Towards integrated health organisations: considerations for policy and NHS leaders
Annex 3. Holding an IHO contract: prompt questions for local NHS leaders
The below questions are intended to prompt local discussion about whether an IHO is the right model to approach based on local arrangements and population needs. The questions are set out in sequential order and could be used, for example, to frame a group discussion or board meeting on each sub-topic.
Prompt questions
Strategic alignment and capabilities
- Do we have a shared understanding across system partners of what an IHO contract is and what it is expected to deliver in this geographical area?
- Have we considered alternative models for outcomes-based contracting and delivering neighbourhood health and the left shift?
Capabilities
- Is there an organisation in our area that meets the national criteria for an IHO host provider? Are they ready to convene system partners and take on the responsibility of managing a capitated contract for a defined population? (See section 3.1 for our proposed IHO host provider competencies).
- Does the ICB have the necessary strategic commissioning capability to effectively commission the IHO contract, including to oversee and provide assurance of whether the agreed outcomes are delivered? Do we have a plan to delegate these commissioning skills and capabilities to the IHO lead provider to be able to effectively sub-contract delivery of certain services?
Partnership and structure
- Do all system partners - including the ICB and all providers - agree on who should be the host provider? Do they each support the collaborative arrangements that will underpin the IHO contract?
- Are we confident that our local relationships are strong enough to support greater risk sharing and collaboration, including the ability to democratically resolve potential disagreements? How will we build and sustain trust across system partners, especially during challenging decisions or resource shifts?
Contracting
- Have we considered the procurement and competition law challenges associated with holding and managing IHO contracts? (See section 2.1 for more information).
- Are we clear on the services and outcomes we expect to be delivered through the contract?
Governance and accountability
- Is our governance set up to effectively oversee population health, not just organisational performance? Do we have the right expertise, transparency, and mechanisms in place to ensure accountability and track progress on population-level outcomes?
- Are we prepared for the implications of being designated as an IHO, including regulatory scrutiny and performance expectations?