Leadership in Integrated Care Systems

20 November 2018

New report from SCIE

It’s challenging but also exciting: it puts you on a personal footing with the work that you do

Christina Quinn, Director, Leadership Academy

Our health and care system is experiencing unprecedented pressures. The population is rising and ageing, and more people are living with complex and long-term conditions. Funding is hugely constrained and there are vacancies and skills gaps across the workforce.

However, Sustainability and Transformation Partnerships (STPs) are now working to improve services. Where strategic partnerships and collaboration are most advanced, STPs have now developed further to create integrated care systems (ICSs) – where NHS commissioners, providers and local councils work collaboratively, taking collective responsibility for resources and population health.

New research published today

The NHS Leadership Academy commissioned the Social Care Institute for Excellence (SCIE) to undertake research to further expand the understanding of systems leadership and leadership of integrated care systems. A new report, published today, sets out the findings from this research and makes recommendations on how system’s leaders are given the support they need as these new ways of working evolve further. It’s the latest Future of Care Report from SCIE. It’s aimed at chief executives, directors and senior managers from the NHS, local authorities, housing organisations and voluntary and community sector.

What is systems leadership?

For decades, it has been widely agreed that breaking down organisational barriers, through better integration, has the potential to deliver higher quality care that achieves better outcomes and uses resources more efficiently. Yet this goal remains elusive in practice. The report, 'NHS moves to end "fractured" care system' (NHS England, 2017) says that ICSs are a critical part of the biggest national move to integrating care of any major western country.

SCIE’s Chief Executive, tony Hunter, says:

Too often leadership is seen as something that goes on in ivory towers. Changing to systems leadership might seem quite daunting to some leaders across health and care but during the research for this project we’ve been consistently told it’s the right thing to do. When leaders in all the various public bodies have great relationships and work together with local populations, it’s a great way of addressing the need to continually improve people's lives.

Being a skilled leader

The research reveals that leaders in ICSs need to be skilled at, for instance, identifying and scaling innovation; having a strong focus on outcomes and population health; and building strong relationships with other leaders, which can often mean working with them informally to develop joint priorities and plans. They can also establish governance structures which drive faster change, often going where the commitment and energy is strongest.

It’s important that you have self-belief that you’re doing the right thing

Jackie Pederson , Chief Officer, Doncaster Clinical Commissioning Group

Relationships are key

With no basis in law, ICSs are entirely dependent on a collaborative approach to leadership and a willingness on the part of the organisations involved, to work together. Leaders of ICSs told us that they spend more time than ever before developing good relationships with colleagues and, as part of this, trying to listen to and empathise with their concerns and issues. Often these relationships are fostered outside formal meetings, with lots of ‘pre-work’ on the phone or over coffee to prepare for more formal partnership meetings.

We need to learn to walk in each other’s shoes; building relationships through changes that need to be made

David Pearson, Corporate Director, Adult Social Care, Health and Public Protection and Deputy Chief Executive at Nottinghamshire County Council.

Policy context

The 2014 NHS Five year forward view represented a major policy shift away from a competition-based model of health care, towards collaboration and integration. It recognised that organisations working together, sharing know-how and resources, are more likely to meet the significant challenges of rising demand, limited funding and the need to improve outcomes and patient experience. The first 10 ICSs vary considerably in geography, demography, population size, drivers for change and number of partners involved. But they also have many characteristics in common, for instance: They are collaborative - involving NHS commissioners, providers, GPs and local authorities; they are place-based; and they adopt a population-based approach.

Case study: Frimley ICS

Frimley ICS set up a review of the way care was provided for people with frailty or complex needs. The review involved Clinical Commissioning Groups, the local authority, NHS foundation trusts, the ambulance service, patient groups, the voluntary sector and the local community. A new vision of care created a new model and a set of guiding principles which have shaped the collaborative work of health and care organisations in East Berkshire and Frimley - and have become part of Frimley ICS. The vision embraces: Promoting health, wellbeing and the quality of lives; respecting choices and capabilities - and encouraging people to influence the care and support they receive; and helping people to maintain independence for as long as possible.

Logic models

Leaders told us that one core skill is about translating complexity – such as a set of complex policies and initiatives – into something that is easy to communicate and can be used to build commitment for change. This could include, for example, creating logic models or plans on a page to explain why change is needed - and how different activities are intended to bring about that change. The SCIE Logic Model for Integrated Care, which we developed for the Department of Health and Social Care, seeks to capture a complex system into a single page.

Notes to editors

NHS Leadership Academy’s support for systems leaders

The NHS Leadership Academy seeks to equip leaders of integrated care systems, and other whole-systems approaches to integrated health and social care, with the skills and capabilities to transform health and care.

Press Contact

Email: media@scie.org.uk
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