Committees in common: Strengthening collaborative governance in the NHS

As the NHS continues to evolve in response to growing demands and systemic challenges, governance models have adapted to support more integrated and collaborative decision-making. One such model gaining traction is the committee in common (CiC) structure, increasingly used by NHS Trusts and NHS Foundation Trusts to facilitate joint working without compromising individual organisational autonomy.

What are committees in common?

A committee in common is not a single legal entity or a joint committee in the traditional sense. Instead, it refers to multiple committees from different organisations meeting simultaneously, with a shared agenda and remit, but each making decisions independently for its own organisation. This structure allows for coordinated leadership and decision-making across NHS bodies while preserving the statutory responsibilities of each Trust board. 

There are two main types of CiCs:

• Advisory committees: These provide recommendations or advice to member organisations. They're flexible in structure and don't require formal governance integration.
• Decision-making committees: These take decisions on behalf of their respective organisations. Each decision is made by the representatives of the individual Trusts, even if the outcome is coordinated across the group. 

Why use committees in common?

The CiC model supports:

• System-wide collaboration: Especially useful in integrated care systems (ICSs) and provider collaboratives.
• Faster decision-making: By aligning agendas and discussions, decisions can be made more efficiently.
• Governance flexibility: Trusts retain control while benefiting from shared leadership and strategic alignment.
• Improved service delivery: Joint working can reduce variation, improve sustainability, and align clinical models.

In addition, CiCs offer a good option for those NHS bodies working towards a longer-term plan of closer collaboration and (potentially) a merger.

Legal and governance considerations 

The Health and Care Act 2022 introduced new provisions allowing NHS bodies to delegate and jointly exercise statutory functions. This legislative framework supports the use of CiCs, provided that:

• Each organisation’s decision is made independently
• Delegation is lawful and consistent with NHS England guidance
• Delegation aligns with the requirements of the provider’s licence and the constitutions of the participating NHS bodies
• Governance structures are clear and transparent

Inevitably, any decision to pursue a CiC will require a review of the governance arrangements, constitutions and schemes of delegation for the relevant NHS bodies.

Challenges and opportunities

While CiCs offer significant benefits, they also present challenges:

• Governance clarity: Misunderstanding the nature of CiCs can lead to decisions being challenged.
• Balancing interests: Ensuring that no Trust is disproportionately affected by joint decisions is critical.
• Cultural alignment: Differences in organisational culture can hinder effective collaboration. 

The NHS 10-year plan and the future of committees in common

The NHS 10-year plan sets out a bold vision for transforming healthcare delivery, with a focus on shifting care from hospitals to communities, embracing digital innovation, and prioritising prevention over treatment. To achieve these ambitions, the plan calls for coordinated, bottom-up action and collaborative planning across organisations and sectors. 

This emphasis on local leadership, integrated planning, and cross-sector collaboration is likely to drive increased use of CiCs. As NHS Trusts and Foundation Trusts seek to align strategic goals, pool resources, and deliver joined-up care, CiCs offer a practical governance mechanism to support these efforts. 

Comment

CiCs represent a pragmatic and increasingly popular approach to collaborative governance in the NHS. By enabling Trusts to work together while retaining autonomy, CiCs support the delivery of integrated, efficient, and patient-focused care. As the NHS continues to navigate complex challenges, models like CiCs will be vital in shaping the future of healthcare governance.

If you're considering a CiC our specialist team can support you. Get in touch with Rob Day for a no obligation conversation on the steps involved and how we can help.