Future of care: Leadership in integrated care systems

November 20, 2018

The latest in SCIE's Future of Care series has set out the findings of research into leadership of integrated care systems. It also makes recommendations to support systems leaders.

Leadership in integrated care systems, commissioned by the NHS Leadership Academy, comes as Sustainability and Transformation Partnerships (STPs) continue to work 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.

The Social Care Institute for Excellence (SCIE) undertook the research to further expand the understanding of systems leadership and leadership of integrated care systems. The report, published today, makes recommendations on how systems leaders are given the support they need as these new ways of working evolve further.

This latest Future of Care report is aimed at chief executives, directors and senior managers from the NHS, local authorities, housing organisations and the voluntary and community sector.

Breaking down organisational barriers, through better integration, is generally seen to have the potential to deliver higher quality care that achieves better outcomes and uses resources more efficiently. Yet this goal remains elusive in practice, according to SCIE.

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.'

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.

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 SCIE 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. The research found that, 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.

SCIE says that 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. They are collaborative – involving NHS commissioners, providers, GPs and local authorities; they are place-based; and they adopt a population-based approach.

During the research for the Future of Care report, leaders told SCIE 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. The SCIE Logic Model for Integrated Care, developed for the Department of Health and Social Care, seeks to capture a complex system into a single page.

More information and the full Future of Care series can be found on the SCIE website.

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