Leicestershire Partnership and Northamptonshire Healthcare Group is a collaboration between Leicestershire Partnership NHS Trust (LPT) and Northamptonshire Healthcare NHS Foundation Trust (NHFT) providing community, mental health and learning disability services. The trusts are part of Leicester, Leicestershire and Rutland Integrated Care System (ICS) and Northamptonshire ICS, respectively.
The group was created in 2021, although the two trusts began working together in 2019 when NHFT was appointed to buddy LPT. The trusts' respective boards agreed they did not want to lose the benefits of collaboration at scale when the formal buddying arrangement ended. But there was no appetite for a merger, which they felt meant losing a sense of identity at place and may have created issues for the organisations' existing partners. Hence the decision to explore opportunities for joint working under the banner of a 'group'.
To develop the relationships and culture across the organisations, before moving to the group model, time was invested in board-to-board development and joint topical discussions. Tasks arising from these discussions were given to pairs of directors to lead and in doing so develop mutual understanding and communication channels (before the creation of several joint posts).
The trusts work in partnership where it will bring additional benefits, as reflected in their eight shared priorities: innovation and research, together against racism, talent management, leadership and organisational development, strong governance, strategic finance, strategic estates, and quality improvement.
To date the group has:
- Jointly committed to work together against racism with every board member making their own personal pledge.
- Developed a non-competitive relationship with the local university medical school for encouraging talent into the organisations.
- Improved and shared on-boarding and corporate induction arrangements.
- Instituted joint Gold Command incident control during the Covid-19 pandemic to share learning and improve resilience.
- Identified joint procurement opportunities for cost savings, delivering social value and achieving net zero.
In February 2023 they were selected as part of NHS England's (NHSE) innovators scheme for provider collaboration.
How are decisions made?
The group's non-legally-binding structure is underpinned by a memorandum of understanding (MOU) which sets out agreed priorities for joint activity.
The group’s collaborative work is governed by each trust board through two (non-decision making) committees in common that meet together as a ‘joint working group’ (JWG) and are accountable to their respective board.
Each committee comprises:
- Chair, chief executive, chief finance officer, director of strategy and partnerships, (each of which are joint posts across both organisations).
- Plus the deputy chair, deputy chief executive, director of HR and operating director, and the director of governance and risk.
The JWG meets once every two months and is responsible for the group’s eight shared priorities, which have been approved by each trust board. It operates ’like a programme board’ overseeing the delivery of the programme of joint priorities. Whilst it has no powers to exercise authority on behalf of LPT or NHFT itself, matters are easily progressed via the authority vested in its individual members.
In addition to its role in overseeing the delivery of the group’s existing shared priorities, providing strategic oversight and direction and a forum for collaboration, performance reporting, and accountability, the JWG can also make recommendations to each trust board for further opportunities for joint working.
A group highlight report from the JWG, including levels of assurance against the delivery of the group model and its eight shared priorities, goes to each trust’s board meeting. Programme management offices are in place in both trusts, and support group work between them.
It had been important to engage NHFT’s governors on the group’s journey to ensure they understood and were bought into the collaborative work.
How do you engage with other system partners?
Each trust retains its own strategy (which reflects the priorities for the group as set out in its MOU). The group priorities are focused on effective enablers for both organisations while the trust’s strategies focus on their system delivery and local population issues such as children’s health and frailty, so it makes sense for the trusts to retain their own strategies and relationships with their relevant integrated care board (ICB) rather than approach both ICBs as a group.
For similar reasons, the trusts have their own relationships with place partners and stakeholders, and undertake their own public and patient engagement.
As noted above, the group has engaged with the local university medical school and would likewise engage with other partners as required to seek benefits at scale.
What’s next for the collaborative?
The group priorities and the progress of the model remains under regular review. The terms of the MOU gives either party the ability to leave the group by giving 12 months’ notice at the end of a financial year.
There are ongoing conversations about the potential to extend the group model further through additional shared priorities. Both trusts are involved in many other partnerships. For example both are part of a six-trust East Midlands mental health and learning disability and autism alliance. NHFT were also involved in learning disability and autism collaborative work in Northamptonshire and LPT have led a learning disability and autism collaborative with local authorities in Leicester, Leicestershire and Rutland.
The two trusts believe that the way the strategic priorities for the group are formulated allows them to be fleet of foot in terms of delivery. They can use subsidiarity as a principle and work with partners and stakeholders as appropriate, using existing delivery arrangements such as the group or mental health collaborative, or establish new ones.
The group would consider accepting any delegated functions from the ICB once that becomes possible, or either trust might consider taking delegated functions through one of their other collaborations. Contract variations are possible now without the need for formal delegation from the ICB. The providers’ focus is on ensuring the ICBs trust them to deliver now without formal delegation being necessary.
Colleagues from both trusts have found NHSE's existing guidance for collaboratives useful but feel their conversations were most important in enabling change and building mutual trust.
What’s the one piece of governance advice that you would share with others?
David Williams, group director of strategy and transformation, and Richard Smith, director of corporate governance at NHFT, said:
"Create the culture for effective collaboration: find the benefits of working together, and tell the stories that demonstrate those benefits. So, whether it’s simply a manager of one trust can now use meeting space in their partner trust, or two heads of services can now pick up the phone to each other and share ideas, frustrations or hold joint team meetings, promoting the benefits of collaboration demonstrates the possibilities to others and helps to build organisational cultures where collaboration can thrive."