Title: The new models of care Vanguard programme in England:national programme evaluation
Funder: Department of Health and Social Care

Abstract: The New Care Models (NCM) programme is a complex programme, where five new models of care are being developed and implemented by Vanguard sites, evaluated at a local level, and supported by a national NHSE support programme. The programme sits within a complicated landscape of health system innovation and change, with multiple overlapping initiatives. Non-Vanguard areas are also being encouraged to develop new models of care, reducing the availability of comparison sites, and Vanguards are complex, with multiple workstreams, goals and services. In order to conduct a meaningful and relevant evaluation of the programme, we are proposing a flexible design that will:&middot; offer rapid formative and summative programme feedback to NHSE&middot; ensure close co-operation with the NHSE support team in order to minimise duplication and the burden on sites&middot; support the learning of enduring lessons about this approach to policy design and implementation, providing value beyond the particular programme addressed. Our overarching aim is to investigate the effects of the Vanguard programme on the NHS, including its local organisations, wider partnerships and service users. Our objectives are to: Determine the extent to which the Vanguard programme has resulted in the implementation of new models of service delivery Identify factors that support or inhibit implementation at the micro, meso and macro levels Ascertain programme impact on a range of outcomes, including economic assessment of costs and cost-effectiveness The following research questions will be addressed to meet these broad objectives: RQ1 What are the factors that support or inhibit successful implementation of new models of care? RQ2 How do Vanguards interact with other policy initiatives such as Sustainability and Transformation Plans? RQ3 How are Vanguards responding to the national support and evaluation programme, and how has this influenced Vanguard activity? RQ4 What does a comparative outcomes analysis tell us about costs and cost-effectiveness? RQ 5 What do the findings tell us about this approach to programme implementation? Our research plan will be operationalised through four interwoven work packages: WP1: an initial scoping phase will include establishing a database of Vanguards and their activity, exploring the broader national context within which Vanguards are working, and creating an economic model to identify key influences on the programme s cost-effectiveness WP2: a synthesis of the findings from local evaluation procurement and implementation. WP3: a primary data collection using case studies to explore the experiences and outcomes of a sample of Vanguards in depth, and a national evaluation of outcomes, costs and cost-effectiveness. WP4: a synthesis of the findings. Through a combined approach of primary qualitative and quantitative research, secondary data and synthesis of existing and on-going evidence, we will identify linkages and potential causal chains between national support programme activities and approaches, local health economy interactions and local level implementation. Our research team combines expert qualitative and quantitative researchers with experience of large scale evaluations. Members of PRUComm (KC, SP & PA) will work together with PSSRU, combining NHS and social care expertise. MS has carried out many national evaluations, and is expert in using routine data to explore outcomes. JB has expertise in case study methods and evaluation. PW has significant expertise in evidence synthesis. Both JB and PW working with different Vanguards on their local evaluations. DS, RG and DH will provide specific methodological expertise. With respect to research impact, the phased approach will provide early feedback and dissemination of evidence about emerging issues, relevant to Vanguard and non-Vanguard sites, as well as NHSE. Summative assessment of outcomes, linked to detailed qualitative exploration of Vanguard experiences, will provide robust evidence of the benefits, costs and unintended consequences of the programme.

Lay abstract: Health and care services are usually provided by different types of organisations, which operate separately and do not communicate well together. This harms patient experiences and can lead to unnecessary costs. The Vanguard New Care Models programme is a new government initiative to help services move quickly to change this, breaking down barriers and improving care. Fifty examples of new ways of providing services have been established, called Vanguards . They have received funding and support to set up. There are five types of Vanguard, covering different types of services. They have been developed, implemented and evaluated locally, helped by a national support team. They aim to improve population health and wellbeing; the quality of care and access to care; and service efficiency. The government now wants this national programme to be evaluated. We are university researchers from Manchester, Kent and London with experience of these types of evaluation. It will be complicated, because the Vanguards are also affected by other initiatives which are trying to change services. We will work closely with them and the national support team to make sure our evaluation is relevant, does not duplicate nor overburden Vanguards. We aim to investigate the overall effects of the Vanguard programme on the NHS. We want to find out how well Vanguards have been able to implement changes, what has helped or hindered, what they think of the support from the national team, and the effects on service users and NHS costs. We will do this in four ways. First we will explore the national backdrop, interviewing people from the national support team and regulators, and start building up a picture of economic issues. Secondly we will analyse the local evaluations. Thirdly we will choose six Vanguards to explore their experiences more in depth, and we will also do a national evaluation of outcomes, costs and cost-effectiveness. We will combine all of the data in order to give some clear messages about this approach to service improvement. We intend to share the results as soon as they are produced to make sure we can rapidly learn from this investigation.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE