Our last twelve months at ANHH have been dominated by one thing.
The Birmingham and Solihull Mental Health Provider Collaborative (“MHPC”) has brought together providers of mental health services – NHS, Local Authorities, voluntary and community sector, and independent sector – across Birmingham and Solihull. We have been the Programme Director as well as providing specific advice on governance.
Provider Collaboratives are the new present and the obvious future. A key element of the Health and Social Care Act 2022, which disbanded CCGs and created Integrated Care Systems, they enable systems to introduce a new form of commissioning and provision.
BSol has plans for four provider collaboratives, each led by a provider trust. The system will eventually have collaboratives for adult acute services, women’s and children’s services, and community services. First, however, from 3 April 2023, is the MHPC.
We were lucky to have a strong and loyal client – although I’m a strong believer that luck isn’t always just chance – in Birmingham and Solihull Mental Health NHS Foundation Trust (“BSMHFT”), and it was they who invited us to the party. It has been a challenging year that has reinforced our purpose as a company, and encouraged us to think afresh
about the values that we stand for.
Partnering
The worst type of management consultancy is called out in the allegory of the sharp-suited executive going into a client’s office, asking to borrow the client’s watch, telling the client the time… and then walking off with the watch.
Fortunately, that extreme is increasingly rare, but there is still a prevailing approach of consultancies standing on the side-lines, watching the game unfold, reacting to events, and then calling out the failings of the client in the post-match interview. Even worse, the punditry is sometimes from “experts” who have never played the game or, if they have, only at a minor league level.
That is not ANHH’s style. You’ve read before my analogy of the “coach on the field” – how we know what to do but also feel very comfortable digging in with our clients to deliver the change. That’s what we mean by partnering, and what we hope we’ve demonstrated that commitment with the provider collaborative.
Partnership is key to collaboration, of course. Shared budget, shared decisions, shared outcomes, shared accountability. But that doesn’t necessarily come easily. It’s not that long ago that the mantra was competition between (in particular) foundation trusts. Different times – and Governments – have different takes on how to raise quality standards and drive efficiencies. It’s no small ask to expect a transition from a commercial to a collaborative mindset, particularly when independent sector providers are now part of the collaborative.
Our responsibility was to direct the programme of activities in ways that brought organisations and individuals together.
No-Nonsense
Nowhere was this better demonstrated than in our work with the third sector.
Many of the ANHH team have a background in the charitable sector, and we have brought that to bear as the NHS and third sector have developed their relationship. Frankly, we found an initial wariness, even suspicion, in play between the two groups. NHS colleagues would bemoan the lack of awareness of their issues from within the third sector, without acknowledging that just as great an issue lay in the other direction. It is too easy to dismiss or criticise from a position of misunderstanding and uncertainty.
It takes mutual trust and compromise to tackle that situation head-on.
Some of NHS colleagues’ concerns focused on the apparent informality of governance within the third sector. The Third Sector Forum was a loose confederation of those third sector organisations, most of them based in Birmingham, which operated in mental health and wellbeing services. The Forum had no powers, no membership arrangements, and was experiencing diminishing attendance at online meetings after the inevitable peak during covid.
The third sector leadership in BSol is strong, and, importantly, has been eager to embed the sector in the MHPC, and awareness of good governance within the sector. Indeed, it’s not a stretch to say that that part of the collaborative is now the most organised. It’s certainly embraced the most change: a new branding as VCFSE (Voluntary, Community, Faith, Social Enterprise); a “Collective”, to replace the previous Forum, with more than 100 registered member organisations; a “Panel”, with elected members, that fronts the sector within the MHPC; an elected Chair and Deputy Chair, explicitly appointed to represent the sector not partisan interests; a Partnership Lead and Administrator who have walked many of the hardest yards; and an Articles of Association that provides the constitutional framework.
ANHH is proud to have played its part in those changes. No-Nonsense means having the difficult conversations, challenging the status quo, and remaining to the point and on target whatever the distractions.
Knowledgeable
There were known knowns and known unknowns, but also some unknown unknowns. We’re not going to lose ourselves down that Donald Rumsfeld rabbit warren, but it sums up the last twelve months pretty well.
The context for the provider collaborative has been clear – the Health and Social Care Act 2022, which abolished CCGs, empowered integrated care systems, and enabled new commissioning models; the system’s and individual organisations’ strategic shift to partnership; and the growing realisation that a system that only responded to the symptoms of ill-health, without tackling the causes that drive variation and inequalities, is only doing half a job.
But that known came with its uncertainties. In a world of firsts there isn’t the usual safety net of experience and precedent elsewhere.
The first system to seek to transfer budget AND responsibility for decision-shaping about how it should be spent.
The first provider collaborative in a system that was talking of a future with four.
The first time that the Integrated Care Board had tested its new assurance process.
The first opportunity for individual, sovereign organisations really to test their appetite and trust for shared accountability through new governance arrangements.
The first chance for things to wrong.
And it is with a great sense of pride and mutual respect for our partners that we can say that this could become the blueprint for the first of many. The process had the clarity of mud, at times, and there were many leaps of faith, but go-live does feel like just that – a fresh start.
At ANHH we like to think that we know what to do but it’s only honest to admit that that knowledge was sometimes based on instinct rather than evidence. I’ve written previously about the need to keep five minutes ahead of everyone else, and I stick by that. The best thing to do with a vacuum is to fill it, and that is what we always strived to do. Speak with confidence, take the lead, remain optimistic about the endpoint, just make sure you have your fingers crossed as you do so.
Changemakers
It seems strange to say that four governance nerds[1} can bring about change. But it’s not so strange if you consider what governance is. It’s not about structures (although I do love a good organogram). Governance, we always teach at ANHH, is about six things – Vision, Strategy, Leadership, Assurance, Risk Management, and Transparency – and all six have been tested, retested, profiled, reprofiled, adapted, amended, reviewed, refreshed, and reaffirmed to within an inch of their lives.
The temptation to list everything we’ve done, or worked with others to do, is almost overwhelming. But I’ll almost certainly forget something, so I won’t. Instead, just one message – that, as always, the greatest change has been in people’s heads. Behaviour change was the biggest and most crucial of all. No amount of new architectures, plans, constitutions, terms of reference, risk registers, frameworks, or agreements will ever usurp behaviour’s number one status.
Only wet babies like change. It’s a phrase that raises a smile, mostly because it’s so true. But it also reinforces that change must bring about a difference. Sometimes it results in something that isn’t everything that people hoped for. Occasionally it results in nothing more than a new type of mess. But, always, it results in something that is different to what was there before. That’s the MHPC in a nutshell.
Doing good…
…Is our purpose at ANHH. I’m confident that the MHPC is a good thing. I’m hopeful that our partners and clients believe that we did well. But I’m certain that this won’t be the end of things. Change will always be the only constant.
[1] Okay - one nerd and three colleagues.
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