National Evaluation of the Vanguard New Care Models Programme Report of qualitative case studies: Understanding system change

This report forms part of a wider evaluation of the National Vanguard programme, funded by the NIHR Policy Research Programme and taking place between 2017 and 2021. The aim of this national evaluation is to explore the implementation and impact of the Vanguard New Care Models programme. This study forms part of a wide-ranging evaluation for the programme, which incorporated internal evaluation by the NHS England Operational Research and Evaluation team, locally commissioned evaluations of each Vanguard as well as this independent evaluation. Our study was conceived as an evaluation of the programme as a whole – i.e. it was our intention to not only explore how local areas made changes, but also to understand in depth how the programme as a whole operated, including the national support programme which ran from April 2016-March 2018. We have focused throughout on understanding how national policy initiatives and local contextual conditions intersect, in order to explore more widely how national policy is interpreted and implemented locally and the factors that affect this. The focus was on the evaluation of the Vanguard programme as a whole, set against the original aims, not the individual interventions being introduced locally. Our study is underpinned by an understanding of the policy literature, notably: the importance of history in determining how national policy is interpreted and implemented locally (Coleman et al., 2010; Pope et al., 2006); the interplay between ‘bottom up’ and ‘top down’ approaches to policy implementation (Barrett & Fudge, 1982; Matland, 1995); and the complexity in determining what constitutes policy ‘success’ in any given situation (Marsh & McConnell, 2010; McConnell, 2010). Our national evaluation consists of four main phases. In the first phase of the project, we explored the operation of the national support programme; the role of Vanguards within local health economies; and the operation of the programme of locally commissioned evaluations. Our findings to date have been published (Checkland et al 2019, Laverty et al 2019 and Wilson et al 2019). The second phase of the study comprised of a quantitative analysis of outcomes associated with Vanguards. This will be reported separately. It is the third phase of the study we are reporting here. We have used qualitative case study methods in order to explore in depth the factors that affect whether and how local initiatives are implemented in response to national policy. We adopted a theoretical framework (the Strategic Action Field [SAF] framework, designed to interrogate the factors affecting policy implementation at macro (national), meso (regional) and micro (local) levels.