Place based partnerships in the healthcare sector are the cornerstone of effective system working, fostering collaboration among health, social care, voluntary sectors and local government. But despite their significance, they have received relatively little central direction since the publication of Thriving Places, the official guidance on the development of place-based partnerships, in 2021.
As a result, they vary in focus and structure – from convening stakeholders to set strategic goals, to tackling specific health challenges. Trusts play pivotal roles in hosting or leading partnerships or participating in committees alongside other organisations including integrated care boards (ICBs) or local authorities. As system working matures, insights into relationship-building and governance are emerging. These are crucial for achieving collective goals amid financial constraints and competing short-term priorities.
NHS Providers has spoken to trusts across the country to explore how they are pioneering integrated care at local level. Here are three leading the way.
Bolton
In Bolton, a focus on relationships from the outset has helped shape the partnership's governance structures, leading to a strong emphasis on collaborative working that benefits the population it serves. Terms of reference for Bolton's partnership were developed together by health, public sector and voluntary organisations, including stakeholders from the housing sector and police. In establishing governance structures collaboratively from the start, Bolton has worked to ensure widespread buy-in and participation from all stakeholders.
While the partnership is accountable to the Greater Manchester ICB, Bolton NHS Foundation Trust, which provides acute and community services locally, and the local authority aligned their strategies with those of the place partnership, giving a consistent focus on shared outcomes from the major partners. Leads from the local authority, foundation trust and ICB help to provide support and reconcile areas of disagreement before decisions are made, highlighting the value of trust and transparency in creating effective relationship-based partnerships.
This collaborative approach to governance supports collaborative delivery. In the six 'neighbourhoods' across Bolton the foundation trust and local authority are working from the same locations and jointly support community care. This collaboration is further underpinned by staff employed by the ICB being deployed locally, responding to local need.
Bolton provided an example of what this meant for the people the place partners served. NHS and local authority staff worked together to hold daily team meetings. One woman, discharged home after a month in hospital, had a council team arrive fifteen minutes after she arrived home to assess and support her needs. By working closely together at all levels, the benefit of integration was being shown in Bolton, with more effective collaboration leading to more effective care.
Dudley
Dudley Group NHS Foundation Trust employs the place's programme director – the partnership's only full-time member of staff – and provides oversight through its integration committee. The trust highlighted the crucial role of relationships in making sure all partners were happy with the hosting arrangements, allowing them to then focus on their shared strategic priorities. This was especially true of relationships with their local authority, where the partnership had sought to support the strategic priorities of the health and wellbeing board, without unnecessary duplication. Members of the partnership were aware of the crucial role local authorities play in their communities, and say it is important to champion and develop effective working relationships to create a shared approach to integration at place.
While in Bolton the focus on relationships within place based partnerships has helped to create effective working behaviours, the Black Country integrated care system (ICS) has instead emphasised collaboration between places.
The four place leads across the ICS work closely together, sharing learning and strengthening relationships through a monthly meeting focused on learning. ICS-wide delivery groups, for example, for out-of-hospital care, include place-based representatives to align local strategies and operations. The places have also set up a joint group focused on population health and inequalities, to help all places within the Black Country to focus on shared outcomes.
This collaborative approach has also developed within places, as well as between them. Dudley place-based partnership recently refreshed its terms of reference and chairing arrangements to improve collaboration across sectors and support integrated working. The new arrangements aim to ensure representation and involvement in the partnership from a primary care collaborative and mental health trust, as well as representatives from children and young people's services, public health, the voluntary sector, Healthwatch and adult social care, to bring a wide range of partners within Dudley together.
Croydon
In Croydon, the One Croydon Alliance is jointly chaired by the mayor of Croydon and the chair of Croydon Health Services NHS Trust. The alliance includes representatives from the council, trusts including the local mental health trust, primary care, and voluntary sector partners such as Age UK.
The alliance is focused on improving pathways such as discharge: its 'Living Independently For Everyone’ programme brings social workers, community geriatricians, nurses and therapists together to help people regain their independence and confidence to live at home after a hospital stay. Croydon is also rolling out 'Integrated Community Networks Plus' that aim to help prevent ill health and keep people well. The networks bring hospital teams together with local GPs, community clinicians, social care workers, mental health experts and the voluntary sector to provide more joined-up care and support within local neighbourhoods.
However, the trust felt that, despite place being the right footprint to organise the delivery of services, national policy focus was given to other system structures such as ICSs and provider collaboratives. The trust suggested that the relationships held locally – with colleagues in the local council or general practice, across a patch all were familiar with – are crucial to successfully making change and driving improvements on the ground.
What next for place governance?
Trusts we spoke with highlighted the need for ICSs to go further in delegating funding and responsibility from ICB to place level as they continue to mature. However, the current financial pressures on ICBs specifically, along with trusts, may delay work to devolve more control of funding, decision making or contracting to place level. In the meantime, places had identified ways of working around these limitations, such as through pooled NHS and council budgets, which can encourage local partners to take more holistic view of how health and care funding is used for local communities.
Policy makers should consider how best to encourage ICBs to delegate appropriately to place level, whether through refreshing Thriving Places or sharing examples of good practice. Through effective place based working, the wider health and care system can ensure that those with real understanding of, and access into, their local communities are able to make decisions about how health and care services are delivered and lead the way on integrating care.
Conversations with trust leaders demonstrate that place based working continues to develop and grow according to local need. What is right in terms of governance, funding and accountability may continue to respond to changing developments, but one constant is the importance of relationships between stakeholders in supporting integration of care.
This blog was first published by Public Sector Focus.
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