As part of this drive towards greater collaboration, NHS England guidance identifies a number of key benefits of working at scale. Over the last year, our provider collaboration support programme has shared examples of how provider collaboratives are committed to working together to realise these benefits and maximise the opportunities of closer partnerships across a single or multiple ICS footprint. A selection of these illustrative examples of their work in progress is set out below.
Reductions in unwarranted variation in outcomes and access to services
Many provider collaboratives aim to improve quality of care and access by standardising service offers. By collaborating across a wider footprint, trusts can pool their insight and data on local populations, develop a common improvement methodology and build on national programmes like ‘Getting it Right First Time’ (GIRFT) to address unwarranted variation.
University Hospitals of Northamptonshire NHS Group
The University Hospitals of Northamptonshire NHS Group was formed in 2021, bringing together two acute trusts: Kettering General Hospital NHS Foundation Trust and Northampton General Hospital NHS Trust. They have a shared leadership model, with a joint chief executive and chair, and have brought together corporate functions to support clinical collaboration.
The group has an agreed clinical strategy which includes creating centres of excellence for cardiology at Kettering General Hospital and cancer at Northampton General Hospital. Their ambition is to transform cancer and cardiac services, and improve surgical outcomes, by bringing together best practice from across the two hospitals, with plans for specialist treatment hubs, single integrated advanced diagnostic services, joint multi-disciplinary teams and investing in new technology to establish single shared patient records.
There are wider plans to consolidate elective services based on this centre of excellence model, including the two hospitals’ elective care teams working as one to minimise unwarranted clinical variation and standardise best practice, such as by maximising day surgery and one stop pathways.
Reductions in health inequalities
Provider collaboratives have a key role to play in reducing deep-rooted health inequalities. This includes using population health data to segment waiting lists to prioritise treatment for those facing the most severe health inequalities, and ensuring more equitable access and provision is at the heart of plans to redesign care pathways and reconfigure services. We know from our provider collaboration support offer that a number of provider collaboratives are laying the groundwork for a concerted focus on health inequalities and are focusing particularly on how they share population health data and encourage providers to use it in the same way to generate a set of agreed priorities.
Efficiencies and economies of scale
Collaborative working offers trusts the opportunity to maximise economies of scale and make the best use of collective resources across several providers. These efficiencies can be released in different ways, including by consolidating corporate support functions or undertaking joint procurement to leverage the benefits of collective purchasing power.
The Acute Hospitals Alliance in Bath and North East Somerset, Swindon and Wiltshire ICS
The Acute Hospitals Alliance was formed in 2018, bringing together three acute trusts: Great Western Hospitals NHS Foundation Trust, Salisbury NHS Foundation Trust, and Royal United Hospitals Bath NHS Foundation Trust.
Greater collaboration during the pandemic catalysed a focus on sharing back-office functions, which will support the sustainability of services. The trusts now have one shared procurement team which has established joint contracts for specific medical devices and clinical consumables. This has several benefits, including making supply lines more resilient, and saving money. It proved extremely beneficial during the early stages of the pandemic when PPE availability was very challenging and is expected to save £4.6m in 2022-23 and £4.9m in 2023-24.
Consolidation of specialised services
Providers are hopeful that they can improve outcomes by agreeing how and where to consolidate low-volume or specialised services. Delivering services across fewer sites can also enable providers to improve clinical care and make best use of limited staff resources.
South London Mental Health and Community Partnership
The South London Mental Health and Community Partnership was formed in 2016, bringing together three mental health trusts: Oxleas NHS Foundation Trust, South London and Maudsley NHS Foundation Trust and South West London and St George’s Mental Health NHS Trust. In 2017 the collaborative introduced a new pathway for forensic care including all medium secure, low secure and community outreach services across south London. Key aspects of the model include a commissioning hub to manage contracts across the network, a single point of access for service users, and a shared capacity strategy and quality improvement programme.
There has been a 36% reduction in out of area patients and a 66% reduction in readmissions since the new pathway was implemented. This has saved money which the collaborative has been able to reinvest in expanding its community services and creating additional adult low secure inpatient beds.
Separately, the collaborative now manages children and young people’s mental health beds in a centralised way across the three trusts. By managing referrals and monitoring occupancy across the system, the collaborative has seen a 32% reduction in the number of children and young people accessing mental health beds, and a 93% reduction in out of area bed use, with an average distance from home falling from 73 to 7 miles for inpatients since the collaborative was established.
Greater resilience across systems and better management of system-wide capacity pressures
Trusts can help each other to stabilise services and manage capacity across a wider footprint than that served by their organisation. This might include trusts collaborating to tackle waiting lists across the system or enabling staff to work more flexibly across trusts through aligned contracts, processes and staff passporting arrangements.
Black Country Provider Collaborative
The Black Country Provider Collaborative was formed in 2020, bringing together four acute trusts: Sandwell and West Birmingham NHS Trust, The Dudley Group NHS Foundation Trust, The Royal Wolverhampton NHS Trust and Walsall Healthcare NHS Trust. Their initial focus was to deliver some priority services through clinical networks using a hub and spoke model.
A lead orthopaedic surgeon was appointed from Dudley Group NHS Foundation Trust to bring together the orthopaedic teams from each provider to review their orthopaedic provision. The clinicians decided to create two elective hubs for the system (north and south) to deliver almost all the elective orthopaedic activity across the Black Country to make better use of existing capacity so they can tackle their elective backlog more quickly.
There are long waiting lists for breast cancer services across the Black Country. A newly appointed clinical lead is developing a model with two centres providing oncoplastic reconstructive surgery services and two other sites providing more routine services. Using one site for lower volume specialised services and the other sites for higher volume, more routine care will enable the trusts to tackle backlogs quicker. The trusts expect that this network approach will also help attract the additional specialists and trainees they need to stabilise these services.
Better recruitment, retention and development of staff
Collaborative working at scale can help providers tackle pressing workforce challenges, with joint initiatives to improve staff recruitment and retention such as shared training opportunities, leadership development programmes and additional support for staff health and wellbeing.
Humber and North Yorkshire Mental Health, Learning Disability and Autism Collaborative
The Humber and North Yorkshire Mental Health, Learning Disability and Autism Collaborative was formally established in 2021 (having operated informally for several years prior) bringing together a range of NHS, independent sector and social care enterprise care providers, with Humber Teaching NHS Foundation Trust as the lead provider for commissioning specialised services.
The Humber and North Yorkshire resilience hub was set up in response to the COVID-19 pandemic to support health and care staff across the members of the collaborative. The hub was launched in February 2021 and has supported more than 2,000 staff to date. It provides a range of services, including support for staff experiencing long COVID. The outcomes have been very positive, with excellent feedback from service users: 99% say they are satisfied or very satisfied with the service they have received. This hub model has now been widely shared, including through the national learning community for staff mental health and wellbeing hubs.