The Lancashire and South Cumbria Provider Collaboration Board (PCB) is a formal joint working and delegation arrangement between the five NHS providers of acute, mental health, community, and specialist services in the Lancashire and South Cumbria ICS[1].
Following mutual aid arrangements in response to the Covid-19 pandemic, the leaders of the five trusts began to discuss mechanisms to enable greater collaboration. Following extensive engagement with the individual trust boards, staff and stakeholders, all the trusts agreed to form a joint committee structure to formalise the collaborative working arrangements and to commit to collective decision-making. The formation of the joint committee and the delegation of powers was then ratified by the ICB in December 2022.
The vision of the PCB is to 'work together as one with a culture of continuous improvement', with the aim of 'driving up quality by sharing skills and best practice, pooling resources and standardising ways of working to reduce variation and duplication'.
One of the key drivers for collaboration was the commitment to making decision-making more streamlined and faster to enable better patient outcomes and quality of care.
The PCB seeks to provide NHS Lancashire and South Cumbria ICB, NHS England, local authorities, and the wider ICS with a single, collective trust view on proposals for service change. It also exists to develop shared clinical and other services, support financial stability and sustainability through reduced duplication and better use of existing resources, and to implement, manage and oversee shared corporate services.
The PCB has agreed to seven principles which guide the work of the collaborative:
- Work together as one structured system to achieve excellence.
- Have a trusting, transparent and open approach.
- Share data and best practice, learning together when things go wrong.
- Build a positive, aspirational culture based on continuous improvement.
- Encourage staff to be creative, innovative, and aspirational in what they want to achieve for the population and for each other.
- Be inclusive, ensuring joint working between the NHS, local authorities, the voluntary, community, faith, and social enterprise (VCFSE) sector, and private providers.
- Work as part of the Lancashire and South Cumbria system.
The joint committee allows the PCB to make decisions on key programmes of work as agreed with trust boards. These key programmes each have a board or group which reports into the PCB. These are:
- The Clinical Programme Board, which leads the delivery of the joint clinical strategy. It also develops new models of care, for example the implementation of a system-wide networked service model for cardiology, the establishment of the Lancashire and South Cumbria (LSC) vascular network with a single inpatient unit, as well as the development of networked services in urology, and musculoskeletal trauma and orthopaedics.
- The Central Services Portfolio Group, which oversees the move to bring together operational services into one ‘umbrella’ service hosted by one of the partners in the PCB. Good progress has already been made in bringing together staff bank and agency, delivering savings from procurement, which the PCB is anticipating delivering a financial benefit to the system this financial year.
- The Elective Recovery Programme Group, which is responsible for six transformation programmes, all supporting the ambition of managing waiting lists and capacity ‘as one’. The group also oversees the expansion of surgical hub capacity.
- The Pathology Network Board is overseeing the development of the Lancashire and South Cumbria Pathology service.
A PCB coordination group oversees and manages the PCB work programme. The group consists of executive directors and senior colleagues from all five trusts, each representing a profession (eg nursing, HR and finance). The role of these executive directors is to be a senior responsible officer (SRO) on behalf of their professional peers from across the collaborative, ensure clear communications between each trust and the group, and to be the SRO for the priorities falling within their professional remit. Director professional groups exist to allow discussion between the executive directors from across the trusts, ensuring the SRO is representing the views of their colleagues.
How are decisions made?
The PCB joint committee is made up of the chief executive and chair of each of the trusts. It is currently chaired by the chair of University Hospitals Morecambe Bay NHS trust and the lead chief executive was until end of September 2023 the chief executive of Lancashire Teaching Hospitals, and is now the chief executive of University Hospitals of Morecambe Bay NHS trust. These positions are appointed for fixed terms by the members of the PCB by consensus.
Each trust board has delegated decision making authority to the PCB, so the PCB may make collective decisions that bind the trusts in relation to its delegated duties and responsibilities. This includes the delegation of decisions which support strategic service transformation priorities (as defined by the ICS and commissioners), priorities for provider productivity improvement, opportunities for developing standardised approaches to service change and delivery, some shared clinical services, and shared corporate services.
In exercising these delegated functions, the PCB has agreed to provide a single, collective view of the partner trusts and agree an annual work programme that promotes the best interests of the whole population. The individual trust boards and related sub-committees are engaged with matters presented to the PCB joint committee for decision.
When making decisions, all PCB members have the right to vote regardless of whether the service or issue is ‘relevant’ to them. Once decisions are made, all members have a collective responsibility to support the PCB in achieving its objectives and delivery of the work programme.
The first major decision made by the PCB was to develop a collaborative bank for nurses, midwives, health care assistants, allied health professionals and administrators. The ICS-wide bank is intended to improve patient care by boosting the temporary workforce and reducing reliance on agency staff.
Building on this first success, the PCB made the next priority to develop a vision for collaborative corporate services, with the aim of standardising the approach across all providers to reduce variation and duplication, and to meet a quadruple aim of 'ensuring the best health and wellbeing of the population, high quality services, a happy and resilient workforce and sustainability'. The providers agreed that collaborating across corporate services would allow them to meet these aims, agree joint priorities for these services and deliver against them by sharing best practice, skills and support, pool resources to support fragile services, provide flexible career pathways across organisational boundaries, and support the local economy.
How do you engage with other system partners?
The PCB connects with other system partners through the Lancashire and South Cumbria ICB. The objectives of the PCB link to the system strategy and will continue to be guided by supporting the health and wellbeing of all of Lancashire and South Cumbria.
In parallel, to help deliver on its aims, the collaborative is considering how to increase involvement of place leaders, acknowledging the role of place-based partnerships as the engine room for delivery in localities.
The PCB is starting to engage with local authorities and is working with ICB partners to navigate this and develop more collaborative working. A major opportunity underway is the Lancashire and South Cumbria New Hospitals Programme. Two of the trusts in the collaborative, Lancashire Teaching Hospitals NHS Foundation Trust and University Hospitals of Morecambe Bay NHS Foundation Trust have been successful in securing investment from the national New Hospitals Programme to build two new hospitals. The programme involves all NHS organisations and wider partners, including local authorities and universities in the system. As a key strategic opportunity and major infrastructure programme, the PCB has an important oversight role and will be involved in extensive engagement with local politicians, local authorities, the public and other partners to develop the plans and agree locations for the new hospitals. It’s hoped that this opportunity for Lancashire and South Cumbria will promote positive system-working.
What’s next for the collaborative?
To date the joint committee structure has supported more effective and efficient decision-making. However, the PCB will continue to keep the arrangement under review, through an annual performance review.
Aaron Cummins, PCB lead chief executive commented: "Going forward, our aim is to build on benefits of the PCB working ‘as one’ in responses to surges in demand and in planning for industrial action and develop those relationships further to really understand what the art of the possible is and co-designing what that could look like in practice with our colleagues, public, and patients.”
One piece of governance advice that you would share with others:
Angela Bosnjak-Szekeres, the senior responsible officer for governance and legal services for the PCB shared that 'good engagement leads to good decisions'. She also reflected that implementing decisions and holding each other to account for delivery is still a work in progress. While the PCB joint committee has facilitated the decision-making process, the collaborative is now looking to build on this to make the delivery of these decisions more efficient.
[1] Blackpool Teaching Hospitals NHS Foundation Trust, East Lancashire Hospitals NHS Trust, Lancashire Teaching Hospitals NHS Foundation Trust, Lancashire and South Cumbria NHS Foundation Trust and University Hospitals Morecambe Bay NHS Trust