Neighbourhood health is broadly about bringing together teams of clinicians to provide seamless services for people in their homes and communities. But the organisations running those very local services usually operate on a larger scale. Therefore, it is critical to find workable models that support collaboration between providers – primary care, community, mental health and acute providers, local government and others – at ‘place'.

These collaborations are maturing in many areas, but how to strengthen and build on them is a key question for the 10-Year Health Plan working group on accountability and oversight. Various models have been suggested, such as the revival of ‘accountable care organisations', which could see a single body managing all services, or lead provider contracting, which bring multiple partners together under a single contract held by one organisation. NHS England has already signalled that, as part of a shift toward ‘strategic commissioning', providers may ‘deliver commissioning directly through delegation arrangement or provider collaboratives'.

It's encouraging to see efforts are underway to break down the barriers to joined-up care. Trusts will play a key role in this transformation. However, success will depend on strong governance and using tried and tested approaches to bring different sectors together.

Trust boards offer the blueprint for good governance

Strong governance is vital to enable responsibilities to be held at a local level, to manage large taxpayer-funded budgets and to take decisions to improve services and bring them together. Robust governance structures are also needed to make it clear who is responsible for services and to enable them to be held accountable to the public, partners and Government.

Trust boards provide the essential blueprint for this. Built on a recognised model of corporate governance, the unitary board remains the gold standard in accountability, risk management and oversight provided by non-executive directors. While no system is infallible, the trust board model offers a tried and tested framework to navigate complex challenges and provides clarity when things go wrong.

Collaboration is essential for shifting where care is provided but partnerships alone can't provide the necessary structure and governance to manage budgets and deliver services that may cross organisational boundaries. Whatever model is adopted, trusts will play a crucial role in delivery and their established governance frameworks will ensure that integrated care is not only delivered but also sustained with appropriate oversight and accountability.

Learn from experience

Bringing local health and care providers together should be grounded in what we know is going to work, drawing from successful experiences of working differently and across organisational boundaries.

A version of the ACO model was trialled through the NHS England ‘new care models' programme, beginning in 2015. On paper, this could offer a straightforward model that removes the ambiguities of partnership working and simplifies budget management. But in practice, there were challenges to this model around agreeing contracts, along with legal, regulatory and financial barriers. The lead provider model has been used successfully by NHS-led mental health provider collaboratives but has not yet been widely tested for acute and community services.

National leaders can helpfully set out options for how systems can build robust collaborations at place but some flexibility in the model will be essential. Providers and their systems must be able to adapt approaches based on the needs of their communities, building on existing good practice. However this evolves, adopting new ways of working demands considerable leadership bandwidth. Doing this within the context of tough financial and performance targets will be challenging for trust leaders, as they are pulled between short-term pressures and longer-term transformation.

Three key interfaces

Successfully shifting care into the community will depend on three key interfaces: between physical and mental health; health and social care; and between primary and secondary care. There will be valuable lessons in the strong collaborations mental health trusts have built, which are now bearing fruit in saving money and improving care.  We will need the Government to articulate a clear vision for high quality social care, including when and how best ICBs and local authorities should pool budgets and jointly commission services.

The interface between primary and secondary care is particularly important to building neighbourhood services and building collaborations around robust governance, clear accountability and the right financial structures will be key. This is no small task: it will require a significant shift in mindset from everyone involved.

As we see big changes unfolding across the health service, it's important that national policymakers don't overlook the essentials: bringing together care and organisations, spanning different sectors will take time and needs to be handled carefully; we should learn from what we know works well in practice and what has been tried before; and good governance must be the foundation of any new way of working.  As the shift to community and move to neighbourhood health are developed and implemented, it will be essential to strike a balance between embracing innovation and building on what we know is effective.