Browne Jacobson and NHS Confederation's report

Browne Jacobson, in conjunction with The NHS Confederation, has released a comprehensive policy paper titled Towards integrated health organisations: considerations for policy and NHS leaders, detailing the necessary elements for successful integrated health organisations (IHOs). This report marks the first thorough examination of IHOs, offering vital insights aimed at policymakers and NHS leaders on fostering effective integrated care delivery.

Among its recommendations, the report urges NHS England to revise the NHS Oversight Framework to promote transformation and cooperation among health organisations. It emphasizes the importance of maintaining a flexible legislative environment regarding IHO governance, cautioning against overly prescriptive governance structures for foundation trusts. Annie Bliss, Senior Policy Adviser at The NHS Confederation and co-author of the report, stated that “The 10 Year Health Plan introduced IHOs as a population-based contracting approach to improve outcomes for patients and improve value for money through greater allocative efficiency – ultimately moving towards models of care that are more preventative and delivered closer to communities."

The report identifies four components essential for the development of IHOs based on feedback from over 30 healthcare leaders across various networks within The NHS Confederation, including community, mental health, and acute care. The first component focuses on the contract structure, proposing a capitated contract awarded by an integrated care board (ICB) to a lead provider, incentivizing collaboration and reducing downstream healthcare demand.

The second component is about structure, suggesting that a high-performing foundation trust should act as the host provider, fostering collaborative relationships with other care entities, including local government. The governance aspect of IHOs is equally critical; while not a new legal entity, the host provider's governance should pivot towards enhancing population health and managing sub-contracting relationships.

Rebecca Hainsworth, Partner in commercial health at Browne Jacobson, remarked that “Host providers, collaborative arrangements and expected outcomes should be agreed locally, rather than imposed from above,” pointing out that national policies must align with the operational needs of IHOs. She emphasized that although initial authorisation of IHOs may come from a central body, future initiatives should originate from ICBs to reflect local healthcare dynamics.

To successfully implement these recommendations, the report highlights the need to address barriers to collaboration, reviewing legal frameworks with the Competition and Markets Authority and ensuring social care and public health services play a role in future IHO contracts. Hainsworth cautioned that “While IHOs are intended to improve allocative efficiency and financial performance, limiting IHO contracts to only ‘high-performing’ foundation trusts risks exacerbating performance variation and inequalities.”

For the future of integrated health, the report advocates for a balanced approach that includes organisations with varying performance levels but strong leadership and partnerships, ensuring that the goal of patient-centred care is always at the forefront of IHO development. To read the full Towards integrated health organisations report, click here