Leading integrated care systems: from heroic to humble leadership

Integration has been the Holy Grail of social care and healthcare for decades. But, like the Holy Grail it can mean different things to different people. All too often the focus is on systems and institutions rather than people and places.

Finding the integration Holy Grail is one of the quests of the sustainability and transformation partnerships. Progress so far? Mixed. STPs are grappling with the here and now pressures of a system running hot whilst incubating new models of care and contemplating new organisational forms.

Over the next few weeks we will hear more about the new NHS Plan’s ambitions for integrated care systems and alliances. NHS England’s national director for transforming health systems, Michael MacDonnell, has said that the spread of ICSs will be “supercharged”.

While it is unlikely in the near future that ICSs will take statutory form, they are likely to be given more weight in planning guidance, trust licence conditions and contracts.

But regulating for new behaviours will not be sufficient to breathe life into new ways of working, especially as the NHS writ does not run in Town Halls.  

ICSs are likely to be given more weight in planning guidance, trust licence conditions and contracts

So as the move towards ICSs takes shape and gathers momentum, how do we move from “paying lip service” to making integration the new business as usual?

How do we mobilise the action necessary to shift the system from chasing ever increasing demand to delivering proactive population health?

That is the question the Social Care Institute for Excellence, working with the NHS Leadership Academy, are seeking to answer in a new research report that examines the skills and behaviours that form the building blocks of effective system leadership.

Over the past couple of years, SCIE has been leading work to create tools to help system leaders to think clearly about integration; starting from the perspective of the citizen and what matters to them to deliver person centred coordinated care.

Last year, SCIE published its Integration Logic Model to help frame the choices in designing integrated models of care. Coproduced with people with lived experience of services and professionals, the model informed the framing of the lines of enquiry in the Care Quality Commission’s local system reviews.  It has informed our work for the NHS Leadership Academy too.

Essentials for success

So, what do successful ICS leaders need?

With no basis in law, ICSs are dependent on collaboration and the rate limiter for success is trust. Accurately gauging the level of engagement of institutional leaders, and their willingness to work together, is critical.  

As Nottinghamshire STP lead David Pearson puts it: “Systems leaders probably spent 10 to 20 per cent of their time on partnership activity 10 years ago. Now it needs to be 50 per cent to focus effectively on collective aims”.

ICS leaders must be able to navigate a complex interconnected “system of systems”; recognising the role of local government, not just as a delivery partner but also as a legitimate democratic actor and shaper of place.

It is about understanding the pressures on NHS organisations from the frontline to the boardroom.  And it is also about bringing the community, voluntary and independent sector into the room as partners not supplicants.

ICS leaders must be able to navigate a complex interconnected “system of systems”; recognising the role of local government, not just as a delivery partner but also as a legitimate democratic actor and shaper of place

Building trusting relationships and finding common purpose are key so that common purpose is translated into institutional action. The heavy lifting has to come from those with the statutory authority.

The business of STPs and ICSs has to be mainstreamed and become part of Board Operational Plans and Assurance Frameworks.

But to take root, the mission of ICSs must be understood and part of the day job of middle managers and practice leaders across the system.  Successful ICS leaders make sure that the right People Development Plans are in place to support systems working and integration.

Perhaps the biggest challenge is to make the change from heroic leadership to humble leadership. Recognising that healthcare is just part – an important part – of a complex ecosystem where traditional command and control has no place.