The formalised approach to collaboration between mental health providers was first introduced in the Five Year Forward View for Mental Health, produced by an independent taskforce to the NHS in England (NHS England, 2016). The report highlighted concerns about inadequate local care for many adults, attributing this to poor-quality commissioning and insufficient investment in local services. It set a goal for NHS commissioning to be based on a comprehensive understanding of local populations' mental health needs by 2020/21, and to unite local partners across health, social care, housing, and other agencies. To achieve these goals, the report recommended that NHS England trial new models of care. Under its mental health "vanguard" programme, NHS England enabled mental health providers to manage care budgets for tertiary mental health services, aiming to improve outcomes and reduce out-of-area placements.
In 2017, NHS England launched the 'New Care Model in Tertiary Mental Health' programme, appointing 17 pilot sites to test innovative approaches to delivering specialist mental health services (NHS England, 2017). Among these was South West Regional Secure Services, a partnership of eight providers and the largest site in the first wave of the programme. By 2018, they successfully increased the number of people receiving specialist care closer to home and planned to reinvest savings into forensic teams (NHS England, 2018).
Mental health provider collaboratives were launched at scale in the NHS Mental Health Implementation plan for 2019/20 – 2023/24 (NHS England, 2019b), following the NHS Long Term Plan (NHS England, 2019a). Building on the new care models approach, the implementation plan sought to establish partnerships of providers to take on new responsibilities for pathway and budget management for specialised services. The initial focus was on the specialised mental health budget, starting with adult low and medium secure mental health services, CAMHS tier 4 services, and adult eating disorder services. There was also an explicit aim to expand the services provided via these collaboratives.
These collaboratives have also been tasked with improving the health of local populations, understanding outcomes and experiences, and transforming pathways of care. The overall aim is to ensure that people with specialised mental health, learning disability and autism needs experience high quality, specialist care as close to home as appropriately possible.
The principles underpinning the approach, set out in the implementation plan (NHS England, 2019b) are:
- Collaboration between providers and across local systems.
- Experts by experience and clinicians leading improvements in care pathways.
- Managing resources to invest in community alternatives and reduce inappropriate admissions and care away from home.
- Working with local stakeholders.
- Improvements in quality, patient experience and outcomes driving change.
- Advancing equality for the local population.
To achieve this, providers have entered into formal arrangements to jointly plan and deliver services. Typically, they use a lead provider model, where a single trust is given responsibility via a contract to deliver a set of services, which it can provide itself or subcontract to others in the collaborative. Currently, the lead provider remains accountable to NHS England, as the commissioner, for the services it runs. However, this is changing as commissioning responsibility for specialised services is delegated to integrated care boards (ICBs) from April 2025 (NHS England, 2024).
Mental health, learning disability and autism provider collaboratives are now successfully building on this approach to improve outcomes, standardise care, reduce health inequalities and reinvest efficiency savings into community services. They are also playing an important role in ensuring that mental health continues to be a priority in system decision-making.