Scale and spread of innovation in health and social care: Insights from the evaluation of the New Care Model/Vanguard programme in England

Objective Little is known about how to achieve scale and spread beyond the early local adoption of an innovative health care programme. We use the New Care Model – or ‘Vanguard’ – programme in the English National Health Service to illuminate the process, assessing why only one of five Vanguard programmes was successfully scaled up. Methods We interviewed a wide range of stakeholders involved in the Vanguard programme, including programme leads, provider organisations, and policymakers. We also consulted relevant documentation. Results A lack of direction near the end of the Vanguard programme, a lack of ongoing resources, and limited success in providing real-time monitoring and evaluation may all have contributed to the failure to scale and spread most of the Vanguard models. Conclusions This programme is an example of the ‘scale and spread paradox’, in which localism was a key factor influencing the successful implementation of the Vanguards but ultimately limited their scale and spread.