20 October 2022 – Mental Health Network webinar

This week, we were joined by David Williams, Joint Director of Strategy and Partnerships, Leicestershire Partnership NHS Trust & Northamptonshire Healthcare NHS Trust.

David shared with the group details of the East Midlands Alliance (EMA), a collaboration between five NHS mental health trusts and one large third sector provider, St Andrews. This cross-sector alliance allows organisations to share challenges, work together to improve outcomes, and reduce workforce competition. The alliance has been operational since 2019 and is not a single organisation, but an agreed way of working underpinned by shared behaviours and values. Decision-making runs through all member organisations, but the money is managed by one organisation. Each organisation leads on a specialised collaborative including CAMHS, adult eating disorders and perinatal. Each organisation leads on one of these areas. This allows the alliance to influence on these areas with a single, unified voice.

The EMA has provided a space for leaders to come together and quickly test and talk through ideas, work together to share and solves challenges, and has raised £1.6 million of income for improvement and support focused on working together. Historically organisations would have bid against each other for this resource now they are working together.

Someone shared how the EMA is governed, with common board papers produced and sent to all six boards. Level 1 quality and finance committees will receive quality and finance papers looking at specific services in the provider collaborative. As collaboratives within the alliance and across ICSs grow, the EMA is considering creating a level 2 collaborative committee to ensure oversight across all collaboratives.

"The role of chairs during the establishment of the EMA in getting boards engaged, and ensuring buy-in from governors by improving their understanding of what was trying to be achieved."

Someone emphasised the importance of setting the EMA’s principles of engagement at the start of process.

"This ensured that when conflict arose, there were a clear set of principles to guide the difficult conversation."

They also raised the importance of recognising changes of people, and acknowledging that with each new iteration of members there needs to be a review of how the established principles work.

David explained that in the context of ICSs, the EMA is a vital lever in ensuring mental health, learning disabilities, and autism are spoken about at a system level with one voice.

"Further to this point, it is worth noting that one of the early conversations the EMA had with ICSs was about them not having control over this highly-specialised commissioning, they were able to explain what was different and why ICSs didn’t have control."

"The way the EMA manages shared risk with organisations outside of the alliance, noting the need to ensure there is a shared understanding of individual risk."

David shared the example of someone in an acute trust needing CAMHS inpatient bed, but there not being one available. They have developed a template which drives a conversation about understanding that person’s risks whether they stay in the acute setting or are moved. The alliance also allows external organisations to better engage around a specialised service across the footprint of the alliance, rather than contacting the trusts individually.

Someone counted on the challenges they faces around how money is managed within their system, and the seeming need for one provider organisation to handle funds and how this impacts any MoU.

"The alliance discusses where funding can best sit according to who is best placed to lead on the work, but roles and workload are shared evenly across the alliance. This is also where the agreed values and behaviours come into play, a lead organisation doesn’t have to be in command when all organisations are working to the same outcomes."

"How is the alliance setting priorities based on metrics and date, and whether there is a model for sharing public estates?"

"The alliance had good data on inpatient numbers and how organisations are managing waiting lists, so they can come together to solve problems. It does not currently share public estates, but has set up systems to have shared supervisions, with one organisation taking on additional supervision as a shared way of working to build quality. In areas being commissioned the alliance wants to improve performance and quality, key to this has been shared learning and shared problem-solving. Sharing intelligence is also vital, when one trust has a CQC visit for example."

Someone highlighted the importance of agreeing the financial envelope for any commissioning pieces from the centre, and for them to understand the alliance’s risk and governance share. They cautioned not to underestimate the challenge that can be thrown at up.

"While they aren’t sharing estates, they are aware of bed base and capacity, they work to manage this across the alliance. Claire Murdoch has come along and been supportive for new bids for capital. As collective they have a stronger voice to bid for capital."

"There is a vital importance of clarity around language nationally and the risk of mixing up collaboratives, alliances and providers."

"Trusts need alliances to work."

"Indeed, much consideration is given around how trusts can best support each other. St Andrews has 200 beds, if they fail and close that’s 200 beds the trusts don’t have. It’s in everyone’s best interest to support each other, there is a lot at stake as a group of providers, so good incentive to work to fill any gaps."

"GGI has been looking at governance around increasingly unwell workforce, the role of boards in improving this, and what investment should look like.”

“We can’t ignore the difficulty of making change across large organisations and the need for enough time to allow change to embed, and the time to allow high-risk decisions to pay off.”

The group agreed this would be a subject they would like to explore further.