What is the most difficult job in England right now? Minister for Leaving the EU? Chief executives of Network Rail? There are many candidates.
But I would argue it’s more likely to be when you’re a senior leader within Integrated Care Systems (ICSs); that is, areas that are testing how to plan and deliver better care and support for whole populations across large and complex health and care systems.
To combine two management clichés into one sentence: Leaders need to have a good grasp of the big picture, whilst also keeping their feet firmly on the ground.
This is because NHS England wants ICSs to fulfil two main roles: The delivery of strategic reforms across large geographical areas through better joint commissioning and collaboration between providers; and championing person-centred, coordinated care for people near where they live.
People not structures
It’s this second role I want to explore. If there has been one persistent criticism of ICSs, and Strategic Transformation Partnerships, it is that they are too distant from the people they are meant to serve; perhaps more focused on structures than people. As we argue in a new paper for NHS Leadership Academy on leadership in ICSs, it is vital that leaders are able to combine a strong focus on making complex governance and structures work, whilst focusing on the needs of people and communities.
How can they best do this? Firstly, by being committed to co-production at all levels in the system; involving people in the design, planning, commissioning, delivery and review of services. This approach best enables a strong focus on what matters most to people.
Secondly, leaders need to be driven by a relentless focus on impact and outcomes. We recommend here that leaders use the Making it Real framework to guide decision making. This framework, developed by Think Local Act Personal with people who use services, helps leaders think through how they can deliver more personalised care.
Finally, it’s about ‘thinking local’. Care is increasingly delivered in very local neighbourhood teams or hubs. In these hubs, practitioners are working together to coordinate and plan care and support around people who most need it. System leaders need to be thinking constantly about how they can support, share learning from and further develop this way of working, e.g. through devolving budgets to local teams or by creating better digital platforms.
Is systems leadership a difficult job right now? Most definitely. And there are so many distractions and competing pressures for time and attention. But focusing continuously on what matters most to people is the key to making a huge difference to people’s life experiences and outcomes.
SCIE: Leadership in integrated care systems: Report prepared for the NHS Leadership Academy