At the same time as facing record pressures on services, the NHS is reimagining and transforming the way it delivers care. Although increasing pressure on NHS leaders in the short-term, these reforms are part of the solution to ensuring best use of resources to reduce health inequalities, improve access to care and improve health outcomes, whilst adapting to rising demand for care. ICSs and provider collaboratives have distinct but complementary roles to play in this journey.
ICSs and provider collaboratives are at the heart of reforms to enable more collaboration within and outside of the NHS. These organisations aim to be vehicles for improving population health, prioritising preventative measures and reducing the stark health inequalities we see across the country.
Provider collaboratives are a key innovation in the policy reforms intended to drive a more integrated approach to health and care. Collaboration across NHS providers has existed for many years, particularly across mental health providers. As with elsewhere in the healthcare system, the COVID-19 pandemic has highlighted the benefit of NHS providers working together to address challenges. The concept of provider collaboratives has emerged from the pandemic as a more formal structural collaboration, with every provider in England required to be part of one such collaborative.
Given their many different shapes and sizes – vertical integration of community and acute providers, horizontal integration of acutes, with different operating models and depth of formal integration – there are at least 50 shades of provider collaboratives emerging, each tailored to local needs. Some provider collaboratives will play a key role facilitating joint working at place level, where they can be a vehicle for devolved funding and driving change on the ground; others may focus on areas like mental health, however it’s important to closely engage primary care at place in doing so. In smaller systems with fewer providers, they can also play an important role facilitating pathways to specialist services.
…we must not mistake the role of provider collaboratives with that of ICSs
Each area must pick the model that works best for them and the community they serve, without being restricted by strict structures or rigid contracts. It’s absolutely right for systems to use provider collaborative and place-based partnerships to encourage innovation, but we must not mistake the role of provider collaboratives with that of ICSs.
A strategic approach to population health
ICSs will be the strategic driving force to address health inequalities and promote population health, including managing the wider determinants of health. Both the integrated care boards (ICBs) and the integrated care partnerships (ICPs), as a partnership of equals, will bring together a diverse range of stakeholders. Through these components of ICSs, the NHS will work with local government, the voluntary, community and social enterprise (VCSE) sector and many others who can address the wider determinants of health on multiple fronts. In particular, expertise from primary and community care and directors of public health will help to prioritise and deliver effective strategies to prevent ill health.
Additionally, ICBs will inherit legacy expertise from clinical commissioning groups in stewardship of public resources. Preserving and nurturing this expertise will help ensure the allocation of resources to where they can most effectively improve health outcomes, in line with ICPs’ strategies, not just respond to where demand appears. For instance, systems will need to ensure that the expected shifts to out-of-hospital care and preventative aspects of contracts are fulfilled and that health inequalities are measurably improving.
Where there are devolved commissioning arrangements, as and when funding uplifts are provided, ICSs must ensure these are passed on upstream to sub-contracted providers, many of whom will be in the VCSE sector. Bristol, North Somerset and South Gloucestershire ICS has already pioneered a new approach with its VCSE investment standard as part of its community services contract, modelled on the national Mental Health Investment Standard, which ensures at least 3 per cent funding to VCSE providers. The diversity of views across the ICS will be a decisive factor in enabling innovative thinking about where limited resources are best used to improve population health and reduce inequalities.
Reform not where power lies, but how we use it
System partners will need to have shared goals and mutual trust if ICSs are to redistribute resources to where they can have most effect
To realise these grand ambitions, ICSs must be about more than just shifting where power lies within the health and care system. To really deliver change, ICSs must transform the way power is used and become vehicles for culture change and joint decision-making. System partners will need to have shared goals and mutual trust if ICSs are to redistribute resources to where they can have most effect. While these different forms have different functions, both ICSs and provider collaboratives have complementary work to do towards a shared goal. There must be alignment in objectives across ICSs and provider collaboratives, with everyone pulling in the same direction while recognising their corresponding roles to achieve them. Local systems, places and neighbourhoods need the freedom to work together more collaboratively in the way that best fits their area so that patients ultimately get a smoother experience.
Peer-to-peer learning and open discussion about the challenges and opportunities ahead will be a key ingredient to do this. That’s why the NHS Confederation is investing in our new offer to provider collaboratives. We will facilitate groups of members to come together as peers, to discuss the issues they face when working more closely together. Whether this is acute trusts working across an ICS, mental health or out-of-hospital collaboratives, vertical integration or groups of organisations coming together at place, we will support peers to come together with people facing the same issues, at the same time, at similar stages of their development. If you’d like to be part of our social movement to support and enable greater collaboration, please sign up on our Provider Collaboration Forum web page.
Lord Victor Adebowale is chair of the NHS Confederation. You can follow Victor on Twitter @voa1234