The planned expansion of Integrated Care Systems (ICSs), coming on the back of Health and Social Care Secretary Jeremy Hunt's speech about the importance of whole-person integrated care, has the potential to injected new urgency and momentum into the quest for much more integrated, person-centred care.
As these ICSs take shape, there is likely to a significant amount of commentary about the structural changes that come with the bringing together of different NHS organisations with local government. There will be talk of new contracts and commissioning; who holds the money and who bears the risks. Important stuff, but it is more likely that the most important determinant of a local areas’ success, will be quality of leadership across organisations, rather than any one of these other factors.
No room for heroes
Leading one organisation in such challenging and financially straitened times is one thing; leading a complex mix of local health, social care, provider, housing and voluntary sector organisations is quite another.
But ISCs require no less than this is required from our leaders if ICS’s are to bear fruit. Chris Ham of The King's Fund, writing recently about ICS, argued that collaborative rather than heroic leadership holds the key to progress. He is right. It will require leaders to look beyond the boundaries of their own organisations to find solutions, to their partners who will each have something to give, but equally will fear they have something to lose. Leaders in this context, therefore, have to be effective negotiators who have to be are willing to both cede power and take the lead where necessary.
Partners increasingly important
As David Pearson, Deputy Chief Executive at Nottinghamshire County Council and ICS lead in Nottinghamshire, recently told us:
“System leaders probably spent 10-20% of their time on partnership activity ten years ago. Now it needs to be 50% to focus effectively on collective aims.”
So they need also to be adept at understanding how to join up complex policy drivers, and interpret what this means for the local system. David says that locally, good system leaders are ‘translators’, making sense of disparate policy drivers, legislation, performance requirements, regulatory systems and funding mechanisms.
But the demands of leaders in integrated systems is ever-evolving, and that is why SCIE is delighted to have the opportunity - in collaboration with the Wessex and Thames Valley NHS Leadership Academy - to research what good systems leadership looks like in the age of ICSs; to be published in September.
In places where public services have been improved, leadership has always been a collective effort. In the age of ICSs, it is likely to become more so.
Ewan King is director of business development and delivery at the Social Care Institute for Excellence (SCIE).