Partners involved in this provider collaborative:
- Bradford District Care NHS Foundation Trust
- Leeds and York Partnership NHS Foundation Trust
- Leeds Community Healthcare NHS Trust
- South West Yorkshire Partnership NHS Foundation Trust
Setting up the collaborative
The West Yorkshire Mental Health, Learning Disability and Autism Services (MHLDA) collaborative was established in 2018 and is part of the West Yorkshire and Harrogate ICS. The boards of each trust involved in the collaborative approved the establishment of a committee in common that year, to help ensure that decisions are made together and in a streamlined way around a shared programme of work, such as service transformation.
The committee in common's membership is made up of the chief executives and chairs of the four trusts with delegated authority from their respective boards, operating together with an agreed memorandum of understanding and a rotational chair from each trust. The collaborative is currently chaired by Cathy Elliott, chair of Bradford District Care NHS Foundation Trust, and supported more broadly by Keir Shillaker, the ICS' programme director for mental health, learning disability and autism.
Cathy and Keir tell us the four providers decided to come together initially to improve the delivery of mental health services that were presenting the most significant challenges to all organisations within the collaborative. This includes those services that are part of the national NHS-led mental health provider collaboratives programme, as well as other areas where this made sense for West Yorkshire and Harrogate, for example: the delivery of complex rehabilitation services, services for people with a learning disability and autistic people, and psychiatric intensive care provision.
At the outset, the trusts worked together to understand their collective use of beds and capacity, workforce challenges and referral criteria across these different service areas. This information was used to assess the potential impact of improved, more collaborative working between the trusts – for example what benefits collaboration would have on reducing the number of people having to be sent out of area to receive the right level of care – as well as the extent to which West Yorkshire and Harrogate might also need additional capacity, and how and where this could be supported through commissioner commitments within the mental health investment standard.
The impact of the collaborative so far
Prior to the pandemic, the collaborative was able to demonstrate reductions in people's length of stay within tier four child and adolescent mental health services and adult eating disorder services, as well as the number of people in West Yorkshire and Harrogate having to be sent out of area to receive the right level of care.
They have improved working relationships across the system as a result of their work to date. However, the strength of relationships between the trusts really came to the fore during the COVID-19 pandemic, with the organisations able to share and learn from each others’ approaches and responses to the new challenges COVID-19 posed for services and the patients in their care.
Keir and Cathy also feel working collaboratively has given more of a voice to the patient population that the trusts serve within their ICS more broadly, it has enabled partners to speak with one voice and help set ambitions for the whole ICS to reduce the gap in life expectancy for people with mental illness, learning disability and autism compared to the rest of the population by 2024.
Alongside service transformation, an example of successful attitudes to collaboration is the ongoing work to align the training that staff from each organisation receive in prevention and management of violence and aggression (PMVA). The co-production process undertaken has enabled the best examples of good practice from each trust to be shared, jointly reviewed and a more consistent way of working proposed across the collaborative for the benefit of patients and staff. This is now being stress-tested with teams and, if validated, will ultimately mean that staff can be more safely shared across the four trusts going forward.
They are now building on their work to align PMVA training to develop a collaborative staff bank. A bank spanning the whole collaborative has already been put in place, in collaboration with West Yorkshire Association of Acute Trusts, for psychology staff to deliver the area's new staff mental health and wellbeing hub. Keir explains that "the wellbeing hub is a really good example of how, once you're in the mindset of collaborating, it's easier to choose to collaborate in order to tackle the next challenge".
The collaborative has also worked together to support all system partners to make best use of funding to transform the delivery of community mental health services. The MHLDA core team, working on behalf of the ICS, has brought together all place-based NHS, primary care and voluntary, community and social enterprise (VCSE) provision to agree how funds should be split amongst system and place. They have also worked together to agree a standard outcomes framework for the provision of community mental health services and which challenges - such as workforce and information governance - need tackling at scale. This has built upon the existing relationship of trust between collaborative partners and extended this ethos and way of working to others.
Sharing lessons learned
Keir and Cathy stress that the fundamental starting point for organisations coming together as a collaborative should be working on the relationships between them and building a willingness to collaborate through the creation of a sense of shared purpose, mutual respect and trust. Cathy reflects on the importance of these relationships and concludes that "what's particularly special about West Yorkshire and Harrogate ICS is that it’s a coalition of the willing".
Cathy and Keir also stress the importance of recognising that collaboration is a journey and the organisations involved in other ICSs need to be prepared to redevelop and refine their approach as necessary over time. They have recently introduced a twice-yearly ‘strategic session’ as part of the cycle of collaborative meetings to give the trusts the opportunity to reflect, problem solve and reset where necessary in order to have foresight in their collective work.
Another key lesson Cathy and Keir highlight is the importance of 'taking everyone with you' and enabling the development of, and engagement, with 'critical friends' when it comes to delivering service transformations. One of the ways the collaborative does this is by holding a non-executive director, governor and lay member meeting twice a year to update and brief them on service transformations before they happen as well as take on board their feedback. Given the complexity of the work across numerous system partners – five CCGs, NHS England and NHS Improvement commissioners, four NHS providers of mental health, learning disability and autism services, five local authorities, multiple primary care organisations, and hundreds of possible VCSE organisations – there are still gaps in communication, understanding and agreement. Importantly though, the role of the collaborative is to learn and improve as it develops and as each piece of work comes to maturity, external communications is on their agenda for 2021/22.
Cathy and Keir also emphasise the importance of involving experts by experience and service users so that the transformation of services is truly co-designed and co-developed. As Cathy explains, "a provider collaborative can be quite hierarchical and it’s made up of very senior leaders, but we have to keep bringing it back to what's the experience of service users to ensure person-centred care".
The collaborative has also recently introduced a template assurance report for each meeting of the committee in common, which goes to all four boards to ensure that they receive the same information about what the committee is assured on, alerted to and what further information it is seeking. Understanding the perspectives of different providers within the collaborative and respecting where their interests lie, which may mean not all need or want to be around the table for every particular agenda item, is also an important lesson learned.
Cathy and Keir also stress the importance of having a balance of formal and informal meetings taking place between leaders of each trust within the collaborative. For example, they have set up weekly meetings on a more informal basis between the chief operating officers of the trusts that provide adult mental health services, facilitated by the MHLDA core team, which have proved to be really effective. The chairs of each trust also meet informally, before each committee in common meeting at least, to exchange practice and updates.
Cathy and Keir also emphasise the importance of provider collaboratives being clear about the scale they are working at and adjusting what they focus on doing together accordingly. For example, those collaborating on a smaller scale may find it most valuable to focus their efforts on the sharing of good practice.
Next steps for the collaborative
The collaborative is now evolving to look at how its members might be able to work together on broader areas, such as capital investment, workforce and recruitment, as well as equality, diversity and inclusion. Keir and Cathy highlight that working collectively should enable the trusts to give more opportunities to their staff to work in different ways and in more exciting roles in particular, such as roles with an element of focus on system transformation. They hope this will help overcome recruitment and retention challenges.
Cathy and Keir are also keen to build on the collaborative’s work with experts by experience and service users, to ensure the voice of people living in West Yorkshire and Harrogate with mental health conditions is a regular part of everything it discusses and is truly embedded in its governance architecture going forward.
The collaborative is equally focused on the engagement and involvement of VCSE organisations in West Yorkshire and Harrogate at a system level. There are strong partnerships at a place level between the four trusts and the VCSE sector, and so they are now thinking about how they make sure that these partners are part of key conversations and discussions at a system level. Keir and Cathy highlight that this will be crucial to the delivery of the national programme to transform community mental health care at scale across West Yorkshire and Harrogate in particular.
The collaborative is also starting to think about how it gets the interface right between itself and the integration and collaboration happening at place level, as well as beyond the boundaries of their ICS.
National policy to support provider collaboration
Keir and Cathy tell us they would welcome support at a national level to develop further system leadership capabilities and collaboration skills across all disciplines, given the different skill set required for this compared to those historically necessary to lead a trust or deliver a service within one organisation. Cathy would also welcome the development of peer learning on a more systematic and coordinated basis so that collaboratives can learn from colleagues across the country as they move along the process of services transformation.
They stress that change management and transformation work requires genuine investment to deliver – that is investment in resources to enable trusts to dedicate existing staff time and energy to collaborate, as well as investment to create and sustain independent, strategic roles that act as a facilitator and 'an honest broker' for the collaborative. At the moment, the collaborative is reliant on a relatively small group of people, a number of whom are also service managers and clinical leaders delivering work locally at place level, alongside some ICS staff on fixed contracts, which does not feel wholly ideal and sustainable. The committee in common is currently considering more sustainable resource in future.
Keir also stresses the importance of ensuring their role as part of (not separate to) the ICS is not undermined as the policy around provider collaboratives develops at a national level. The ability for collaboratives to be able to focus on tackling the challenges that they decide are the right ones to focus on for their local populations is also crucial to maintain.
Cathy and Keir emphasise that the process of setting up, and the continuous development of, a provider collaborative needs to be driven by its constituent organisations based on what works best for their local communities, as opposed to a "one size fits all" model imposed nationally. However, Cathy and Keir are keen to stress that there are a number of "ingredients" that are key to provider collaboratives succeeding, as well as ICSs more broadly. Cathy shares that "it would be helpful for these common 'ingredients' of collaboratives to be set out for providers across the country so that local areas can 'pick and mix' from these fundamental elements based on what works for their local area specifically within their ICS".