ARTICLE

What makes a good partnership agreement, and what makes it work?

By 
Lev Pedro 
&  Emma Baylin and Aimie Cole
14 Feb 2023

This article aims to help people that are developing a written agreement on the working relationship between NHS integrated care boards and voluntary sector alliances, as part of integrated care systems. We discuss the challenges that colleagues working on these are facing, and what is helping to overcome these challenges and enable success. The learning here also has relevance more widely, to other types of partnership agreements.   

The headlines  

If we could summarise all the learning in one sentence, it would be: The PROCESS is the most important thing. In other words, it’s the act of coming together and working through what it means to work in partnership, what you hope to achieve and how things will be addressed when things go wrong – this is the thing that build relationships, trust and mutual respect.  

In summary, the four things that are enabling success are:  

  • creating a mutual working culture 
  • the existence of good working relationships 
  • leadership from both sectors  
  • resources.  

Why are these agreements needed?  

Integrated care systems have been created to transform the way the public receives health and care services, bringing different parts of the system together more coherently. Within this ambitious plan is an enhanced role for the voluntary, community and social enterprise (VCSE) sector. The sector is envisaged to play a much bigger role in both planning and delivery of services. To enable this, VCSE alliances are being built in all 42 ICSs across England. NHS England requires all systems to have a partnership agreement in place by 31st March 2023 that defines the nature and scope of this working relationship. It will be agreed between the new NHS integrated care board and the VCSE alliance in each ICS area.   

How did we do this?  

NHS England commissioned Aimie Cole, Emma Baylin and Lev Pedro of Lev Pedro & Associates to:  

  • gather insight from those areas that have achieved their agreement on what they did, what enabled success, and how they overcome challenges 
  • gather examples of agreements 
  • provide some bespoke support to areas that are still working on this.  

This article summarises what we learnt.  

Barriers and enablers  

The following were seen as both a barrier and an enabler, depending on whether they were in place and how effectively they were operating.  

  1. Culture  

Where there is already a positive relationship between the sectors, culture is an enabler. However, where there was distrust, or the VCSE was feeling disenfranchised, culture is seen as a barrier. Key factors in developing a positive working culture are:  

  • open and honest conversations 
  • developing a shared vision or statement of intent 
  • identifying shared values 
  • understanding what each other brings to the table – both the positive contribution and possible working constraints, pressures and challenges.  
  1. Relationships 

People we spoke to talked about the importance of relationships within the VCSE and between sectors. Where there were strong and trusted relationships, the process of developing a partnership agreement is shorter and smoother. However, many areas said they used the process of developing their partnership agreement to build relationships and influence culture. Many systems spoke about the positive impact of a cross-sector ‘shared values’ development session, drilling down into what it means in practice, in terms of behaviour, to work together in a way that reflects these shared values. 

  1. Leadership  

Having a senior champion in the ICB was a significant enabler in building relationships, developing joint working strategies and developing a partnership agreement. Where this was not in place it impacted on the overall culture of the partnership and the value placed on it and the resources being allocated to the work. The absence of an ICB champion also made the actual process of writing and getting the partnership agreement signed off difficult. Where there was a dedicated VCSE lead and a dedicated ICB lead for working with the sector, there was an incredibly positive impact.  

  1. Resources 

Where the VCSE is developing this work without dedicated resource, lack of time and energy is a huge barrier. Where the VCSE has dedicated resource, for example, funding for the alliance and/or a coordinator role, the process becomes much easier. 

Where there are existing structures for engagement within the VCSE and across sectors, the process is greatly enabled, with a lack of this presenting a significant barrier. 

Where do we start?!  

Most systems we spoke to talked about the importance of understanding where they were starting from before they started to develop a formal partnership agreement.  

These questions will help you work out what you may want to consider: 

Question to ask Things to consider 
Who is the agreement for and what is its purpose? Think about the scope of the agreement, what aspects of collaborative working it will cover, who the intended audiences are and whom it needs to influence.  
How will we ensure wide-ranging understanding and ‘buy-in’ to the agreement?   Existing networks, structures or meetings can be used to engage the wider VCSE in order to obtain wide involvement.  
Write then engage? Or engage then write?   There are different ways this can be done. You could work up a draft among a small group, such as the VCSE leadership group, and then go to wider engagement. OR, you could gather insight through wide engagement first and draft content from that?  The maturity of your VCSE alliance, and whether it already has a mandate and is trusted to progress work such as this, will determine which approach you take.  Another option might be for your leadership group to draw up a ‘heads of terms’ and bullet points on the areas the agreement should cover, then gather insight from the sector through a coproduction process.  
How long/detailed should the agreement be?   Systems that have produced 2- or 3-page versions usually have other documentation that covers some of the aspects that the partnership agreement would. Our advice is to err on the side of more detail, not less. Having the detail recorded will be especially useful if key people leave their jobs.  
Is there a clear understanding of shared vison and values?  We know from our learning that shared vision and values are an important starting point for effective partnership. It helps if these are documented and a good diversity of stakeholders from both VCSE and statutory sectors are involved in developing them. 
What factors will impact on the agreement?  Existing policies or guidance, for example from NHS England, or within the system, can add weight to the argument for an agreement to be produced, and maybe to necessitate resourcing of the development process.  
How will we make sure that the written agreement has ‘life’?  Your agreement might contain an implementation plan or commit to developing one as a next step. Or it could include tangible actions that the partnership plans to take in the short term. This could alternatively be a separate document.  
Is there resource to support this work?  We know that partnerships require people, time, events, drafting, and so on, and this all requires capacity. In our experience, where capacity is stretched, resourcing accelerates progress.  
Does the agreement require any form of formal sign-off?  The sign-off process for documents such as this in public bodies often has multiple stages. It may need to go to different committees or working groups. It might also require input from the ICB’s legal team. Knowing the process from the outset, and key dates, will support you in planning for getting it done.  
Shall we just borrow an agreement from another system and cut and paste the name of our area?  All our work has told us that the ‘process’ of developing documents such as this is more important than the resultant document. So, the answer is no! Seeing what other people have done, once you have agreed the meat of your agreement, can be a helpful guide, but only then. 

What resources are  helpful? 

People we spoke to told us that the practical things they found most helpful were:  

Finally…  

Good luck with your agreement! ICS colleagues – don’t forget to send your final agreed version to england.voluntarypartnerships@nhs.net  

Lev Pedro is a consultant to charities and the public sector, specialising in the role of charities in public service delivery, health and social care policy, and building consortia and partnerships.
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