Trusts leading transformation

These examples show how strategic commissioning can create the conditions for providers to innovate, share risk, and deliver at scale. Provider collaboratives in particular have demonstrated how trusts working together can deliver more consistent, efficient, and patient centred care.

NHS-led mental health provider collaboratives

Across England, NHS-led mental health provider collaboratives have been established to take on delegated commissioning budgets for specialised services, including children and young people’s mental health (CAMHS), forensic services, and adult eating disorder care. By codesigning pathways with patients and local partners, these collaboratives have redesigned services to reflect need over organisational boundaries. 

By working in this way, access to specialised services has improved, with patients able to receive care closer to home. Out-of-area placements have reduced significantly, keeping people within their communities and improving continuity of care. Outcomes have become more equitable across regions, as commissioning at scale ensures consistency and reduces fragmentation. 

This approach demonstrates how delegating budgets to collaboratives can unlock provider innovation, embed codesign, and deliver more consistent and equitable services across the country. 

The South London Mental Health and Community Partnership

The South London Mental Health and Community Partnership (SLP), formed in 2017, brings 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, to deliver mental health, learning disability, and autism services for 3.7 million residents. Pooling resources and devolved budgets through a joint committee, the partnership has overseen large‑scale transformation. 

Over eight years, SLP has reduced reliance on inpatient and out‑of‑area placements by shifting services into community settings. The number of adult secure patients treated out of area has fallen by 60%, CAMHS placements have halved, and 84% of patients with severe mental illness are now cared for locally. Recovery scores have improved, while dependence on independent sector beds has reduced. 

A flagship initiative, the £43m Complex Care Programme, integrates community rehabilitation, specialist teams, peer support, and personal health budgets. This has enabled patients with complex needs to be repatriated into local, least restrictive care, demonstrating how commissioning collaboratives with pooled budgets can deliver transformation at scale. 

South Yorkshire cancer alliance

The South Yorkshire Cancer Alliance brings providers together to improve and reconfigure cancer pathways across the region. Working closely with the South Yorkshire ICB, the Alliance oversaw a system‑wide redesign which aimed to improve local access and links to regional specialist care. Diagnostics and follow‑up care were commissioned locally to ensure patients could access tests and routine support close to home, while specialist surgery was centralised in centres of excellence to concentrate expertise and deliver consistently high outcomes. 

The reconfiguration was achieved through collaborative governance, with the alliance board including provider leaders, clinicians, voluntary partners, and the ICB. This structure enabled decisions to be made collectively, aligning local place‑based priorities with regional service planning. Clinical teams worked across organisational boundaries to standardise referral processes, expand diagnostic capacity, and embed consistent follow‑up protocols.

The impact has been significant. Patients now benefit from faster access to diagnostics, reducing treatment delays and enabling earlier interventions. Concentrating surgery in centres of excellence has improved clinical outcomes, while localised follow‑up care has reduced travel burdens and supported recovery closer to home. By aligning commissioning decisions, reconfiguration of services can improve patient experience, deliver equity, and make best use of resources across systems. 

More case studies setting out how provider collaboratives have led system redesign, including acute reconfigurations, workforce sharing and joint investment in diagnostics can be found here. 

Success depends on building with providers, not just transacting with them. Culture matters – trust, openness, and mutual accountability must be the foundation. Every trust offers essential operational insights that ICBs should fully leverage, from ambulance trusts identifying pressure points to community and mental health providers highlighting local inequalities. While national tools like the Federated Data Platform are still being rolled out, providers can already collaborate on analytics, modelling, and risk stratification, to help ICBs plan services more effectively, monitor performance, and make better-informed decisions to improve services and outcomes for patients and communities. 

If ICBs are to commission strategically and deliver impact at scale, partnership with trusts will be key. Rather than relying on fragmented, transactional approaches, ICBs should use a range of levers - contracts, incentives, and system planning - to create space for providers to lead and succeed. This is vital to achieving the government’s three shifts and, ultimately, improving care experiences for patients and communities.