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| The NHS vanguard schemes aiming to deliver quicker, better care | The NHS vanguard schemes aiming to deliver quicker, better care |
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| The prevention of ill health, rather than just its cure, lies at the heart of moves to improve the NHS to make it fit for another 70 years. The message is the same across the UK. | The prevention of ill health, rather than just its cure, lies at the heart of moves to improve the NHS to make it fit for another 70 years. The message is the same across the UK. |
| In England, the way forward has been signalled by the work of a number of “vanguard” schemes, selected and funded to trial new models of care based on local partnerships between the NHS and council-run social care and public health. | In England, the way forward has been signalled by the work of a number of “vanguard” schemes, selected and funded to trial new models of care based on local partnerships between the NHS and council-run social care and public health. |
| One such scheme, in Tower Hamlets in east London, has sought to involve all agencies concerned with children’s health, offering families early identification of emerging issues and support through services such as well-baby clinics, advice on healthy eating and home visits. | One such scheme, in Tower Hamlets in east London, has sought to involve all agencies concerned with children’s health, offering families early identification of emerging issues and support through services such as well-baby clinics, advice on healthy eating and home visits. |
| “Research shows that early childhood experiences have a lifelong impact on physical and mental health, including many long-term conditions such as diabetes, coronary heart disease and some cancers,” says Esther Trenchard-Mabere, consultant in public health for Tower Hamlets. | “Research shows that early childhood experiences have a lifelong impact on physical and mental health, including many long-term conditions such as diabetes, coronary heart disease and some cancers,” says Esther Trenchard-Mabere, consultant in public health for Tower Hamlets. |
| Like all the vanguards, the scheme was funded for only two years. It received a total of £8m. But since the end of national support earlier this year, the most successful elements of the pilot have been worked into mainstream practice and learning has been shared across England. | Like all the vanguards, the scheme was funded for only two years. It received a total of £8m. But since the end of national support earlier this year, the most successful elements of the pilot have been worked into mainstream practice and learning has been shared across England. |
| Important spin-offs of the initiative include housing advice, language classes and employment training for parents identified as having such needs when attending local children’s centres, where the scheme has been based. | Important spin-offs of the initiative include housing advice, language classes and employment training for parents identified as having such needs when attending local children’s centres, where the scheme has been based. |
| Prevention and early intervention lie similarly at the heart of moves to reform healthcare in Northern Ireland, following a review led by Spanish doctor and health policy expert Prof Rafael Bengoa. It reported in 2016 that health and social care was already absorbing £4.6bn or 46% of the then budget of the Northern Ireland executive. Within 10 years, it would cost £9bn just to maintain the existing system. | Prevention and early intervention lie similarly at the heart of moves to reform healthcare in Northern Ireland, following a review led by Spanish doctor and health policy expert Prof Rafael Bengoa. It reported in 2016 that health and social care was already absorbing £4.6bn or 46% of the then budget of the Northern Ireland executive. Within 10 years, it would cost £9bn just to maintain the existing system. |
| Change was vital not just to make the system affordable, Bengoa said, but to tackle health inequalities, deliver more personalised healthcare and meet the needs of an ageing population. | Change was vital not just to make the system affordable, Bengoa said, but to tackle health inequalities, deliver more personalised healthcare and meet the needs of an ageing population. |
| The review triggered the launch of a 10-year reform framework, entitled Delivering Together. Michelle O’Neill, Northern Ireland’s then health minister, identified 18 initial action points to relieve a system she described as being “at breaking point”. These included the allocation to every GP practice of a district nurse, health visitor and social worker. | The review triggered the launch of a 10-year reform framework, entitled Delivering Together. Michelle O’Neill, Northern Ireland’s then health minister, identified 18 initial action points to relieve a system she described as being “at breaking point”. These included the allocation to every GP practice of a district nurse, health visitor and social worker. |
| However, the collapse of Northern Ireland’s government just months later – and the continued political stalemate in the province – have cast doubt on the programme and some of its funding has been diverted to tackle hospital waiting lists. | However, the collapse of Northern Ireland’s government just months later – and the continued political stalemate in the province – have cast doubt on the programme and some of its funding has been diverted to tackle hospital waiting lists. |
| Richard Pengelly, permanent secretary at the Northern Ireland Department of Health, announced in March that £30m of the £100m allocated for the programme in 2018-19 would be used to cut “unacceptable” waiting times. While system reform remained the long-term goal, he said, “we also need to increase public trust in the system and relieve some of the pressure on our staff”. | Richard Pengelly, permanent secretary at the Northern Ireland Department of Health, announced in March that £30m of the £100m allocated for the programme in 2018-19 would be used to cut “unacceptable” waiting times. While system reform remained the long-term goal, he said, “we also need to increase public trust in the system and relieve some of the pressure on our staff”. |
| Does this mean reform is mothballed? The civil servants running the province’s affairs insist not. More than a dozen health policy consultations have been launched, an adult social care review published, a workforce strategy developed and a community development framework is coming down the track. | Does this mean reform is mothballed? The civil servants running the province’s affairs insist not. More than a dozen health policy consultations have been launched, an adult social care review published, a workforce strategy developed and a community development framework is coming down the track. |
| In a message to staff at Christmas, Pengelly said Delivering Together was “a clear roadmap” and transformation could deliver quicker and better care, “taking the pressure off hospital services by supporting people to stay well, safe and independent in the first place”. | In a message to staff at Christmas, Pengelly said Delivering Together was “a clear roadmap” and transformation could deliver quicker and better care, “taking the pressure off hospital services by supporting people to stay well, safe and independent in the first place”. |
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