A core driver of the vision for the NHS in recent years, from release of the five year forward view and long term plan through to the Health and Care Act 2022 and guidance around provider collaboratives, involves NHS bodies working together with a more integrated and collaborative approach.
This new policy and legislative landscape encompassing integrated care systems and provider collaboratives presents an opportunity for acute hospitals to be fundamentally different in the future. The approach will deliver a greater proportion of care outside of the hospital setting, and present acute providers with an increased role in wider prevention and population health initiatives. However, these changes will need to be supported by the development of redesigned care pathways, workforce approaches and organisational models including:
- a system-wide perspective to decisions and operations (in line with the triple aim);
- more work with local partners, including primary care, social care and community services at place; and
- integrated service approaches with other acute providers that cross organisational boundaries.
Where are the NHS acute collaboratives focussed?
From the examples we have seen and worked on to date in the NHS the main areas of focus for acute collaborations have tended to be around issues such as service redesign, quality improvement, workforce development, and data sharing.
- Service redesign: efficiency and patient flow are critical factors in modern healthcare delivery, and acute provider collaboratives can prioritise service redesign to optimise this. By streamlining processes and adopting evidence-based practices, there is the potential to reduce waiting times, enhance patient flow, and improve overall operational efficiency.
- Quality improvement: delivering high-quality care is a primary goal for NHS acute provider collaboratives which can be achieved by implementing strategies to enhance patient safety, reduce medical errors, and improve clinical outcomes. Standardised protocols, clinical guidelines, and best practices are employed to ensure the highest standards of care across the board. By continuously monitoring performance metrics, collaboratives can identify areas for improvement, implement necessary changes, and consistently provide high quality care to patients.
- Quality improvement: delivering high-quality care is a primary goal for NHS acute provider collaboratives which can be achieved by implementing strategies to enhance patient safety, reduce medical errors, and improve clinical outcomes. Standardised protocols, clinical guidelines, and best practices are employed to ensure the highest standards of care across the board. By continuously monitoring performance metrics, collaboratives can identify areas for improvement, implement necessary changes, and consistently provide high quality care to patients.
- Data Sharing and analytics: data plays a crucial role in driving informed decision-making. NHS acute provider collaboratives can leverage data sharing and analytics at scale to gain insights into population health trends, identify variations and inequalities in care, and make more evidence-based decisions using this data. By effectively sharing and analysing data, they can also inform and develop targeted joint programmes of work.
Healthcare collaboration internationally
Looking beyond the NHS it is worth noting that there is already a large body of positive evidence of the impact that collaborative working across healthcare providers can have. Some of the better-known examples of this are:
- Kaiser Permanente (United States): a renowned healthcare system in the United States which has successfully implemented an integrated care model combining health insurance with healthcare delivery. Its collaborative approach focuses on preventive care, chronic disease management, and the use of electronic health records to support seamless information exchange. The model has resulted in improved patient outcomes, reduced healthcare costs, and enhanced patient experiences.
- Region Hovedstaden (Denmark): a network of hospitals and primary care centres that promote collaboration and shared decision-making which has led to reduced hospital admissions, improved patient experiences, and optimal resource allocation. The success of this acute hospital provider collaboration demonstrates the potential for enhanced healthcare delivery through effective collaboration between healthcare providers.
- Canterbury District Health Board (New Zealand): Following a major earthquake, the Canterbury District Health Board in New Zealand embraced an integrated care model. By fostering collaboration between primary care, hospitals, and social services, they achieved better health outcomes, reduced hospital readmissions, and improved coordination between healthcare providers. This collaborative approach looked to empower healthcare organisations to deliver comprehensive and patient-centric care.
- Singapore Health Services (SingHealth): a healthcare group in Singapore which integrates primary care, acute care, and specialty services. It looks to deliver a seamless continuum of care for patients with a collaboration which extends beyond hospitals to include community healthcare providers, resulting in improved patient care, enhanced care coordination, and better health outcomes.
Lessons from collaborative working in the NHS
As well as the international examples we can also take lessons more locally from the collaborative work which we have seen in the NHS to date (joint ventures, vanguards and collaborations) including:
- Collaboration is not a short term quick fix: results generally only start to be achieved after a number of years of sustained and consistent effort, with a particular emphasis on building the necessary relationships and trust between the organisations.
- Get the governance right: System wide governance structures should be developed to support the development and implementation of the integrated work only once there is clarity from the parties as to the scope of the collaboration and how decisions will be taken. Those involved should be wary of simply duplicating other existing groups responsibilities and creating an overly complex web of governance and meetings which confuses accountability and decision making across the parties.
- Get the governance right: System wide governance structures should be developed to support the development and implementation of the integrated work only once there is clarity from the parties as to the scope of the collaboration and how decisions will be taken. Those involved should be wary of simply duplicating other existing groups responsibilities and creating an overly complex web of governance and meetings which confuses accountability and decision making across the parties.
- Collaborative approaches can allow management of issues at an ICS level and increase system resilience: There are increasing numbers of examples of how integrated working can help manage issues more effectively across a system and increase system resilience (for example the response to Covid 19 from the Cheshire & Merseyside trusts within the acute hospital cell).
Collaborative approaches between NHS Trusts and Foundation Trusts under provider collaboratives offer the potential for transformational changes and a response to the growing financial, quality and workforce challenges amongst others. International success stories from organisations such as Kaiser Permanente, Region Hovedstaden, Canterbury District Health Board, and SingHealth also showcase the positive impact of provider collaborations on healthcare outcomes. Within the NHS there are also an increasing number of positive examples which members of our team have worked on, for example:
- the West Yorkshire Association of Acute Trusts (WYAAT) which was established in 2016 and aims to organise hospital care around the needs of people living locally to join up high quality care for patients; and
- the Cheshire and Merseyside Acute and Specialist Trust Alliance (CMAST) which was set up during the Covid-19 emergency period to ensure integrated working through close co-ordination and is now building on the trust and partnership developed through that period to lead system wide programmes to provide high quality services.
Embracing this collaborative model can offers a route to transform healthcare delivery and benefit both the Trusts and the wider population and healthcare systems they work in. Please contact us if you require any further information.
We are delighted to confirm that we will be running a session at this year’s NHS ConfedExpo in Manchester on 15 June 2023 around developing collaboratives within the new NHS. The session will discuss successes and setbacks of collaboratives to date, as well as looking forward to 2023/24 and beyond to understand upcoming challenges and opportunities for provider collaboratives. Find out more at ConfedExpo’s website, and sign up now to make sure you don’t miss out the insights from our stellar panel of industry leaders.
For further information, please contact:
Robert McGough, Hill Dickinson
robert.mcgough@hilldickinson.com
