The value and processes of partnerships in the English National Health Service: A study of the Greater Manchester Health and Social Care Partnership

Background The Long Term Plan for the English National Health Service (NHS) (2019) states that partnership structures, in the form of Integrated Care Systems (ICS), are to be developed by 2021. The Plan is preceded by a long history of expectation around partnership working, particularly between health and social care organisations, which has been structurally enabled by both NHS Care Trusts (from 2002) and the formation of Health and Wellbeing Boards in response to the Health and Social Care Act (2012). Further to these forms, in June 2017, ten areas of England were confirmed as the first-wave of ICSs by the overall NHS governing body—NHS England. Objectives This research seeks to understand the current value and benefit of governing, planning and delivering health services using ICS structures through addressing the primary research question: What is the value of partnerships for organisations aiming to transform health and wellbeing outcomes? It is concerned with the experience and insight of senior leaders and managers involved in partnership working in the Greater Manchester Health and Social Care Partnership (GMHSCP) in the United Kingdom (UK). GMHSCP was one of the ten areas confirmed by NHS England as a first-wave ICS in 2017. Methods This thesis comprises a single in-depth case study of the GMHSCP, and utilises data from 39 one-hour semi-structured interviews, conducted in two rounds with senior policy, governance, clinical and operational leaders involved with the GMHSCP. In order to answer the primary research question, interviews were focussed on understanding the key concepts of value, partnership process optimisation, and the challenges faced at both the system-level across Greater Manchester (GM), and at the place-level across the ten locality areas of GM. Interviews were transcribed and summarised, followed by full thematic analysis using the NVivo software package. Lessons learned Data analysis identified eight theme areas of critical importance for the GMHSCP. From analysis of these themes, broader conclusions are drawn regarding the overall value, process optimisation and challenges facing ICS partnerships. Four research contributions are offered: (1) new thinking on leadership for partnership leaders, (2) a value proposition for partnerships, (3) a profile of an optimised partnership, and (4) a set of factors which have enabled greater progress of the locality partnerships towards their outcomes within the GMHSCP. Additionally, the importance of articulating the value proposition is linked to the challenges and barriers faced by partnerships; if the value is deemed high enough, it is argued that there is a requirement for a change at the national and policy level to support partnerships in their work. Implications The findings are intended to be useful for leaders and managers interested in improving partnership working to effectively deliver outcomes, and for policy makers and regulatory bodies in determining how best to centrally support and monitor such partnerships. Furthermore, the findings make a contribution in closing a gap in the academic literature around the value of partnerships such as ICSs, and in providing greater specificity on the factors that might optimise partnership processes in the current context