The Mid and South Essex Community Collaborative (MSECC) was formed in September 2020. Collaborative working began when the five clinical commissioning groups, now re-established as the Mid and South Essex Integrated Care Board (MSE ICB), contracted the commissioning and delivery of all community services to the three providers in mid and South Essex. Each provider had and still holds a separate contract for the same broad range of community services. The initial work on establishing the strategic relationships between the organisations dates back to 2019 and the collaboration was formalised via a contractual joint venture agreement in spring 2020.
MSECC describes itself as a partnership and is notable for including a community interest company (CIC). The providers forming the collaborative are:
- Essex Partnership University NHS Foundation Trust (EPUT).
- North East London NHS Foundation Trust (NELFT).
- Provide Community Interest Company (Provide CIC).
Their focus is on reducing variation in outcomes for patients, sharing clinical good practice, and ensuring community services are fit for the future and delivered closer to home.
Their work is structured around six outcome areas:
- Higher quality sustainable services.
- Reduction in variation and duplication.
- Effective use of resources.
- Unified provider voice.
- Health equality and equitable access.
- Improved staff experience and retention.
Three years into their collaborative arrangements, the partnership’s notable achievements include:
- Creation of 120 virtual ward beds, reducing patient deconditioning and acquired infection rates in hospital settings.
- A single service model for Urgent Community Response Team, community beds, virtual wards, and respiratory and long Covid services.
- Joint procurement and shared staffing, creating efficiencies.
- Development of a single inequalities plan and joint participation in the East of England anti racism strategy.
- Reduced use of agency and bank staff, and a reduction in the vacancy rate for community nursing.
- Joint roles reducing duplication and offering more attractive career pathways.
The collaborative was chosen to be part of the NHS England innovator scheme in early 2023.
How are decisions made?
The providers established a community collaborative board, leadership team, and a joint operations group and a clinical reference group to enable effective joint delivery of their separate contracts.
The partners sought legal assistance to think through the options around the form and governance of the collaboration. They considered and discarded the creation of a new organisation, for simplicity's sake and to avoid costly restructuring when finances were tight.
The remaining choices were restricted by the involvement of a community interest company provider (since delegation to joint committees and decision-making committees in common is not permitted to non-NHS organisations). The choice of a joint venture model was therefore mainly driven by practicalities as it allows the ICB to hold 'one joined up conversation' with its three community care providers and offers flexibility to adopt a different structure later if appropriate.
Underpinning the joint venture agreement are a series of quality concordats, which function as standard operating procedures.
The MSECC board is made up of the chair and chief executive of each of the NHS organisations, and the group chief executive of Provide CIC. Each partner organisation has delegated authority to make decisions at the MSECC board.
The MSECC does not have any employees: it has a lead director with a team of four partnership directors and a children and young people (CYP) operations director, who are employed by the three partner organisations (one of the partnership directors was already a joint post with Thurrock Council local authority).
The leadership team operates like an executive team and includes a lead director, the chief operating officers of all three organisations, a quality lead, nursing lead, governance lead, finance lead and communications lead. The leads are nominated from one of the three partner organisations and liaise with their counterparts in the other two organisations to undertake their role on the team effectively.
The four partnership directors and CYP operations director act as a single operational leadership team. They have shared the different service portfolios between them, each with oversight of cross cutting services that span the whole geography: for example, wheelchair provision and local services (such as district nursing) in each of the four places.
The governance challenge is to join up discussions and decision-making to avoid duplication while keeping everyone informed, and to enable the relevant provider boards to have effective oversight of decisions and services for which they are accountable. Relationships, mutual respect and understanding are seen as key drivers in overcoming any challenges to successful collaboration.
Work is allocated on a consensual basis based on capacity or expertise. The relationships have been established such that open and honest conversations can take place wherever there may be differences of opinion.
Risk management is undertaken within MSECC but with a focus on collaborative rather than organisational risks. This seeks to complement the oversight undertaken by the partner's own boards.
How do you engage with other system partners?
Members of the collaborative are driven by the need for services to be high quality and joined up – and to 'make sense' patients.
Since the very start, the collaborative has employed a director of workforce and engagement to help support working relationships between partners to help achieve this.
Over the past few years, the collaborative has therefore slowly been blurring the boundaries between commissioning and provision, taking the lead role for community services on behalf of the system. Working together has also allowed the three organisations to engage more effectively with other partners, allowing for single strategic conversations.
The approach is set out in a Memorandum of Understanding (MOU) with all system partners.
Having partnership directors across four places, and the support of engagement teams, has also enabled more interaction with local partners and this in turn has influenced the collaborative's planning and decision-making.
What's next for the collaboration?
The collaborative are keen to strengthen delegation from the provider boards to the collaborative leadership through a revised scheme of delegation and are receiving support from NHSE's innovators programme to create an accountability framework to support this shift. The partners believe that the trust and relationships are in place to enable delegation and more flexible decision-making in future.
The collaborative is also working on how to effectively enable clinical and care staff to move between organisations. This involves standardising procedures, for example, around infection prevention and control. Colleagues in the NHS organisations are also keen to learn from colleagues within the community interest company about ways to streamline policies and procedures, to become more nimble.
What's the one piece of governance advice that you would share with others?
Simon Evans-Evans, director of corporate affairs at NELFT told us:
"Do the groundwork. It was important to establish the shared vision, mission and purpose, and agree the principles behind the collaboration, including clear accountabilities and dispute mechanisms (recognising that a backstop is required for when things go wrong, because even with the best will in the world, it's a question of 'when' not 'if' in the longer term).
Governance should facilitate operational delivery. It should be kept simple and provide assurance, utilising existing structures where possible to avoid introducing additional, unfamiliar processes or being seen as a block instead of an important enabler of effective service delivery. Don't over-engineer it."