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Small hospital vanguard sites delayed again

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Progress on an important strand of NHS England’s new care models ‘vanguard’ project has stalled, meaning work on the ground will not begin until summer at the earliest, LGC’s sister title Health Service Journal has learned.

  • “Viable smaller hospitals” is the final part of forward view’s new care models
  • NHS England expected to send out new expression of interest this month
  • Large teaching hospitals could be involved in the project


NHS England still plans to select a number of sites to trial “viable smaller hospitals” – one of the new models of care identified in the NHS Five Year Forward View last year.

The national body had intended for these to be included in the cohort of vanguard sites announced in March, having asked interested parties to submit expressions of interest at the beginning of the year.

Samantha Jones

When launched, the vanguard was delayed because NHS England was not clear about the question bidders had to answer, Samantha Jones said

At the time of launching the vanguard, NHS England director of new models of care Samantha Jones told HSJ the work on smaller hospitals had been delayed because NHS England had not been clear enough about the “exam question” that bidders had been expected to answer.

Trusts that had submitted an expression of interest were initially told that NHS England would issue a new request for viable smaller hospital proposals by the end of last month.

This never happened, and HSJ understands that the current expectation is that the request will not be sent out before late May.

This is partly because of uncertainty over who will form the next government and what direction its policy on acute care could take.

However, it is also understood to be because NHS England’s new care models team are still working with interested parties on the criteria that bidders will be expected to meet.

It means that the final vanguard sites will not be selected until June at the earliest. The first wave of vanguards took several weeks to select.

When it is established the viable smaller hospitals stream will form the fourth and final part of the vanguard, alongside sites already working to establish primary and acute care systems, multispecialty community providers, and enhanced health services in care homes.

The original specification suggested that the viable smaller hospitals vanguard could be the means by which NHS England implemented the findings of the Dalton review of the provider sector, which included the establishment of hospital chains among its recommendations.

The request for expressions of interest issued in January said small hospitals could focus on one of three areas:

  • becoming centres of excellence for elective care within particular specialisms;
  • delivering tertiary care across many sites “using an NHS franchise model”; or
  • establishing chains, or “foundation groups”, of district general hospitals providing a range of services, potentially working with larger teaching trusts.

Ms Jones told HSJ in March that this was one area of the vanguard that the largest teaching hospital providers could potentially become involved with. Several leading foundation trusts are already in “buddying” relationships with smaller struggling providers.

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