NHS Provider Collaboration: is it time to mandate a model?

It is likely to be beyond the current resources and workforce capacity of many trusts to take on these responsibilities in the short term. How we get to a position where trusts have sufficient capacity to fulfil this role will have big implications, and provide new opportunities, for what we might call the ‘commissioning workforce’ and retaining their important skills within the NHS at a time of significant structural change.

There is also the perennial question of the level at which different activities should be carried out – centre, system or place. While some systems have reached consensus on this issue quite easily when developing hospital groups or provider collaboratives, in other systems this has been a challenging and, at times, painful process. In the worst cases, the issue of place versus system is played out repeatedly. It’s too easy to reach a fudge for the sake of saying parties have signed off on an MOU or similar, while everyone goes away with differing views of who is doing what.

This lack of clarity can create gaps in responsibility and accountability, where issues ‘slip through the cracks’. Even worse, there is risk of unnecessary duplication, wasted resource and diversion of significant management time to managing relationships which inevitably become strained when responsibilities are unclear. In some instances, therefore, the costs associated with establishing collaboration have been disproportionate to the value they’ve created.

Has the time come for the centre to become more directive, potentially using legislation to mandate baseline requirements for collaborative arrangements between providers?

By taking many of the questions about “how” NHS providers should collaborate off the table, this would allow leaders to focus on “what” collaboration needs to achieve and get on with delivery. An overarching framework would reduce the often-significant time and effort spent on discussions of form and structure and ensure system-specific needs are central to collaboration discussions, without distraction.

Further benefits of mandating a model for collaboration with a statutory underpinning include:

• Standardising arrangements for public, patient and wider stakeholder engagement
• Delivering corporate services such as information systems, procurement and HR at scale with greater efficiencies realisable
• Providing suppliers to the NHS with more easily identifiable routes to market and clarity of contracting
• Clarifying lines of accountability for the delivery of services
• Achieving a consistent understanding of what good looks like for both clinical and support services
• Coordinating education and training to ensure consistency of learning across systems

There is no reason why such a model shouldn’t preserve space for developing models of care which reflect local needs. Efforts can then be focused in this direction, making it more likely that patients will experience positive change and outcomes will improve.

We only have to look to our near neighbour France, where since 2016 hospitals have been required to join Groupements hospitaliers de territoire with the features described above. These have not been a panacea, but the consensus seems to be that they were a step in the right direction. The fundamental aspects of these arrangements are set out in just seven short paragraphs of the Public Health Code. Looking to the West, the Irish health service has also established hospital groups with broadly similar characteristics.

The learning gained through these examples and others can help our NHS to streamline its governance and push more resource to the front line.

Blake Morgan has significant expertise in both the private and public healthcare markets. Find out how more about our services and how our team can benefit providers here.