Clinical leadership and clinical networks form a fundamental part of the governance structure of the collaborative, and all strategies and plans are discussed and signed off by clinicians in the clinical reference and governance group before being taken to the board and implemented. A clinical director also sits alongside the programme director to ensure that the clinical voice is shaping the work of the collaborative. The new clinical model was designed and developed in this way, with the following goals identified:
- Less reliance on in-patient, bed-based services.
- Population needs-based service provision.
- Personalised, co-produced, outcome-focused services.
- Integration with health and social care systems.
- Culture change across the regional secure care system, incentivising collaboration for patient benefit.
- Better community support.
Since the redesign of the model, clinicians representing all nine partner trusts now meet weekly to consider the bed state across all providers for each service line, discussing admissions, discharges and transfers, which has meant that there is now a shared understanding of the needs of patients across the region.
A culture of shared problem solving has also developed, and when circumstances arise that require patients to be moved between providers, relating to acuity or previous admission histories, they come together to discuss how to manage the situation in the best interests of patients.
With these new ways of working, patient flow and bed occupancy have been improved. The partners have now signed a risk and incentive agreement outlining that any efficiency savings created by reducing the amount of bed occupancy days across the collaborative will be reinvested into transformation schemes which will have benefits to all. This has further incentivised the organisations to work collaboratively.