Seven strategic objectives to prioritise in the New Year - Mark Butler

GGI Executive Director Mark Butler sets out the seven strategic priorities for the leaders of public sector organisations to realise the potential of integrated care systems.

Anyone invested in the future of health and care wants to see the new system working to achieve its potential as a meaningful vehicle to transform health and wellbeing. Moving back the go-live date by three months recognises the huge leadership challenge involved in getting the foundations right in the face of other pressing demands on time and capacity.

Much is already being done to fashion new system working. But even extra time is unlikely to be enough for systems to be set up with the right ambition, focus and momentum they need. The difference will come from facing down this fundamental strategic risk on focus, capacity and expertise.

As the newly appointed system leaders start to come together in the next month or so, their New Year leadership is about mobilising the relationships, resources and expertise to secure the right system arrangements from the start. Work on crafting a credible, shared local ambition has been happening in many places, but what will really make it land?

Even securing a smooth transition involves finding solutions to complex embedded problems of culture and governance. It is clear that these now more than ever require dedicated expertise and specialist skills. If the aim is to provide a foundation for transformation this is even more so the case.

GGI is already supporting ICSs all over the country with this important work. There are seven critical areas where GGI can help build on the work done so far in systems and help local leadership meet the very specific demands placed on them in this small window of opportunity over the next few months:

Turning strategic intent into action. Many systems have already articulated a high-level commitment to a shared ambition for their local communities. The hard graft of overcoming traditional boundaries and settling on meaningful priorities and measurable outcomes in a way that translates into collective action and ownership is still a step or two away. This requires both hard-edged brokerage and clarity of how measures of impact can be landed, and keeping energised when the short-term pressures are all-consuming. GGI is doing this in some systems already as a trusted partner.

Growing integrated leadership. True system working demands a shift in leadership mindset and working, especially in the controlling mind for the system. This will not always be a comfortable transition from the current collaboration between partners ‘in the old world’. A true critical friend should challenge systems to test whether they are just accommodating all parties without really changing. Well thought-through board development will be a hallmark of any integrated board likely to succeed. Our experience suggests this can be most effective if initiated before the formal start date. This means now. Our personalised approach focuses on how the board needs to work collectively to achieve specific impacts. This includes working through the implications of potential conflicts of interest and responsibility and growing understanding of expected contributions, including through engagement and use of influence beyond the board itself.

Building the “two at the top”. Our approach is based on evidence of the high value of focused and personal support to just the chair and chief executive at the start of their work together. In a system growing the basis for trust, building mutual understanding of expectations and values is critical to do well and quickly. This can be difficult without the type of experienced support that is prepared to challenge which GGI offers as peers.

Shaping place-based governance – Developing place-based partnerships through provider collaboratives and thinking through how they are going to function is something we have spent time getting our head around. This is not easy territory and can be time-consuming and often not done at the right pace. This is one area where there is obvious added-value in having dedicated capacity and specialist expertise working to complement internal capacity to make sure focus is not lost. It’s an early decision to make this quarter.

Addressing system risk. Many systems have started to make headway on their system risk strategies and system assurance frameworks. We can help stress test and quality assure the work you have done to date to make sure your approach is sustainable and provides the best possible platform for success not just for go-live but beyond. Our approach is increasingly looking at how best to accommodate live learning from the pandemic and from other sectors.

Increasing system development. The chance of systems being transformed is only likely if “organisational development” is worked through early in a way that complements the structural and process changes in core governance. Lessons from our work in the past suggests that too little attention is paid to resourcing credible external support for new working relationships, communications, messaging and capacity building – all of which GGI is equipped to provide.

Preserving corporate memory. We recognise that many systems have momentum around the due diligence work associated with closing down clinical commissioning groups and deciding what should be handed over to ICBs. As people leave roles, corporate memory will soon begin to fade. We can help you safeguard this valuable resource.

Here to help

Negotiating this immediate period of set-up, challenge and change calls for the sort of expert support that the Good Governance Institute is providing in systems already. With more systems on board, we can help share best practice and learning and improve delivery.

We have contributed to the national conversation on integration can see its potential and understand how it can be achieved. We bring extensive experience of working with non-NHS partners in integrated care systems: education, third sector, local government, hospices, and the private sector. And no one understands core NHS governance better than us.

We are independent, thoughtful, ethical and practical. This is what is needed to work through the foundations of system success. We understand where we can enhance and complement what you are already doing, and where it is best to leave things up to you.

We can add real value at a time when it is needed. And we are ready to help.

If you’d like to find out more about how we can help, please call us on 07732 681120 or email advice@good-governance.org.uk