


“I would like to offer my congratulations to the vanguard sites that have been selected to develop ways to provide more person-centred and joined-up care than ever before.


“By end of 2015 we will have inspected the majority of health and adult social care services in some areas. This will put us in a unique position in understanding not only how care is being delivered in different locations, but also in being able to use that information to create a picture of how well the health and social care system is working as a whole for people in different parts of the country.


“This information will be key to supporting the vanguard sites as they develop their models to assure high-quality care and encourage collaboration.”

  • In January the NHS invited individual organisations and partnerships, including those with the voluntary sector to apply to be ‘vanguard’ sites.  Applications asked for expressions of interest in four models of care that will reduce demand, improve productivity and breakdown structural barriers.
  • Support will be tailored to the needs of each area but could be a combination of peer learning and expertise in areas such as:

o   patient empowerment and community engagement;

o   clinical workforce redesign;

o   using digital technology to redesign care;

o   optimal use of health and care infrastructure;

o   creating joined-up information systems;

o   devising new legal forms and new contractual models; and

o   integrated commissioning across CCGs, NHS England and local authority and procurement.