Building Long-Term System Partnerships With ICBs and NHS Trusts

Integrated Care Boards (ICBs), NHS Trusts and independent mental health providers increasingly work within long-term partnerships rather than traditional commissioner–provider relationships. Commissioners now look beyond individual contract performance and assess whether organisations actively contribute to wider system objectives, collaborate openly during periods of pressure and support continuous improvement across local mental health pathways.

This article forms part of the Mental Health Services Knowledge Hub and should be read alongside Working with ICBs, NHS Trusts & System Partners, Community & Integrated Mental Health Care, Service Models & Care Pathways and Quality, Safety & Governance.

Commissioners increasingly favour providers that consistently demonstrate transparency, collaborative leadership and shared ownership of system challenges, recognising that trusted partnerships deliver more resilient services and better long-term outcomes for people using mental health support.

Moving beyond transactional commissioning

Traditional commissioning relationships often focused on contractual compliance, activity reporting and performance management. Modern Integrated Care Systems increasingly expect providers to work collaboratively, recognising that sustainable improvements require organisations to solve problems together rather than operate independently.

Long-term partnerships typically focus on:

• Shared system outcomes.
• Population health improvement.
• Collaborative service development.
• Joint problem-solving.
• Continuous quality improvement.
• Collective system resilience.

This broader approach helps create services that are more responsive to changing local needs.

What commissioners look for in trusted system partners

Commissioners rarely judge partnership quality on a single meeting or project. Instead, they observe how organisations behave consistently over time, particularly during periods of operational challenge.

Strong system partners typically demonstrate:

• Open communication.
• Honest performance reporting.
• Constructive challenge.
• Flexibility during service pressures.
• Commitment to shared learning.
• Support for wider system priorities.

These behaviours help build confidence that providers will remain reliable partners during future service transformation.

Operational example 1: responding collaboratively to rising demand

A local mental health system experiences a sustained increase in referrals, placing pressure on community teams and crisis services. Rather than focusing solely on contractual performance, a provider works alongside commissioners and NHS Trust colleagues to identify practical solutions.

The organisation:

• Shares real-time operational data.
• Identifies emerging capacity pressures.
• Proposes temporary pathway adjustments.
• Supports joint workforce planning.
• Reviews outcomes collaboratively.
• Contributes learning through partnership forums.

This proactive approach strengthens commissioner confidence while helping protect continuity of care.

Building trust through everyday operational behaviours

Long-term partnerships are built through consistent operational practice rather than occasional strategic meetings. Commissioners increasingly notice organisations that communicate openly, respond promptly and remain dependable even during difficult periods.

Everyday partnership behaviours include:

• Providing early updates on emerging risks.
• Maintaining regular communication.
• Meeting agreed commitments.
• Escalating concerns promptly.
• Sharing operational learning.
• Supporting collaborative decision-making.

Reliability often becomes one of the strongest indicators of partnership maturity.

Aligning with wider system priorities

Providers strengthen relationships when they understand how their own services contribute to broader Integrated Care System objectives. Commissioners increasingly expect organisations to demonstrate awareness of wider population health priorities rather than focusing solely on individual contracts.

Examples include:

• Reducing avoidable crisis admissions.
• Supporting earlier intervention.
• Improving equity of access.
• Reducing health inequalities.
• Strengthening community-based care.
• Improving integrated working.

Alignment with these priorities positions providers as strategic contributors to local system development.

Operational example 2: supporting service transformation

An ICB launches a programme to redesign community mental health pathways. Rather than waiting for formal consultation, a provider contributes operational expertise throughout the programme.

The provider:

• Shares pathway performance data.
• Participates in design workshops.
• Tests revised referral processes.
• Supports implementation planning.
• Evaluates service outcomes.
• Shares learning across partner organisations.

Commissioners value this collaborative approach because it demonstrates long-term commitment to improving local services.

Managing challenge constructively

Differences of opinion are inevitable within complex partnerships. Mature organisations address disagreements professionally while maintaining positive working relationships.

Constructive approaches include:

• Addressing issues early.
• Using evidence to inform discussions.
• Focusing on shared objectives.
• Agreeing practical solutions.
• Documenting actions clearly.
• Reviewing progress jointly.

This approach supports trust even when organisations face significant operational pressures.

Investing in long-term partnership capability

Successful providers view partnership working as an ongoing organisational capability rather than an activity undertaken only during procurement or contract reviews.

Investment often includes:

• Leadership development.
• Collaborative governance.
• Partnership training.
• Shared improvement programmes.
• Cross-system learning.
• Relationship management.

These capabilities strengthen organisational resilience while supporting future collaboration.

Operational example 3: learning across organisations

Following several similar incidents across multiple services, providers and commissioners agree to undertake a joint learning review rather than separate investigations.

The partnership:

• Identifies common themes.
• Shares good practice.
• Develops consistent guidance.
• Updates operational procedures.
• Monitors implementation.
• Reviews improvements collectively.

This shared learning approach improves safety while reinforcing trust between partner organisations.

Commissioner expectations

Commissioners increasingly expect long-term system partners to demonstrate:

• Collaborative leadership.
• Transparency and openness.
• Reliable operational delivery.
• Constructive problem-solving.
• Shared ownership of system challenges.
• Continuous improvement.
• Support for transformation programmes.
• Commitment to population health outcomes.

Common pitfalls to avoid

• Viewing partnerships only through contractual obligations.
• Communicating only when problems arise.
• Working in organisational isolation.
• Protecting organisational interests ahead of system outcomes.
• Delaying escalation of operational risks.
• Failing to contribute to wider improvement programmes.
• Defensive responses to commissioner feedback.
• Neglecting relationship-building between formal meetings.

How to evidence this in tenders and commissioner reviews

Providers should demonstrate long-term partnership capability through practical examples of collaborative service redesign, transparent communication, shared improvement projects, joint governance, operational leadership, system-wide learning and constructive responses to emerging pressures. Commissioners value evidence that organisations actively strengthen local mental health systems rather than simply delivering contracted activity.

Conclusion

Strong relationships with ICBs, NHS Trusts and wider system partners are built over time through consistent operational excellence, openness and shared commitment to improving mental health services. Providers that invest in genuine partnership working become trusted contributors to Integrated Care Systems and are often better positioned to support future transformation, service development and sustainable improvements in outcomes for local communities.

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