Trusts in systems: working with partners to deliver success

Miriam Deakin profile picture

16 November 2022

Miriam Deakin
Interim Deputy Chief Executive / Director of Policy and Strategy


The health and care system is under extraordinary pressure. There are a host of concerns, including care backlogs, demand for urgent care, and the flow of patients through the health and care system.

And there is no sign of this letting up. As we look to winter and beyond there are new problems on the horizon. Rising inflation will squeeze existing NHS budgets, and cost of living pressures will take a toll on both staff and patients. This is likely to increase demand for care while making it even more difficult to deliver.

However, even in these difficult days we can, and should, highlight and celebrate the excellent, innovative work of trusts and their partners to address these challenges and improve care for patients and service users.


System working as a solution

Our latest Providers Deliver report reflects on the great work that trusts are doing every day, all over the country, to drive forward the core ambitions of system working.

Over recent years, trust leaders have worked towards this vision, despite the enormous other demands on their time. They know that this more collaborative way of working can help to address some of the immediate and pressing challenges they face.

But it's not just about the here and now. Trust leaders are also supporting the longer-term vision of system working, and playing a leading role as integrated care systems (ICSs), which were put on a legal footing in July 2022, develop towards delivering greater health and care integration.

Trusts are already working closely with key partners to progress the core priorities for ICSs, including around tackling health inequalities.

Miriam Deakin    Interim Deputy Chief Executive / Director of Policy and Strategy

As the report shows, trusts are already working closely with key partners to progress the core priorities for ICSs, including around tackling health inequalities. North West Ambulance Service NHS Trust has shared hypertension data collected by ambulance crews with primary care partners, to support interventions targeted at reducing health inequalities and preventing ill-health. To do this, they worked closely with local primary care partners to share relevant data for high-risk groups. Evidence shows this joint working has supported new diagnoses, lifestyle interventions and medication reviews.

Similarly, staff at Central London Community Healthcare NHS Trust, and their acute partners in West Hertfordshire Teaching Hospitals NHS Trust, have been working collaboratively across sectors to expand the use of virtual wards to support both frailty, and heart failure and chronic obstructive pulmonary disease. This has helped to reduce length of stay and avoidable hospital admissions. And, the teams across the partnership have maintained a focus on tackling health inequalities by ensuring that all patients can access virtual wards, regardless of potential barriers, digital or otherwise.

Developing partnerships around specific service areas is also key to improving outcomes for patients and service users, and to boosting productivity and value for money. These are all key tenets of system working. The Clatterbridge Cancer Centre NHS Foundation Trust have developed an alliance bringing together urgent care and cancer care partners to address challenges in accessing urgent cancer care close to home.

Likewise, Avon and Wiltshire Mental Health Partnership NHS Trust are leading a system-wide mental health finance oversight group covering both ICSs in which they operate, bringing together key partners from across the NHS, local authorities, and the third sector. Alliances such as this, and The Clatterbridge example, show collaboration at its best, with groups of partners exploring ways to improve quality, reduce unwarranted variation, and ultimately, drive up patient experience and outcomes.

As these practical examples show, trusts are the engines of system working.

Miriam Deakin    Interim Deputy Chief Executive / Director of Policy and Strategy

At the heart of all these examples, and steering the shift to system working, are the staff delivering care to patients and service users every day. Leaders of Maidstone and Tunbridge Wells NHS Trust attribute their effectiveness in meeting elective recovery targets to the way they have prioritised staff wellbeing and promoted a clinically led approach to recovery. In turn, this has enabled the trust to truly embrace the spirit of system working by delivering care to long waiters from neighbouring trusts and developing local partnerships to tackle system level challenges around health inequalities.

As these practical examples show, trusts are the engines of system working. They are acting as local leaders to deliver on the priorities of ICSs and drive improvement for the benefit of patients and service users.

This is only the beginning of the journey; there's still further to go in implementing and embedding system working. However, trusts will continue to play a vital role as both system leaders and system players as ICSs develop. We can see from the examples highlighted in our report, trusts are already making inroads in impressive and varied ways – and that is a real cause for optimism about the impact that system working can have both now and in the longer term.

This blog was first published by the HSJ.

About the author

Miriam Deakin profile picture

Miriam Deakin
Interim Deputy Chief Executive / Director of Policy and Strategy
@MiriamDeakin

Miriam is our director of policy and strategy and is currently leading our programme of work on sustainability and transformation partnerships and accountable care to inform our influencing activities on trusts’ behalf and ensure we are offering the support that trusts and their partners need to deliver new, collaborative arrangements. Read more

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