NHS England’s flagship vanguard programme has not delivered the depth and scale of transformed services originally aimed for, according to an investigation by the National Audit Office (NAO).

A key objective of the scheme was to design new models of care that could be quickly replicated across England.

Fifty sites were selected by NHS England to act as ‘vanguards’, tasked with coming up with creative and innovative solutions to address health and social care needs at a local level, as well as shape plans for long-term investment to boost population health and ease pressure on services.

However, money originally intended to enable the initiative to transform services “was instead spent on helping to relieve short-term financial pressures in the NHS by reducing trusts’ financial deficits, weakening its chances of success,” the watchdog said.

NHS England had originally planned for £2.2 billion of funding for new care models for between 2016-17 and 2020-21, but has used much of the funding “to reduce deficits faced by hospitals,” according to the NAO.

Actual direct funding of vanguards was much less at £329 million over three years from 2015-16, with another £60 million spent by NHS England on central support. “Consequently, with less funding for transformation, the original intention to expand the programme was not realised,” it said.

Also, while NHS England coordinated their development it failed to set clear national objectives for the programme or state how new care models would be spread across the country. “While this approach provided local, individual vanguards with more freedom to design system change, it makes it harder to assess the performance of the programme overall,” the report argues.

However, vanguards have made some progress in developing new care models, the NAO said, noting that NHS England forecasts that they will make net savings.

“It estimated that vanguards would secure £324 million net savings annually by 2020-21, which is 90 percent of the £360 million that had been expected. However, it remains too early to confirm these expected longer-term savings and NHS England does not intend to continue measuring savings,” the NAO noted.

It recommends that NHS England should “strengthen its approach to transformation, by setting out what it has learned from the vanguard programme,” and that the Department and NHS England should consider “setting out clear plans” for long-term service transformation.

“The vanguard programme is one of a series of attempts to transform the NHS. Its progress has been mixed but there are some early signs of a positive impact,” said Amyas Morse, the head of the NAO.

“I am pleased that the Chief Executive of the NHS has confirmed to us his commitment to sustaining and spreading vanguard new care models through a long-term plan, and hope that NHS England can break out of previous cycles of missed opportunity.”