NHS Arden and GEM recently hosted executive leaders from provider collaboratives, NHS regions and NHS England at our headquarters in St Johns House, Leicester.
The purpose was to connect those at the centre of developing and maturing provider collaboratives, to provide space for reflection and to share peer experience in understanding what conditions are needed to succeed.
This was an opportunity for Arden & GEM and other partners to listen and understand how we can also collaborate in our service delivery to best support this key innovation and ultimately improve care for patients and communities.
Provider collaboration offers the opportunity for two or more NHS organisations to work together to achieve joint objectives which, in turn, benefit local and national populations. Working at scale may involve formal groups and mergers but also may be a range of collaboration models, from lead provider to shared governance, and usually includes a formal partnership which gives organisations the autonomy to work closely to provide services which are more sustainable and efficient.
We know that provider organisations have historically worked together to address mutual challenges, particularly learning from working together during the pandemic. Now provider collaboratives have been driven forward from several NHS initiatives, are cited within formal NHS England guidance and - as of July 2022 - all NHS mental health and acute trusts are required to be part of a collaborative.
Arden & GEM is supporting the collaboration ambitions of provider organisations by delivering tailored packages (bespoke or scalable) to facilitate not just the stand-up of new partnerships but also enable them to add value and align within the wider system in achieving the NHS’s Triple Aim duty.
The session was chaired by Tim Guyler who is Assistant Chief Executive at Nottingham University Hospitals NHS Trust, part of the East Midlands Acute Provider collaborative. Hearing from three speakers provided the opportunity for reflecting on lived experience of standing up and functioning as a collaborative.
First, we heard from Sohaib Khalid in his role as Managing Director of the Black County Provider Collaborative reflecting candidly on its journey. Learning about the drivers for collaboration - centred on escalating pressure in elective backlogs and cancer health outcomes - it was clear that trying to innovate while facing the ‘burning platform’ is a challenge and can bring out territorial behaviours that need to be addressed when developing partnership arrangements.
The benefit realisation and outcomes for population health groups were illustrated by Rachel Redgrave, Managing Director of East Midlands IMPACT, a mental health provider collaborative which has a lead provider model comprising nine public and private sector organisations. This collaborative has been able to agree, deliver and evaluate their objectives by listening to and co-designing with service users, seeing progress on key issues such as reduced restrictive practice by over 20% and reducing placements out of area by over 8 % since 2020.
Next, NHS England gave an update on policy development, noting there are now 100 provider collaboratives and benefits are being seen across areas including length of stay, elective backlogs, financial and workforce efficiencies. It was acknowledged that there are challenges in ensuring peer support, the current operational climate, and roles and relationships clarity across system partners. Nine provider collaboratives are part of the Innovators Scheme which NHS England supports by providing a peer network to add momentum, respond to action learning and thus accelerate change. A maturity self-assessment tool was also discussed looking at key domains of outcomes, leadership and system working for partnerships to consider in evolving collaborative arrangements.
Breaking into two groups, colleagues were then asked to consider the following questions:
What are the challenges and needs in bringing together services across a system/regional footprint?
What would a support programme look like that could help you to achieve the demonstrable change?
What does the success of a programme like this look like?
Culture: Understanding the transition and cultural shift from providers working in a competitive environment to one of collaboration/co-production was a key insight shared by all. It was recognised that established relationships were seen as safe spaces to start collaborating. The opportunities afforded by independent sector and voluntary sector providers were also seen as positive, particularly regarding enabling change at pace due to different financial and governance controls.
Leadership and organisational development: Along with establishing appropriate governance arrangements was the role of executive leadership in role-modelling new ways of working. Senior leadership must also have clarity on where governance aligns with the wider system, seen as key to prevent siloed working and ensure clinical pathway integration is understood from primary care/place level through to system and regional executive.
Common purpose: Understanding the motivating factors from providers and how to coalesce these into partnerships that dock into System Joint Forward Plans delivery on health equity and inequalities was seen as the driver to build momentum, build the case for change and prevent inertia.
Clinically led: The importance of clinical leadership and ‘bottom up’ approaches to complement strategic priorities was identified as a way of harnessing providers around a common strategic goal, with tangible measures attached that benefit service users and support population health outcomes. Of note, was the advantages of clinical community of practice around health conditions and MDT working to enable best-practice and prevent unwarranted variation.
Sustainability and the social value of working as a collaborative across wide geography was also touched upon especially when looking at opportunities within MOU arrangements, workforce and estates strategies.
Outcomes and next steps
Feeding back through a plenary session provided an opportunity to really consider the conditions required for success and how resources can be shaped into:
a value proposition around community of practice
professional expertise to deliver and help embed strategic goals
a menu of support that reflects the stage of development and the priorities for partners.
Nicely summed up by Tim Guyler, when considering change and transformation activity, as…“the goal is the goal, not the structures”.
Arden & GEM provides consultancy expertise to support organisations in establishing provider collaboratives and safely accelerating this process. We enable collaboratives to identify and meet their specific goals and objectives, supporting prioritisation and integrated planning activities which are designed to meet population health ambitions.
Find out more about our support offer for provider collaboration by contacting the Strategy and Innovation team via email@example.com