A new way of working

7.7. As local health systems work more closely together, the same needs to happen at national level. NHS England and NHS Improvement will implement a new shared operating model designed to support delivery of the Long Term Plan. There will be a reduction in duplication through shared regional teams accountable for managing local systems and the providers within them. The new way of working will draw together people and capabilities, resources, activities and leadership to collectively deliver greater value for the NHS and for patients. The revitalised culture of support and collaboration will be underpinned by a new approach. The key commitments to deliver this approach are:

  • a reorientation away from principally relying on arms-length regulation and performance management to supporting service improvement and transformation across systems and within providers;
  • strong governance and accountability mechanisms in place for systems to ensure that the NHS as a whole can secure the best value from its combined resources;
  • a reinforcement of accountability at Board, Governing Body and local system ICS level for adopting standards of best practice and making their contribution to critical national improvement programmes, on a comply or explain basis;
  • making better use and improving the quality of the data and information that local systems and providers have access to improve patient services.

7.8. The establishment of ICSs everywhere from 2021 will be built on strong and effective providers and commissioners, underpinned by clear accountabilities. Trust boards are responsible for the quality of care they provide for patients and for the financial resources and staff they manage. Many initiatives will require cross-organisational actions, and it is only through working collaboratively that trusts and commissioners will agree the services that each organisation will provide and the cost they will reasonably incur in providing those services – ensuring these are affordable within the system’s collective financial budgets.

7.9. As ICSs take hold, we will support organisations to take on greater collaborative responsibility. There will be a clear expectation that strong, successful organisations not only provide high-quality care and financial stewardship from an institutional perspective, but also take on responsibility, with system providers, for wider objectives in relation to the use of NHS resources and population health. This will mean that neither trusts nor CCGs will pursue actions which, whilst potentially improving their institutional financial position, would result in a worse position for the system overall. This will be supported by a system oversight approach which reviews organisational and system objectives alongside the performance of individual organisations, whereby our regions seek to understand the drivers of challenges facing organisations and ensure that solutions reflect the wider system changes required.

7.10. Mutual Aid will be an integral part of the role of leaders, both managers and clinicians. As we move to an NHS which is deeply interconnected, leaders in all parts of the NHS will be encouraged to support one another across and beyond their organisations. This will be especially the case for thriving, successful organisations which will increasingly be asked to support their neighbours develop capabilities and build resilience. This will form part of a ‘duty to collaborate’ for providers and clinical commissioning groups alike.

7.11. The NHS has an almost unrivalled ability to bring together data to inform care, and we will build on the Model Hospital by increasing its transparency and extending it into the model health system. We will do this by automating and standardising the generation and storage of data to reduce the burden on frontline services and eradicate unnecessary and duplicative assurance templates.

7.12. Our new regional structures will play a key role in locally devolved initiatives. The collaborative work which will need to underpin the development of local plans, and the detailed understanding of the services that each provider will need to deliver to meet the trajectory of outcomes, will be supported by the new regional teams. In particular, these teams will play a key role in ensuring the system is securing the best value from its combined resources to deliver the Long Term Plan.