We know that creating good governance can be challenging.
Working together, Browne Jacobson LLP and NHS Providers hope this guide will support NHS acute, mental health, community, specialist, and ambulance trust boards to focus on the considerations that enable well-governed provider collaboration. We know there is considerable enthusiasm to develop new collaborative arrangements at scale and at place-based partnership level. This guide includes considerations relevant to partnership at any level of population, although we have focused more on collaboration at scale.
This aims to be a practical guide – reflecting the legal framework for collaboration and NHS England (NHSE) policy, as well as building on the experiences of trusts.
Given that the Health and Care Act (2022) is relatively permissive legislation, we do not seek to suggest how providers should set up their collaborations but to describe the legal and governance considerations relevant to different forms of collaboration and collaboratives.
We hope the guide will support trust boards seeking to establish collaborative arrangements as well as those already involved in provider collaboration(s) and seeking to review and improve existing arrangements.
Further information and feedback from trust leaders involved in developing collaborative arrangements can be found in NHS Providers' survey [1] of provider collaboratives, case studies, and feedback from NHS Providers' Provider Collaboration programme.
How to use this resource
Section one, provider collaboration: why focus on governance, discusses the statutory basis for collaboration and makes the case for an early and ongoing focus on good governance.
Section two, the fundamentals of governance in collaboration, identifies some key principles to bear in mind whatever partnership working you are considering or when thinking about governance in collaboration(s) you are already engaged in.
Section three, what are the options for collaborative arrangements, sets out the various organisational models and legal forms that can be used to ensure lawful and effective decision-making in your collaboration. It identifies some principles of good governance that might particularly apply to the model or form under discussion. This section includes examples of provider collaborative arrangements in practice, and links to five longer case studies included in the annex.
The annex comprises:
- An 'at a glance' summary of considerations.
- Considerations concerning councils of governors (specific to foundation trusts).
- In-depth case studies about current governance practice in five provider collaboratives.
Glossary
In this guide we refer to the following key legislation and guidance:
We refer to NHS trusts and foundation trusts collectively as 'trusts'. Where we need to differentiate between them, we refer to NHS trusts as such and NHS foundation trusts as FTs.
The terms provider collaborative and provider collaboration can often be used interchangeably. Here, we use the term provider collaborative primarily to refer to a formal partnership between providers and/or in relation to NHSE's guidance about establishing provider collaboratives. We refer to provider collaboration where we discuss working together as an activity.
Please note that although NHSE's guidance may be statutory or non-statutory, all trusts have relevant provider licence obligations [2] such that they must have regard to all NHSE (and secretary of state) guidance about co-operation and collaboration.
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[1] Undertaken jointly with the NHS Confederation.
[2] Provider licence conditions WS1 and G4.