Evaluating the first place-based programmes for systems leadership

Back in July, on behalf of Public Health England, I signed a memorandum of understanding with NHS England and the Greater Manchester Combined Authority. Together, we have undertaken to unite public health leadership across Greater Manchester. Partly, we have done this so that we can better focus our preventative and targeted work to help people to stay healthy, be able to work and have a better family life.

This reflects Public Health England’s strategic priorities, especially as they relate to helping people live as well as possible, for as long as possible.

I also fundamentally believe that if we are going to make the transformative changes in health and care that citizens want and need, we need to focus our efforts on places, and on making change happen at a local level. This is at the heart of what we’re seeking to deliver through the NHS Five Year Forward View. To succeed we need organisations to come together and plan collaboratively on a geographic and population basis.

But how do individuals and organisations make this happen when the issues they face are complex and multi-layered, when there is no single leader or simple solution, and when they need to bring together people with different perspectives and priorities?

‘The aim The aim of it is to transcend individual organisational interests and work together on the basis of a shared ambition’

It takes a particular style of leadership: systems leadership. Systems leadership is about how you lead across boundaries – departmental, organisational or across sectors. It describes the way people need to behave when they face large, complex, difficult and seemingly intractable problems. Where they need to juggle multiple uncertainties; and where no one person or organisation can find or organise the solution on their own. Where everyone is grappling with how to make resources meet demand which is outstripping them; and where the way forward therefore lies in involving as many people’s energies, ideas, talents and expertise as possible.

Grappling with complex issues

Systems leadership is particularly relevant for people involved in integrating complex services around individuals across health, social care, housing and other sectors. The aim of it is to transcend individual organisational interests and work together on the basis of a shared ambition, with a view to making progress towards better outcomes in a particular place. It’s a practical, grounded approach to integrated working and long-term behaviour/culture change.

Over the past three years, there has been a national systems leadership programme, backed by Public Health England and also by (among others) NHS England, the NHS Confederation, Monitor, the Local Government Association, local government’s leadership Centre, Skills for Care, the Children’s Services’ Virtual Staff College, and the NHS leadership Academy.

Alongside commissioning national and international research on ‘what works’ in systems leadership, and supporting joint learning and development in programmes like leadership for Change, we have helped places around the country that are grappling with complex issues around integration and population health, through a programme called systems leadership – Local Vision.

Knit and quit

Improving the public’s health has been the main driver for these projects, and as the report demonstrates the evidence that using systems leadership has supported real change and progress. In Gloucestershire, a programme to reduce inter-generational obesity has had an impact by focusing as much on opportunities to take part in healthy activities in the community, such as a food co-operative and a ‘knit and quit’ smoking cessation group, as on traditional approaches based purely on diet.

‘These results are real, measurable, and capable of having a profound impact on both health services and health finances’

In Torbay, which has a relatively large eldery population, the local public health has worked closely with Healthwatch and with people living with dementia, with service users in the lead, to promote the ‘Purple Angels’ scheme to increase dementia awareness across local businesses and services. And in the West Midlands, local Directors of Public Health have come together with the regional PHE team to find new ways to tackle TB levels across the region.

The results are compelling. In Plymouth, for example, a project to reduce alcohol abuse has seen not only fewer alcohol-related hospital admissions, but also a drop in the number of children going into foster care as a result of parents having alcohol problems. These results are real, measurable, and capable of having a profound impact on both health services and health finances.

The work has now expanded to some 50 places around the country, including for the Health and Social Care Integration Pioneers, and more Local Vision projects, especially in relation to devolution and to supporting behaviour change.

Essential tools

I am delighted to launch the report today which gives us a clear evidence base, through independent evaluation, that systems leadership can shift behaviours, mindsets and therefore what happens in services and people’s lives.

So as Nick Timmins said in his recent report for the King’s Fund (The Practice of System leadership: being comfortable with Chaos. King’s Fund, May 2015), systems leadership “has become less of a ‘nice to have’ and more of a ‘must have’.” I believe that systems leadership, and the work of the national systems leadership programme, are now essential tools in our armoury as we strive to create, despite all the challenges that we face, the health and care systems of the future.

Duncan Selbie is chief executive of Public Health England