IHOs are not the only model

For many areas, IHOs may not be a viable or desirable option in the short term. Therefore, while this report focuses on how to hold IHO contracts, there are multiple other ways that local systems can, and have been, integrating care and improving population health at a lower cost. 

For instance, providers are already exploring various forms of increased provider collaboration via statutory committees, joint ventures, host provider models and group models. ¹  These can each support service integration in areas with and without an IHO. Provider collaboratives act as a supporting structure for delivering care across different settings, including neighbourhoods, by standardising care, managing workforce and delivering services at scale. This is explored further in section 2.2. The 10YHP also introduces a range of other contractual mechanisms to transform care, including Year of Care Payments and two new neighbourhood provider contracts. IHOs can co-exist with other lead provider arrangements for specific services and pathways. 

Some healthcare leaders issued the need for caution in the rollout of IHOs, suggesting the ‘first wave’ of IHO host providers be treated as pilots to avoid ‘putting too many eggs in the IHO basket’. This reflects lessons from previous attempts to implement similar approaches, recognition of the wider operating environment and the complexities involved and concerns about the alignment of other policy levers (explored further in chapter 3). 

Successfully delivering an IHO requires a high level of system readiness, including strong provider capability and performance, system maturity, trusted relationships and strategic commissioning expertise. These conditions will not be present in all areas yet, reinforcing our view that IHOs are not the only, or the best, option for every system.

Chapter footnotes

1. See Paul Roberts, ‘Greater Than the Sum of its Parts?: Sharing Board Leadership Between NHS Trusts (NHS Confederation, 2024) for an analysis of the learnings from shared leadership models in provider trusts in England. ↑