This case study explores how Bradford has used the financial levers of system control totals and fixed-income contracts to align incentives, pool risk and achieve financial balance.
Five key lessons can be drawn from Bradford’s experience, which will be of note to system leaders looking to develop a similar approach:
- Get the system fundamentals right: strengthen local partnerships, spend time setting and demonstrating a new culture, and prioritise what you will do together, for example by focusing on a small number of priorities you want to work on together and developing an agreed memorandum of understanding.
- Optimise the principles and behaviours for cross-organisational working, for example by being authentic and honest in conversations – contract as a group of senior leaders and stand by the Strategic Partnering Agreement avoiding a ‘winners and losers’ approach.
- Use system governance to support shared accountability and to create space for joint problem-solving, by sharing data, for instance, and build a shared picture of financial issues.
- Maximise the benefits of using fixed income contracts whilst protecting against their limitations, for example the need to understand that this approach does not eliminate underlying deficits; rather, it encourages partners to decide how best to use the available resources.
- Recognise that the NHS, on its own, does not have the scope or the levers to achieve the local ambition for change, for example working more closely with local authority and voluntary sector in the development of future financial mechanisms.
This is the first in a series of in-depth case studies distilling practical learning for sustainability and transformation partnership and integrated care system leaders. Thanks to the Social Care Institute for Excellence (SCIE), who developed this case study.
Listen to the podcast
You can also learn more about the approach in this new podcast: Financial reform: a day in Bradford.