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Permissive approach key to NHS system collaboration

Permissive approach key to NHS system collaboration
By Rory Deighton and Miriam Deakin
3 March 2023

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If the journey to integrating health and care services, and moving from competition to collaboration, is to be a success then the effectiveness of provider collaboratives will be key. As NHS England has set out, by working effectively at scale, provider collaboratives offer opportunities to tackle unwarranted variation, make improvements and deliver better care for patients and communities.

Indeed, NHSE planning guidance issued in the summer of 2021, mandates that all trusts providing acute and mental health services, as well as ambulance and community trusts, where appropriate, have been required to be part of at least one provider collaborative. 

Yet, to date, little has been known about the overall picture of how they are developing across the country.  

The NHS Confederation and NHS Providers recently surveyed leaders from England’s provider collaboratives. Our joint report – The evolution of provider collaboration – provides the first national picture of how these partnerships are progressing, the state of relationships with other partners and Integrated Care Boards as well as successes and where support may be needed.  

Our findings make for encouraging reading. The deliberately open statutory framework which has allowed ICSs and their constituent providers the flexibility to decide which arrangements will work best, has enabled collaboratives to take approaches that make sense in their local areas.

Whether this is focusing on a collaborative bid for funding a new state-of-the-art sterile drug manufacturing aseptic hub in the North East, testing new models for shared waiting lists for paediatric dentistry in the South West, or joint working around pathology and imaging in Lancashire and Cumbria, the permissive approach, appears to be paying off. We believe NHSE and ministers must preserve it. 

Unsurprisingly, there is consensus that the quality of relationships is key to the success of a collaborative, with leaders and clinical teams investing time and energy to develop mutual understanding to establish shared ambitions. Eighty-five per percent of collaboratives we surveyed focused on building relationships in their initial 12 months. Our survey also indicates early signs that positive relationships are being established between provider collaboratives and ICBs, with 70 per cent stating they are working well together on planning and setting priorities. 

One of the most exciting developments is the breadth of issues the new partnerships are working on and the scale of challenges they are seeking to address. Although 70 per cent of provider collaboratives surveyed have been focusing on set up in these initial stages, they are committed to working on areas such as the redesign of clinical pathways, tackling backlogs and delivering at scale in areas such as procurement, digital and workforce. This demonstrates that whilst many are at a relatively early stage in development, local systems are really grasping the ambition and vision that collaboration will be able to deliver.

Despite their relative newness, there are already examples of provider collaboratives delivering benefits for their communities. Mental health collaboratives have been able to provide care for residents closer to home and reduce the number of days in hospital. The North West London CAMHS provider collaborative, has significantly reduced both out of area placements and length of stay by 35 per cent since 2020. And acute trusts have worked on quicker diagnostic and elective procedures, for example in South Yorkshire patients are seeing improved outcomes in stroke services and reduced waits for gastroenterology. 

However, collaborations need staffing, resource and leadership capacity, things that are in short supply given the extreme operational and financial pressures the NHS faces. The survey highlights significant variation in the resourcing and set up of the collaboratives. These range from programme management offices to a handful of staff combining the provider collaborative functions alongside full-time day jobs. As collaboratives mature, we believe it is vital that national leaders are realistic about the impact that external factors will have on their development.  

Overall, the key message is one of optimism. Systems are embracing the change and provider collaboratives are working well, in establishing themselves, building local relationships and identifying the ambitions that can be achieved through working together. The freedom and flexibility they have been given to deliver is central to making this work.  NHS England and the Department of Health & Social Care should be commended for not being overly prescriptive and we want to see this permissive approach continue over the coming years to allow collaboratives to flourish.

As collaboratives progress maintaining focus on building core relationships will be essential, there can be no shortcuts. Building trust and understanding the way different organisations work will be key, as will defining a shared ambition for what collaboratives want to achieve through working together.  

Provider collaboratives are emerging at a time of significant change, and we should be mindful of the fact that it will take time for some to deliver substantial transformation. However, our engagement shows they have progressed well so far and with the right support they will continue to grow and be in a position to deliver tangible benefits for patients. 

By Rory Deighton, director of the NHS Confederation’s acute network and Miriam Deakin, director of policy and strategy at NHS Providers

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