Continuing our series of briefings on the Health and Care Bill (‘the Bill’), we look beyond the provisions of the Bill itself to consider NHS England and Improvement’s recently published document “Working together at scale: guidance on provider collaboratives”.
What are provider collaboratives?
In the same way as Integrated Care Systems and the Triple Aim, the term provider collaborative is not to be found in the Bill. It instead refers to mechanisms that, for the first time, allow Foundation Trusts and NHS Trusts to delegate or jointly exercise functions between themselves. This is a significant change in the FT model, which was previously based on provider autonomy, but NHSE&I have been promoting provider collaboratives for some time. The new guidance describes the new statutory mechanisms for collaboration as well as other models including provider leadership boards, lead providers and shared leadership.
In the case of trusts providing acute and mental health services, they must be part of a provider collaborative by April 2022. Community trusts, ambulance trusts and independent providers can participate in collaboratives “where this would benefit patients and makes sense for the providers and systems involved”.
Provider collaboratives are distinguished from “place-based partnerships”, as the former will involve providers operating across multiple places and potentially multiple systems. A provider collaborative should be formed with one or more of the following goals in mind:
- Reducing unwarranted variation and inequality in health outcomes, access to services and experience
- Improving resilience by, for example, providing mutual aid
- Ensuring that specialisation and consolidation occur where this will provide better outcomes and value
Overall, the emphasis is on the benefits of scale, helping to address key challenges including Covid-19 recovery and scarce resources such as workforce and capital. While there are clear advantages to this approach, there are also a number of issues which will need to be worked through in the coming months. We discuss some of these below.
Agreeing objectives and priorities
Collaboratives are asked to agree objectives and priorities, but these must be consistent with the objectives of the one or more ICSs within which the collaborative sits, as well as being aligned with place-based partnerships. It will be a happy coincidence if the aspirations of collaboratives, systems and places are all consistently aligned from the get go. We can therefore expect an intense period of discussion (and perhaps horse-trading?) through the autumn as the emerging leadership of ICBs and collaboratives seek to develop strategies that have something for everyone. The benefits of scale are less likely to be achieved if collaboratives are having to adopt significantly different models across a range of systems and places.
Where objectives and priorities would have a tangible impact on how patients experience services, or the range of services available to them, then trusts should consider their duties of public engagement when developing those proposals. Given the expectation that collaboratives will be aligned with their local ICS(s), the collaborative’s engagement activity should be coordinated with engagement undertaken by ICBs.
Which organisations should form a provider collaborative?
Unlike in the case of ICSs, NHSE&I will not determine the organisations which should work together as provider collaboratives. This reflects the fact that, to date, different combinations of trusts have come together for different purposes. A trust may have networked clinical services with a number of its neighbours, not all of whom will fit together as a cohesive collaborative.
Trusts will therefore have to determine which collaborative is, on balance, the best fit for it in the medium to long term. Consequently, it may be necessary to unpick some existing arrangements.
What next?
Finally, although acute and mental health provider collaboratives should be in place by April 2022, the mechanisms that would allow them to formalise their collaboration through joint decision-making are likely to only become law in late March. Trusts will therefore have to take steps to develop collaboratives assuming that the new legislation will be largely as currently proposed.
In addition to developing objectives and governance arrangements, trusts should consider the foundations that must be laid for initiatives such as population health management, formalising the shared use of workforce and a common estates strategy.
How we can help
DACB’s experts in all aspects of NHS law and governance can support you to:-
- Take defensible decisions on your priorities and objectives
- Agree governance arrangements for collaboratives and review governance arrangements of trusts for consistency with collaborative arrangements
- Implement new models for delivering care and corporate functions
