Enough talk about system leadership, time for action

When “system leadership” first came to prominence about 10 years ago it was seen as the best way to tackle some of health’s most wicked issues. Leaders working collaboratively across the system – across organisational boundaries, it was argued, were essential to successfully addressing challenges like rising obesity and comorbidity that defy a single organisational response.

Not fit for purpose

Far from being solved, these wicked issues have remained unresolved. Why? Because our approach to leadership hasn’t been fit for purpose.

In too many local health systems, leadership is inward looking, competitive and driven by institutional performance. Too often health and social care services remain fragmented and disjointed.

The NHS long-term plan is ambitious about the integration of care, and the potential of new models of care to overcome the most complex problems we face. The plans for developing system leadership need to match this ambition

The NHS People Plan is a tacit acknowledgement that past efforts have fallen short. It says, “we must do more to foster systems-based, cross-sector, multi-professional leadership, centred around place-based healthcare that integrates care and improves population health.”

What needs to be different this time? First, we need more boundary spanning leaders. This means deliberately creating leadership roles that encourage people and organisations to collaborate. Roles that shift people’s focus onto places and populations, rather than on organisational performance metrics.

In Hertfordshire and West Essex Sustainability and Transformation Partnership, which I chair, we have appointed a leader from one of our clinical commissioning groups and a leader from local government social care to share the STP lead role.

It’s early days, but I believe this sharing of leadership between the NHS and local authorities will help to break down barriers, accelerate progress and model system leadership behaviours. I believe we need more roles shared by organisations, accountable to place-based partnerships rather than single organisations.

Second, we need to develop and support our leaders differently. Our leaders must be equipped with the skills they need to work across boundaries: building relationships and trust, negotiation and sharing power, collaboration and facilitation.

In a new report for NHS Leadership Academy, SCIE looks at lessons from two innovative place-based leadership programmes: Frimley 2020 Leadership Programme (based in Frimley Integrated Care System) and Leaders in Greater Manchester, and both show a potential way forward.

Unlike traditional approaches, these two programmes deliberately lock their focus on place rather than organisations. In each programme, participants are encouraged to work together with other leaders on a place-based challenge to learn how to use the strengths of those living and working in the place to make lasting impact.

Each intentionally involves a mix of healthcare professionals, and participants from social care and the voluntary sector. External evaluations of these programmes are positive; Frimley 2020 won an HSJ award. However, the overall reach of these programmes is limited.

I am a firm believer that leadership of systems can only improve if decisions are grounded in the experiences of those who receive care and wider communities. So third, there is a need to up our investment in skilling up our leaders in citizen engagement – in genuine co-production. This means equipping people with the capabilities to involve people throughout the planning and delivery of services.

The NHS long-term plan is ambitious about the integration of care, and the potential of new models of care to overcome the most complex problems we face. The plans for developing system leadership need to match this ambition.

That means sustained investment in place-based leadership – including involving leaders from beyond the NHS – the creation of more boundary spanning leadership roles and the development of a cadre of leaders committed to co-producing the solutions with citizens.