NHS England told us about the West Yorkshire collaborative, which it considers to be the most advanced and an example for how hospices in all ICB regions could work in partnership. NHS England pointed to the economies of scale and improved commissioning that the collaborative model enabled.66 Professor Murtagh told us that the Department and NHS England should be including collaborative working within the Modern Service Framework.67 However, although NHS England told us that forming a collaborative was perhaps the most effective first stage for groups of hospices experiencing financial difficulties, it expects hospices to take this step themselves and it did not signal any intention to encourage or support the creation of collaboratives.68 66 Qq 45, 48 and 51 67 Q 17 68 Qq 48 and 51 18