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Since 2015 the fifty Vanguard initiatives have developed local models of care by collaborating within local health systems, following on from the Pioneer initiatives.

The Vanguards have adopted a range of different service configurations, including Multispeciality Community Provider (MCP), Primary and Acute Care Systems (PACS) and Primary Care Homes (PCH).  One of the reasons that the services offered in these local models work well is that they have involved patients and staff in the design process.

In Next Steps on the NHS Five Year Forward View (2017), Healthwatch sets out five steps to ensure that local people have their say:

1. Set out the case for change so people understand the current situation and why things may need to be done differently.
2. Involve people from the start in coming up with potential solutions.
3. Understand who in your community will be affected by your proposals and find out what they think.
4. Give people enough time to consider your plans and provide feedback.
5. Explain how you used people’s feedback, the difference it made to the plans and how the impact of the changes will be monitored.

Next Steps on the NHS Five Year Forward View also reiterates the ‘rule of thumb’ that integrating care locally requires ‘horses for courses’ , not ‘one size fits all’.  Hence while it is important to learn from the Vanguards, it is also vital that each local health and social care system undertakes its own collaborative and consultative approach to integration, rather than simply adopting a model used elsewhere.