14 October 2022 – NED webinar – Provider collaboratives

This week’s session opened in conversation with Michael Parker CBE, former chair of Kings College Hospital NHS Foundation Trust, senior partner at Parkers chartered accountants, and former chairman of the Corporate Governance and Risk Management Committee for the Association of Chartered Certified Accountants.

Introducing the session, GGI senior adviser Usman Khan said: “As a NED of an ICB, it’s not something that’s on our agenda very much. We talk about system challenges and how we can support system objectives as an ICB, but less about PCs so I’d be interested to know whether they’re getting traction. My own sense is that the transparency of them perhaps isn’t quite as great as other parts of system working. And how effective are they going to be in getting collaborative working going?”

Michael Parker said: “There was a time in the 1950s called ‘structure, conduct, performance’. The government said if we provide the structures, people will change behaviours and hey presto, performance will yield. And I think they did the same with the Health & Care Act of 2022 because they forgot to mention integrated care pathways as the evidence-based decision making for focusing on healthcare for patients and health inequalities. They think if they just say it, it will happen and that’s not the reality. The idea is that you just dictate the ICBs, ICs, ICPs and things will change, but really form should follow function not the other way around. We could turn this around

“I’m not certain if the government didn’t understand what they were doing or knew what they were doing and didn’t understand the impact. We are at risk if we get this the wrong way around. That’s why I talk about the forked tongue. It’s not necessarily deliberate but many of the things politicians say and what they mean might have a different consequence to what they expect. What we should do is ignore the structure, conduct, performance and just make sure this works, but it needs leadership from the system.

“What we’ve got to learn is to use the system to promote evidence-based decision-making, make sure the care is effective, efficient and economic, and prioritise prevention over cure, cure over treatment, and treatment over palliative care.

“We need economies of scale. Certain ventures have a minimum economic size to survive, and we need to understand that this is what makes a hub work. Then we need to facilitate the spokes. You can do things with back-office amalgamations, but we’ve been doing those for a long time. We should also be exploiting the fact that the ICB is the primary commissioner of services, together with the local authority’s social care, so we should use this so that the money supports the provision of clinical services.

“We should get people back to not trying to follow the legal structure but follow the objective that we want the best for patients, and we can be more clinically effective to more people if we follow that path. If we’re more effective to more people, there will be fewer health inequalities. Funding has changed from a competitive model where we have providers against commissioners.”

Also overheard during the session:

“There was some suspicion about smaller organisations not having a voice at the table, but it hasn’t been like that. As a chair, we worked hard to make the provider collaborative accessible. We get a regular update about top five priorities. We have an opportunity as chairs to meet regularly. And we built on the experience of the pandemic where resilience, mutual aid were things that we all needed at different times and that gave us a good foundation.”

“One of the things we should think about is taking the principles of provider collaboratives but trying to think more flexibly. I see it as a set of principles that can be applied appropriately in different ways in different settings. We shouldn’t get overly hung up about structures provided we’re delivering better quality services and getting the best value for the commissioners and the best outcomes for the people we’re here to serve.”

“Provider collaboratives seem to me to be a structure through which to handle difficult decisions – those on which providers can’t agree e.g. about who provides and who relinquishes services. They have to build on established relationships of trust and all members need to commit to them, So I agree with Michael that form must follow function and if I may further aliterate – fellowship.”

“There is a fundamental problem with the word provider collaborative. How may provider collaboratives have all experts under one umbrella i.e. public health, primary care, secondary care, MH, community services, CICs, VCS, Local Law enforcing agencies, AHSN ... the list is quite long.”

“It's almost masochistic that we collect so much data that gets passed up the line only for it to be used to beat us up over flawed perceptions of performance.”

“Agree with the points made about a focus on patient care and finding targets on which to make a start rather than top focusing on the structural / top down. We sit on the border of two places and also face south into a different ICS for some of our service delivery. The mapping to the provider collaborative structures could be unhelpful as it creates potential tensions so we are probably more focused as a board on collaboration with neighbouring providers and building the relationships that will most benefit our pattern.”

These meetings are by invitation and are open to all NHS non-executives directors, chairs and associate non-executive directors of NHS providers. Others may attend by special invitation.

If you have any comments, questions or suggestions about these webinars, please contact: events@good-governance.org.uk