Large-scale health system transformation in the United Kingdom

Abstract

PurposeFollowing publication of a new vision for the English National Health Service (NHS) in 2014, known as the NHS Five-Year Forward View, a Vanguard programme was introduced by NHS England charged with the task of designing and delivering a range of new care models (NCMs) aimed at tackling deep-seated problems of a type facing all health systems to a greater or lesser degree. Drawing upon recent theoretical developments on the multilevel nature of context, we explore factors shaping the implementation of five NCM initiatives in the North East of England.Design/methodology/approachData collection was based on semi-structured interviews (66 in total) between December 2016 and May 2017 with key informants at each site and a detailed review of Trusts' internal documents and policies related to the implementation of each NCM. Our analysis explores factors shaping the implementation of five NCM pilot sites as they touched on the multiple levels of context ranging from the macro policy level to the micro-level setting of workforce redesign.FindingsIt is far too early to conclude with any confidence that a successful outcome for the NCM programme will be forthcoming although the NHS Long-Term Plan seeks to build on the earlier vision set out in the Five-Year Forward View. Early indications show some signs of promise, especially where there is evidence of the ground having been prepared and changes already being put in place prior to the official launch of NCM initiatives. At the same time our findings demonstrate that all five pilot sites experienced, and were subject to, unrealistic pressure placed upon them to deliver outcomes.Originality/valueOur findings demonstrate the need for a deeper understanding of the multilevel nature of context by exploring factors shaping the implementation of five NCMs in the North East of England. Exploring the wider national policy context is desirable as well as understanding the perceptions of front-line staff and service users in order to establish the degree of alignment or, conversely, to identify where policy and practice are at risk of pushing and pulling against each other.

Comparison of the impact of two national health and social care integration programmes on emergency hospital admissions

“…First, we were not able to account for local contextual factors which might have affected the adoption and implementation of integration processes. Moreover, implemented initiatives were heterogeneous across sites and difficult to describe in detail using interviews and documentary analysis [15,19,[32][33][34][35][36][37]. A recent evidence synthesis of 115 local Vanguard evaluation reports concluded that none of the reports offered "explanations and/or nuanced insights into the Vanguard operation" [38], making crossinitiatives comparisons difficult.…”

“…Hitherto, the Pioneer or Vanguard programmes have been studied separately [15,19,[32][33][34][35][36][37][38], but never in combination. However, a number of Pioneers subsequently applied to become Vanguards, and thus the two programmes overlapped in time and partially in place.…”

UK Health Care Workers’ Experiences of Major System Change in Elective Surgery during the COVID-19 Pandemic: Reflections on Rapid Service Adaptation

“…The MSC field to date has focused on examples of planned system changes, such as centralising service provision 1,29,30 , integrating different forms of public service 31 , and introducing new technologies into health systems 32 . The case study of changes to elective surgery provision during the pandemic enables investigation of the enablers and consequences of unanticipated, rapid change.…”

Creating pre-conditions for change in clinical practice: the influence of interactions between multiple contexts and human agency

“…The role of context is well established in implementation science and in recent years attention has been paid to understanding the relationship between context and implementation in mediating change processes in healthcare organisations ( Damschroder et al , 2009 ; Pfadenhauer et al , 2015 , 2016 ; Dopson and Fitzgerald, 2005 ; Kaplan et al , 2010 ; Aarons et al , 2011 ; Bate, 2014 ; Robert and Fulop, 2014 ; Squires et al , 2015 ; May et al , 2016 ; Maniatopoulos et al , 2020 ). This paper identifies and characterises elements of contexts that influenced the introduction (or not) of TEP and the nature of the work to manage them.…”