- National policy emphasises the importance of place-based collaboration within integrated care systems, as one means to support more integrated, person-centred care for local populations and make best use of collective resources.
- All providers across the acute, mental health, community and ambulance sectors are important partners at place level – alongside primary care, local authorities, social care providers, and voluntary sector organisations. Trusts will need to navigate increasing complexity in systems as they drive vertical integration at place and also work with other trusts as part of at-scale provider collaboratives.
- Trust leaders are optimistic about the opportunities afforded by collaboration at place, including integrating and transforming health and care services, and improving patient outcomes, access and experience. Trusts often see this as part of a longer-term agenda to develop as local anchor organisations, supporting local economic and social development, and working with other partners to shift the dial on health inequalities and the wider determinants of health.
- The role played by trust boards in multi-agency partnerships at place varies. In some cases, trusts enable greater health and care integration through collaborative working or providing infrastructure, expertise or capacity to the partnership. In other cases, trusts are leading the partnership and making place-based working their core business.
- Trust boards play an important role in fostering a collaborative culture and establishing the conditions in which frontline teams can think and work differently. Breaking down barriers to enable staff across the NHS and social care to deliver better joined up care for local communities, in a way that maximises collective resources, is a priority for many trust leaders.
- There is no ‘one size fits all’ model at place. Partnership arrangements vary across the country, reflecting different local geographies, population sizes and organisational configurations. Trusts and their partners at place know how best to deliver their aims based on an understanding of their local communities, services and geographies. The current flexible and permissive policy framework around place is working well. We urge national policymakers to maintain this flexibility and allow places to design what works in their local context.
- Decisions about pooling and aligning NHS and social care budgets are best taken locally. While funding mechanisms can support integration in some contexts, trusts are clear that such formal changes to funding flows do not guarantee more joined up care. National policymakers should focus on practical enablers of integration – such as shared data and support for a more integrated workforce across health and care – rather than further structural change.
- There are some systemic issues facing health and care services in England which place-based partnerships cannot fix by themselves. If the potential of place-based collaboration is to be maximised, national leaders will need to take action on the long-term fault lines underlying the health and care system, including developing an effective model of workforce planning and supply, securing sustainable funding settlements that reflect changing population needs and properly reforming the social care system.
