It may be useful here to share the learning from Moorfields’ networked care history and relationship experience.
In most cases in our model, host trusts and landlords have little or no day-to-day involvement in our services unless they are providing support such as anaesthetic cover or cleaning as part of the lease/licence. The exceptions are our partnerships where we provide only clinical support.
Interdependencies tend to focus on issues such as IT connectivity, space constraints, environmental issues and the clinical support agreed in any service level agreement.
- the host trust had no further business interest in the service being transferred (it was no longer a host trust priority).
- the service exists as a tenant arrangement only (for instance where the services are independent of the landlord).
- our preference is to own and run the service autonomously under the Moorfields brand.
- smaller ambulatory services are not so co-dependent on other local clinical services.
When we interviewed standalone (not providing networked care) DGH board members, they expressed a clear expectation that not only should there be a relationship between the host and specialty provider, there would also be a need to routinely report into the host trust through something like a joint management board.
A smaller DGH with a number of its services networked to specialty providers had from experience not seen the need for more than a light touch CEO-to-CEO relationship annually with the clinical relationships between the specialty provider centre and the networked site being managed by the specialty partner.
We talked to 25 executive board members – potential providers and host trusts – to understand what they would want to know about the potential networked care solution. They said they would ask:
- Will it be better for patients?
- Is there a good strategic fit between the two organisations?
- Is there a good cultural fit?
- What are the risks of doing it and of not doing it?
- Will I be taking on a lot of issues rather than providing a sustainable alternative?
- What kind of governance is needed to keep the relationship on track?
“Who will the CQC want to speak to if something goes wrong? I think I’d feel responsible if it’s our name above the door.”
“You do need a bit of give and take – it’s impossible to try and come up with an arrangement that always works well financially for everyone.”
“You’re all good friends at the beginning but there’s a danger that everyone becomes complacent after a while. You need a joint management board.”
“We’re trying to get people to think of the thing as one NHS footprint rather than seven individual organisations.”
“We recognise that no one provider can afford the other one not to exist. If one provider fails that’s a problem for everyone so we need to proactively manage things.”
“You can go only at the pace of the slowest.”