Background Following the 2012 Health and Social Care Act, Local Authorities became responsible for the provision of Sexual and Reproductive Health services. Birmingham City Council and Solihull Metropolitan Borough Council redesigned their service and introduced an integrated, lead provider model through Umbrella Health.

Study aims This study was the first qualitative study to explore the experiences of the commissioning and redesign of the innovative Umbrella model. The study aimed to understand the impact of the Health and Social Care Act and cuts to funding on the provision of contraceptive services in Birmingham and Solihull.

Methodology The methodology is founded on Realist Evaluation, exploring data gathered from the thematic analysis of 12 semi structured, one-to-one, qualitative interviews.

Findings Through re-design and innovation, the introduction of Umbrella has improved outcomes in a time of uncertainty and austerity. For Umbrella those individuals involved in commissioning and service redesign have been key in driving a shared vision for change, as has the culture of collaboration and partnership working.

Conclusion The Umbrella model has achieved greater efficiency, cost savings and reinvestment opportunities, while re-introducing accountability and a strong clinical governance framework through collaborative commissioning, innovative leadership and a shared vision for change.

While this study has its limitations, it provides insight into the experience of Umbrella in evading the detrimental impact of cuts to funding, while operating in an environment of austerity, offering advice and direction for others in this challenging time and raises considerations for the future.