In April 2022 we reviewed some of the challenges and opportunities for provider collaboratives as they developed prior to the enactment of the Health and Care Act 2022 in July 2022. As we move through the initial transitional period towards the first full year of operating for the new Integrated Care Boards (ICB), Robert McGough considers some of the emerging challenges we are working through with clients to ensure that the new structures achieve key aims of improving patient outcomes, increasing efficiency within the system and reducing cost.
What are they?
Provider collaboratives in the National Health Service (NHS) are networks of healthcare providers that work together to achieve common goals. NHS England (NHSE) describes them as partnership arrangements involving at least two trusts working at scale, with a shared purpose and effective decision-making arrangements.
These collaboratives aim to improve the quality of care and outcomes for patients, while also increasing the efficiency of the healthcare system. Bringing together healthcare providers from different organisations, including potentially hospitals, general practices, community health services, and mental health services they are able to work effectively together on initiatives such as quality improvement projects, service redesign, and shared services.
The goal of provider collaboratives is to improve the coordination of care for patients, reduce duplicated efforts and waste, and promote best practices across the NHS. By working together, healthcare providers can share expertise and resources, and leverage each other’s strengths to improve the quality of care for patients. NHS acute and mental health trusts are expected to be part of one or more provider collaboratives. Other providers (such as community and ambulance trusts) should be part of a collaborative where it is beneficial for patients and makes sense for the providers and systems involved.
Providers and their partners are expected to identify the shared goals, objectives, membership and governance of each collaborative. They should also have defined responsibilities and ways of working with the ICB, places and other health and care collaborations.
The collaborative role in the changing NHS
Provider collaboratives are an important part of the NHS effort to transform the healthcare system and provide more integrated, patient-centred care and are set out in guidance (rather than legislation) (see Working together at scale: guidance on provider collaboratives: NHS England 2021 and the ICS design framework). They are expressed as being a key vehicle in supporting integrated care systems to deliver some of their strategic priorities.
However, they face several challenges in the current NHS environment, including:
- Funding: the NHS faces increasing financial pressures, which may make it difficult for provider collaboratives to secure adequate funding for their initiatives and impact their appetite to share risk.
- Integration: collaborating across different organisations and regions can be challenging, as there may be differences in culture, priorities, and processes. Also there may not be much history of collaboration across an ICS in the way which the collaborative is being asked to work.
- Resistance to Change: some collaboratives may face resistance from stakeholders (whether at board level or otherwise) who are used to working in a traditional, siloed manner and may be resistant to new approaches and ideas.
- Data Sharing: sharing data between organisations can be complex involving concerns around data privacy and security.
- Workforce Capacity: providing adequate support and development for staff in a collaborative environment can be challenging, especially in terms of delivering the collaborative activities as well as individual trust requirements.
- Scalability: the success of a collaborative initiative in one region does not guarantee that it would be successful in other regions such that scaling up effective initiatives across the NHS may not always be straightforward.
- Measuring Impact: collaboratives may struggle to measure the impact of their initiatives, particularly in the short-term, through effective data and this can then make it difficult to secure ongoing support and investment from the ICB/NHSE or other members.
- Regulation and governance: the complex regulatory and governance environment in the NHS can make it difficult for provider collaboratives to implement new initiatives in a timely and effective manner. Although there are new tools available for joint decision-making under the Health and Care Act 2022, there remains a need to bring each of the member organisations along with the collaborative and agree to delegate decision-making to e.g. a joint committee of Trusts which is more challenging given the financial context. There may be resistance from some Trust boards (or governors) to actions which may benefit the wider system but not the Trust itself. Likewise, the ICBs (which are key in terms of delegating to and contracting with collaboratives) are still at an early stage of development and maturity. We are seeing significantly different approaches across ICBs in terms of how they deal with their collaboratives.
Despite these challenges, provider collaboratives still have the potential to deliver significant benefits for patients and the NHS, including improved patient outcomes, increased efficiency and reduced costs, and enhanced collaboration between providers. However, organising them to have this impact will be more challenging given the current strains on the NHS.
In future articles, we will pick up on each of these challenges in more detail, and describe some of the strategies we are developing with our clients to overcome them.
For further information, please contact:
Robert McGough, Hill Dickinson
robert.mcgough@hilldickinson.com
