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Networked care – value to the wider NHS

The burning question for vanguard programmes is what benefits are there for other organisations through replicating your model? Leaders of the trusts we interviewed identified a number of potential benefits but because of the way that most networks have developed, the evidence for these is not always apparent.

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They identified a number of ways they expect a network to benefit the wider NHS including:

  • higher standards and quality.
  • improved efficiency through more standardisation, less unwarranted variation and less duplication.
  • improved access to local services that may otherwise not be sustainable and a greater range of sub-specialties.
  • improved equity of access to services.
  • better fit with the local commissioning landscape.
  • greater resilience of specialty providers.
  • improved careers and opportunities.

A review of our network and many other models has shown that in almost all cases NHS networked arrangements have been primarily about helping failing services. So the benefits to the wider NHS from a financial perspective will be more related to the counterfactual – what will the costs to these organisations be if smaller services are not supported and developed? What will the cost be to the wider health economy and what cost to patients’ health and wellbeing?

It is not easy to evidence the clinical and financial benefits of implementing our networked model of care as baselines for measuring this were not established at the outset of developments. At that stage it was mainly about helping organisations to reduce avoidable costs and improve quality but without the involved stakeholders quantifying them.

The toolkit recognises the need to set these baselines as best practice and to take account of the changing commissioning and regulatory landscape.

The toolkit brings together up-to-date reflections and information collected from colleagues in our own and other national and international organisations. It’s hoped this codified learning will avoid the need to endlessly reinvent the wheel. It also offers a detailed guide, with appropriate document templates, to enable accelerated implementation of a networked care model.

Replicating new care models is intended to reduce the variation in the quality of care delivered by different providers. This is particularly applicable in smaller clinical specialties which are rarely a high strategic or operational priority in district general hospitals.Networked care graphic
Setting service baselines at the outset will enable the partners to evidence better clinical outcomes, improved patient experience and more local and timely patient access to sub-specialist expertise. While all these can be measured in existing networked models of care, without the pre-transfer baselines it is much harder to demonstrate the value of the change to the host trust and commissioners.

10 steps to a networked care model has been developed as a result of our own network review, the lessons learned and what other organisations have told us, including board level executives. A key theme is to be able to robustly measure the benefits of the new arrangement.

There is a dual responsibility for establishing service baselines to measure success – a host trust must collect information and data about the existing service and be able to clearly articulate what they expect to happen with a new provider. The 10 steps model includes practical templates to help with early decision making and replicating the model at pace using the suggested methodology.

While the lack of baselines mean that some of the broader benefits are still to be robustly evidenced, those we spoke to pointed to some specific advantages they had identified, for example with the purchase of equipment.

A large specialty network can use its greater buying power and reputation to drive down costs as well as use its equipment and consumables more flexibly and intensively.

  • Bulk buying brings greater economies.
  • Suppliers may wish to be associated with the good reputation of specialty providers.
  • A network may be able to use the same equipment and consumables at different sites to optimise standardisation or move it across sites when there is equipment failure. First-line and routine maintenance of equipment can be standardised to achieve economies of scale.
  • Some equipment needs frequent checks and calibration and this needs to be taken into account.

Two staff members

“Seven trusts came together for the tender. We had seven radiologists, seven PACS managers, seven IT managers and clinicians who came together on certain days and spent the whole day together, looking and exploring with the supplier. But everybody saw that we could do this.”

“We didn’t really know what we wanted, to be honest. We knew we didn’t want what we’d got previously and we wanted to move forward.”

“Each trust has an individual contract with the supplier which says that if the trusts continue to work together the supplier will consider them as one organisation for the purposes of cost. And if a trust opts out of the consortium, the supplier will charge them more.”