Mental Health Provider Collaboratives in BOB Region
The Buckinghamshire, Oxfordshire, Berkshire West (BOB) Mental Health Provider Collaborative Discussion document highlights the importance of collaboration in addressing health inequalities, improving services, and enhancing productivity within Integrated Care Systems (ICSs). The document explores the role of Provider Collaboratives in managing specialized mental health services effectively, emphasizing joint management and delegated commissioning responsibilities. It also discusses the structure of BOB ICS and the significance of operating at scale and place-based partnerships. The Provider Collaboratives aim to bring together NHS trusts, commissioners, and other partners to benefit populations and transform the health and care system.
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Buckinghamshire, Oxfordshire, Berkshire West (BOB) Mental Health Provider Collaborative Discussion document
Context The creation of Integrated Care Systems (ICSs) have been rooted in underlying principles of subsidiarity and collaboration. Collaboration between partners, both within a place and at scale, is essential to address health inequalities, sustain joined-up, efficient and effective services and enhance productivity. As ICSs have developed, providers have increasingly embraced wider system leadership roles, working with partners to join up care pathways, embed population health management, reduce unwarranted variation and tackle heath inequalities. By working effectively at scale, in addition to their work at Place, providers can properly address unwarranted variation and inequality in access, experience and outcomes across wider populations, improve resilience in smaller trusts, and ensure that specialisation and consolidation occur where this will provide better outcomes and value. The policy drive to develop NHS-Led Provider Collaboratives created a shift in the approach to commissioning specialised mental health, learning disability and autism services. Both BHFT and OHFT have been leading or partnering in formal system or pan- system Provider Collaboratives for a number of years, gaining rich experience of jointly managing provider services and delegated commissioning responsibility e.g., CAMHS Tier 4, Adult Eating Disorders, and Forensic Services. Provider Collaborative are thus a way by which ICSs can harness the expertise, ambition and clinical leadership of the organisations directly responsible for delivering NHS care. There is now an opportunity to build on this significant expertise to develop a provider collaborative for the full Mental Health pathway in BOB. Our BOB ICS has two component parts: BOB Integrated Care Board (ICB)- a statutory NHS organisation with responsibility for the NHS budget, plans and delivery BOB Integrated Care Partnership (ICP)- a statutory committee that brings NHS with local authorities and other key partners
Our system architecture Place and localities The work of the Provider Collaborative will operate at scale and at Place via the membership of its constituent NHS provider members in the place-based partnerships. Bringing the benefit of efficiencies at scale and integration at place together. Voluntary and Community Sector Lived experience expertise Primary Care NHS Provider Organisations Acute, Community and Mental Health BOB Integrated Care Partnership Healthwatch Our BOB Integrated Care Board Provider Collaboratives communities Place-based Partnerships Local Authorities BOB In BOB building on existing Joint- Commissioning arrangements in Bucks and Oxon and the locality integration work in Berkshire West we will work together to identify best way to ensure that this work build on existing strengths and adds to current gaps. Other public sector bodies e.g. police Moving to new ways of working All of our partnership organisations will need to change the way the work to maximise the opportunity of operating as an ICS.
Understanding Mental Health Provider Collaboratives What are provider collaboratives? Provider Collaboratives bring together NHS trusts, commissioners, VCSE, and other health and care partners to work in partnership at scale to benefit their populations. Provider Collaboratives move the health and care system away from an emphasis on organisational autonomy and competition to collaboration and partnership working. The Rationale Significant challenges are too much for a single organisation to tackle in isolation. Challenges include rising demand for services, severe workforce challenges, legacy of a prolonged funding squeeze and effects of pandemic. Formalising provider collaboratives is a culmination of a national policy focus on addressing these challenges through system working and working at scale to improve: efficiency, sustainability and quality of care. Guiding Principles a shared vision and commitment to collaborate strong accountability mechanisms for members building on existing successful governance arrangements efficient decision-making embedding clinical and community voices streamlining ways of working. Collaborative arrangements could: consolidate corporate services for greater efficiency, Form partnerships with other key stakeholders maximizing the collective power of a collaborative increase sustainability by making better use of a limited workforce, and improve quality of care by standardising clinical practice to tackle variations in care across different sites.
The BOB Mental Health Provider Collaborative and MH Partnership
BOB Mental Health Provider Collaborative A Provider Collaborative between Berkshire Healthcare and Oxford Health, in partnership with BOB ICB . And a model to be expanded and developed with Partners in BOB ICS going forward. Services provided in scope: Non-specialised all ages Mental Health services- there is however an opportunity for the BOB Mental Health Provider Collaborative to reach across the whole mental health pathway, linking with our existing specialised mental health, learning disability and autism provider collaboratives in the longer term. Our Aim: To improve the mental health of our population in BOB ICS by leading comprehensive transformation of mental health services at scale, linking with and supporting the work of our Place-Based Partnerships. We will strengthen the joint working between our organisations to ensure that resources are used in the most efficient way possible, that unwarranted variations are tracked and tackled, and pathway redesigned, to improve the lives of our population with a focus on addressing health inequalities.
The Why Significant Challenges that we need to work together on - such as increasing demand, rising unmet need, funding squeeze and workforce challenges. We recognise as statutory organisations, we cannot achieve our ambitions and scale of transformation alone. Our BOB Mental Health Provider Collaborative will enable us to systematise this joint working for the benefit of our population. The Provider Collaborative will be the engine room to drive the delivery of a comprehensive Mental Health Programme for BOB ICS as part of a cross sector BOB ICS Mental Health Partnership. Working with BOB ICB Management team we will strengthen how we manage and deliver the Mental Health Programme of work for our ICB, fulfilling the statutory function of the ICB for NHS performance and resource management, but also ensuring that all key BOB ICS partners are involved to enable a comprehensive programme of transformation and improvement for Mental Health across sectors.
Anticipated benefits: For patients, organisations and staff It doesn t matter where you live in BOB you will receive the same quality and consistency of service Patients can access local services rather than out of area Working together to provide better outcomes and value. Staff will feel braver together to take action, working together developing innovative solutions to our challenges Improve resilience by, for example, providing mutual aid within the Provider Collaborative including working together such as sharing staff Learning and improving together to make a difference to patients Create opportunities for staff development across Collaborative organisations Encouraging diversity in discussions to test new and innovative approaches for Mental Health services Identifying where efficiencies and economies of scale can be made
Why Provider Collaboratives? Example of benefits delivered via the Specialised Provider Collaboratives Substantial reduction in out of area beds (reduce by over 50%) OBDs over 4 - year period in line with reducing length of stay and static numbers of episodes of care. The latter is now at less than 0.5% of activity. Out of area activity has fallen from 23% of the bed days in 2018 to 13% of the activity in 2022. Reducing acuity through shift of medium secure to low secure activity; as well as increasing management of patients through community forensic models. Consistency of access assessments Reduction in length of stay Improved access to Forensic Community Mental Health Services
Strategic priorities Alongside driving the delivery of the Mental Health Programme of work for the ICB, as part of the Joint Forward Plan, the Provider Collaborative will support identifying and delivering on key priorities that can best be driven at scale across partners in the ICS. The following priorities have been identified to support early discussion. Further engagement work with our clinicians, people with lived experience of mental health services and wider stakeholders will help us identify priorities for our collaborative. Potential areas of focus include out of area placements, community mental health transformation and physical health checks for those with serious mental illness. CAMHS: Building on the collective work done to date to tackle system wide challenges. A CQC provider collaborative review was carried out last year to support this and the challenges raised in this report form part of our plans alongside locally identified priorities for change. Implementation of the new national Mental Health, Learning Disability and Autism Inpatient Quality Transformation Programme, working in partnership with other relevant groups in the ICS. Addressing health inequalities: This includes improving the use of data and insights to strengthen our equalities strategy at scale, a focus on workforce transformation, and embedding our equalities work across our services. Embedding a culture of quality improvement: Using the Provider Collaborative as a way to learn from each other and scale best-practice across both of our trusts, engaging with the ICB to embed learnings from quality improvement work at system level.
Principles Residents from across the different communities within BOB ICS and people with lived experience of poor mental health will be at the centre of decision making. We will work together to co-produce the provider collaborative. We will secure the benefits of working at scale and at place with our partners. It will thrive for both vertical and horizontal collaboration and integration. Through our Providers, we already play a key role in each of the Places of BOB ICB- in line with the principle of subsidiary, the provider collaborative will enhance transparency, accountability, and enable decision-making to take place as close as possible to the communities it serves. Through the BOB ICS Mental Health Partnership, will offer a clear point of accountability and governance for Mental Health in BOB, fulfilling the NHS statutory function of the ICB, whilst bringing together all partners across the ICS to drive transformation and improvement across sectors in line with our Integrated Care Strategy. Ensuring that transparent and robust information on use of resources against need, performance, and plan is available to all partners and used to drive improvement and transformation in BOB ICS. We will harness clinical leadership and build on QI methodology and transformation programme of work. We will develop our approach to population health data to inform planning and transformation at scale, with a key focus on reducing health inequalities.
Proposed Governance Framework Key: Report into Aligns/ inform BOB ICS Provider Collaborative BOB MH partnership ICS structures BOB ICB BOB ICP MH Provider Collaborative Design Group (Monthly) MH Partnership Board (Quarterly) Project Group (weekly) Performance and Assurance Committee Transformation Committee [Relevant working groups to be developed by Design Group] (TBC) Bucks MH Board Oxon MH Board BW MH Board (tbc)
Current Proposals BOB Mental Health Provider Collaborative: BOB Mental Health Provider Collaborative Design group Purpose: Initially the Design, including both Providers and the ICB and cross-sector representatives from the ICS , will oversee and drive the development of the Provider Collaborative including the membership, operating model and governance, as well as proposals for delegated commissioning and budgets. It will also support the development and work of the BOB Mental Health Partnership. Membership: ICB, BHFT, OHFT, Voluntary Sector, Local Authorities, Primary Care, People with Lived experience BOB Mental Health Partnership: BOB Mental Health Partnership Board Purpose: To drive the vision for our population and residents in BOB ICS, leading on strategic development and transformation for Mental Health services at scale and across sectors, including each Place-based Partnership Mental Health governance. Membership: ICB, BHFT, OHFT, Voluntary Sector, Local Authorities, Primary Care, People with Lived experience, Public Health BOB Mental Health Transformation Committee Purpose: To lead on transformation pieces of work across BOB ICS, as identified and directed by the Partnership Board, working with each Place-based Partnership Mental Health governance. Membership: ICB, BHFT, OHFT, Voluntary Sector, Primary Care, People with Lived experience BOB Mental Health Performance and Assurance Committee Purpose: to oversee performance, quality improvement programmes of work at scale; to oversee Mental Health finances at scale; to provide an Assurance function for the Mental Health Programme in BOB ICS overall Membership: ICB, BHFT, OHFT Purpose: Drive the Mental Health vision at Place, working as part of the Mental Health Partnership, and focuses on integration and on delivery of programmes of work best-suited to place Place-level Mental Health Governance (existing forums)
Further considerations Alignment of BOB and Frimley priorities Role of primary care Development of a co-production model utilising Experts by Experience Early clinical buy-in Clear benefits realisation plan Supporting cultural change through organisational development work Protecting clinical and operational time Communication and engagement plan, including partners not directly involved in MH Partnership Understanding the development of the different Places and their priorities for Mental Health.
Future vision and opportunities for further development
Key: Possible future model to discuss ICS structures BOB MH partnership NHS budget and Commissioning delegation BOB ICB BOB MH Provider Collaborative Providers, working with ICB, to provide strategic leadership and a collaborative approach to strategic planning, assurance and delivery of Mental Health services across BOB Provider Collaborative Local authorities funding BOB ICP BOB Mental Health Partnership governance Infrastructure to support the design and delivery of Mental Transformation priorities as well as operational performance and assurance across sectors. Delivery of Mental Health priorities at Cross-sector MH Partnership scale Delivery of Mental Health aligned with local priorities and population needs Bucks Place- Based Partnership Oxon Place-Based Partnership Berkshire West Place Based Partnership Bucks MH Board Oxon MH Board BW MH Board (TBC) Joint funding arrangements Joint funding arrangements Joint funding arrangements MH Provider Collaborative- Buckinghamsh ire MH Provider Collaborative- Berkshire west MH Provider Collaborative- Oxfordshire Local Local authority Local authority authorities x 3
Opportunities for discussion Area Stronger together; Braver at scale Budget delegation All NHS MH budget delegated to MH Provider Collaborative, in partnership with BOB ICB. Could start as a joint executive (ICB, OHFT, BHFT) and move to formal delegation to Provider Collaborative (OHFT, BHFT) in the medium term. Provides a clear single oversight of all MH spend in the ICS (across sectors), regardless of where it is spent Where in place, pooled budget at Place with Local Authorities retained- budget pooled with provider collaborative at Place-level Contracts 1 single block contract with each NHS MH Providers Opportunity to co-design and optimise contract with VCSE partners at place Reduction in contractual management activities, and shift to strategic commissioning and transformation Commissioning Responsibility for commissioning of NHS MH services delegated to Provider Collaborative, in partnership with BOB ICB. Could start as a joint executive (ICB, OHFT, BHFT) and move to formal delegation to Provider Collaborative (OHFT, BHFT) in the medium term. Provides a clear single point of accountability for NHS MH programme and service delivery in the ICB, at strategic commissioning level. Provides overview of all MH programme of work in the ICS across sectors. Where in place, joint commissioning at Place with Local Authorities retained- joint commissioning with Provider Collaborative Aligned and streamlined performance and contract management- easy read-across ICS-level strategic objectives and Place-level delivery objectives Resource optimised both in terms of focus and scope: ICS and Place level ICB resources working as one team across scale and place to support priorities programmes of work Shift of use of resources from contractual management to delivery support and service development and improvement Mental Health Programme Delivery Robust cross-sector governance in place at ICS and Place level via BOB ICS Mental Health Partnership (NHS providers, Primary Care, Local Authorities, VCSE sectors)- all commissioning and programme delivery coordinated between ICS and Places via BOB ICS MH Partnership Board, Performance and Assurance Committee and Transformation Committee, linking to Place-based Partnerships Board and Place-level MH Boards (where in place). Enhanced transparency: total available budget for MH across NHS and Local Authority transparently shared with all partners; Single oversight of NHS delivery requirements (performance KPIs) and broader ICS delivery requirement (linked with ICS strategy) supported by clear plan and strategy coordinated between places Possibility to develop comprehensive and coherent mental health population health management approach for BOB ICS , linking budget with needs to inform and iterate priorities. Approach can then be enhanced at Place, linking to specific local communities needs.
Useful readings To learn more about BOB Integrate Care System (ICS), and the role of BOB Integrated Care Board (ICB) and BOB Integrated Care Partnership (ICP): https://www.bucksoxonberksw.icb.nhs.uk/about-us/what-is-the-integrated-care-system/ https://www.bucksoxonberksw.icb.nhs.uk/our-places/oxfordshire/ https://yourvoicebob-icb.uk.engagementhq.com/bob-integrated-care- partnership#:~:text=The%20BOB%20ICP%20strategy%20sets,Oxfordshire%20and%20Berkshire%20West%20area. To access all guidance available on ICSs, including guidance on provider collaboratives: https://www.england.nhs.uk/publication/integrated-care-systems-guidance/ https://www.england.nhs.uk/publication/integrated-care-systems-guidance/#heading-12 To learn more about the work of the NHS-Led Provider Collaboratives in specialised Mental Health, Learning Disability and Autism services: https://www.england.nhs.uk/mental-health/nhs-led-provider-collaboratives/
