What did the research find?


Partnering is an integral part of improvement efforts

Preparatory interviews with national stakeholders by the HSMC research team confirmed that partnering will be a central component of efforts to improve services for the foreseeable future. Policymakers now expect that all provider organisations should explore how partnering could improve services within the local health economy, as well as in their own organisations.

Partnering is also a clear theme in many national policy documents. The need to move beyond organisational boundaries to improve services for patients was emphasised in the Five year forward view in 2014 and in Sir David Dalton’s review of options for NHS providers later that year. Both reports outline the range of ways that two or more providers could work in partnership to improve quality of care for patients, from joint ventures and management contracts to primary and acute care systems and hospital chains.

The language of both the Dalton review and the Five year forward view emphasises a degree of voluntarism – there is no ‘one size fits all’ model for provider organisations or for service delivery, and providers should select and adapt the approach that best suits their own aims and objectives. But some of the most recent examples of partnering have been mandatory, and involve building relationships between organisations when there may be a power imbalance between the two. An example of this is buddying, introduced in 2013 as part of the special measures regime. Special measures were created following the report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, and trusts placed into special measures have to be buddied with high-performing trusts for advice and support, as part of a regulated programme of improvement.

Many different types of partnership can be applied

The preparatory background research for this project established that partnerships in the NHS may:

  • take many different shapes and forms, with a range of ambitions, objectives and mechanisms to drive improvement
  • range enormously in scope, from small-scale collaborations between individual clinicians to the structural integration of entire organisations
  • be initiated voluntarily to pursue opportunities for improvement, or be mandated by regulators as part of a response to organisational or quality failures.

From this initial sweep of examples, the HSMC research team developed a typology to reflect current interests and practice in partnering in the NHS (Table 1), which vary in terms of nature, scale and form.

Table 1: Typology of interests and practice in partnering in the NHS




Partnering that has been brokered by a body outside of the organisation, such as a regulator.


Partnering that has been instigated by the involved organisations.




Partnering that primarily occurs through a limited number of individuals or services within the partner organisations.


Partnering which is of larger scale and more formally constituted. This could include mergers, acquisitions and contractual agreements.




Partnering where two organisations combine their resources to form a new organisation.


Partnering where one organisation becomes subsumed by another.


Partnering where individuals or organisations with more experience help, mentor, advise, or train others.

A rapid review of the literature (summarised in the full report) suggested that most research has focused on the impact of structural mergers and acquisitions between health care providers. Studies show that realising financial or quality benefits from mergers of health care organisations is far from straightforward and often takes years to materialise. On the other hand, while buddying schemes are popular across occupational sectors, there is little academic research available on the effects or effectiveness of these more informal forms of partnership. Accordingly, the research team selected five case studies to explore examples situated on different points of the typology above (Figure 1).

Figure 1: Typology of the five case studies explored in the research

* Stakeholder interviews were completed with representatives from: the Department of Health; arm’s length bodies, including the Care Quality Commission, and Monitor and the Trust Development Authority (before these two organisations merged to become NHS Improvement); representative bodies; NHS trusts and foundation trusts with experience of improvement; and academics with expertise in this area of policy and practice.

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