Provider collaboratives are developing across the country. While some have existed for several years in a range of formal and informal arrangements, others have formed recently in the context of the national policy direction and the experience of mutual aid during the pandemic. Whether establishing new collaborative arrangements or evolving existing ones, trusts have needed to address some common tasks associated with developing and progressing a joint programme of work, including establishing their membership, scope and priorities; agreeing ways of working; and setting up governance and decision-making arrangements. Here we briefly outline some of the approaches that collaboratives are taking and illustrate some of the main ways they differ.
Membership and footprints
Some collaboratives bring together a group of trusts of the same sector. Examples of this approach include the Acute Hospitals Alliance (AHA) which is made up of the three acute trusts operating across the Bath and North East Somerset, Swindon and Wiltshire ICS. Similarly, there are well established collaboratives in mental health and learning disability services – for instance, the South London Mental Health and Community Partnership has supported collaboration between three mental health trusts in south London since it was established in 2016.
Other provider collaboratives bring together all the trusts within an ICS footprint – for instance North Central London ICS has an ‘all in’ collaborative, known as a provider alliance or the ‘UCL Health Alliance’. Some at scale collaboratives have memberships which reach beyond the statutory trust sector, for instance including voluntary sector providers and social enterprises as formal delivery partners. An example is the West Yorkshire community provider collaborative, which includes Leeds Community Healthcare NHS Trust and two community interest companies: Locala Health & Wellbeing and Spectrum Community Health.
In some systems, collaboratives – particularly NHS-led mental health provider collaboratives – have a wider membership beyond the provider sector, including commissioning/planning bodies (such as ICBs) and they are starting to move away from the provider collaborative terminology to reflect this. For example, Northamptonshire ICS is working through four collaboratives, each of which has a thematic focus either on a cohort of service users (e.g. children and young people) or a group of services (e.g. mental health, learning disability and autism). In addition, provider collaboratives are looking to develop relationships with wider system partners, including local authorities, primary care and place-based partnerships, to ensure priorities and delivery are aligned, and developed with people and communities.
There are some collaboratives which span several ICSs or regions. Some of these focus on services which benefit from being planned on larger footprints and delivered to larger populations, such as specialised services and ambulance care. For example, the East of England specialised services provider collaborative spans six ICSs and includes seven acute and specialist trusts across the region. Provider collaboratives will also need to work closely with ICS- and multi-ICS level clinical networks, building on established relationships and forums to develop clinical strategies and support service redesign and improvement.
Collaborative form or model
There is flexibility in the national policy framework for trusts to develop collaborative arrangements that make sense in their local context, and as a result collaboratives vary in the form they take. Trust leaders have been concentrating on shared priorities, which will then shape the structural and governance arrangements underpinning the collaborative.
National guidance highlights three main governance models for collaboratives:
- Lead provider. This model involves a single trust holding a contract with a commissioner and sub-contracting with other trusts in the collaborative to coordinate service delivery and improvement. In some cases, a lead provider may use its existing governance arrangements to support decision-making within a collaborative. For example, Devon Partnership NHS Trust is the lead provider for the South West Provider Collaborative, a mental health partnership including several trusts, independent sector partners and community interest companies to improve specialised mental health care.
- Shared leadership. This model involves multiple trusts appointing a single person (or group of people) to fulfil key leadership roles across the collaborative – particularly the chief executive role – while maintaining specific leadership capabilities for each member trust within the group. This approach is used in the Foundation Group in the West Midlands where three trusts – South Warwickshire NHS Foundation Trust, Wye Valley NHS Trust, and George Elliot Hospitals NHS Trust – operate with a shared chief executive and chair and have a committee in common governance arrangement.
- Provider leadership board. This model involves senior leaders from participating trusts establishing a joint forum to shape a collaborative agenda. The joint forum may operate with delegated authority to take decisions for the member trusts. West Yorkshire Association of Acute Trusts is an example of a collaborative operating in this way.
These three models are not mutually exclusive; a trust could be part of more than one provider collaborative arrangement each with different priorities or delivering its own programmes. Additionally, some trusts are deepening their collaboration through other approaches based on what makes sense in their local geographies. For instance, in Somerset ICS the trusts have opted to pursue a full merger to maximise opportunities to bring their services and capabilities together.
Looking ahead, the ambition is for provider collaboratives to play a central role in delivering service change and improvement within ICSs. National bodies have suggested that to play this role, it will be important for collaboratives to have certain capabilities. For example, the Act enables collaboratives to take on functions and budgets from ICBs via delegation, where appropriate (although NHSE does not expect ICBs to implement delegations in 2022/23). The Act also allows trusts to come together via a joint committee to make legally binding decisions which some provider collaboratives are considering adopting. We understand that NHSE plans to set out some more information on how provider collaboratives could relate to ICBs in the future, including via delegations.
Resources
There is no additional funding from national bodies to set up and run provider collaboratives, so trusts have drawn on existing budgets, clinical staff and leadership teams to resource their establishment and programmes, in some instances seconding staff to do the ‘set up’ or sharing the costs of a shared programme management or director role to oversee the development of a collaborative. In some systems this involves establishing a programme management function to provide operational support to senior leaders and coordinate joint activities. The scale of programme management functions depends on the ambitions of the collaborative, with some using only a small number of staff and others creating substantial teams.