The ICS leadership challenge part 2 - Professor Andrew Corbett-Nolan

By Andrew Corbett-Nolan, Chief Executive of the Good Governance Institute.

Last week, Andrew Corbett-Nolan listed some of the key priorities facing ICS leaders. With so much to do in the first 100 days or so, prioritisation is vital, he said. This week we focus on the importance of engaging clinical leaders in ICS decision-making and setting a strategic vision for the system.

First and foremost, system leaders have to understand how systems work. That grounding is fundamental for all ICS chairs and chief executives and their executive teams.

That was the premise of the first part of this short series of blogs on ICS leadership priorities for the critical 100 days or so in the run-up to April. As is always the case when mastering anything, we must start with the basics and develop from there.

Beyond this grasp of the vital banalities of system governance - understanding how decisions are made and taken, knowing where assurance comes from and so on - in part one we wrote about the importance of ICS chief executives and chairs investing in their development as a critical axis of strategic system leadership - the ‘two at the top’ - and also about cultivating the right culture, getting the fundamental governance frameworks and structures in place and starting as you mean to continue. If you haven’t read that piece yet, it is probably worth circling back to it now.

So what else should be at the top of system leaders’ in-trays right now?

Building relations with clinical leaders

A key facet of effective system leadership is favouring influence over imposition, relying on skills to engage, persuade and build strong relations around trust rather than on the command and control of positional authority. Good system leaders guide learning rather than enforce controls. They understand the importance of communication with key players and ensuring that they are fully aligned with system goals.

One of the most important stakeholder groups to have on board with the system’s strategic vision and its operational priorities is frontline clinicians.

In its response to the government’s development plans for ICSs, the British Medical Association stressed the importance of ensuring there is ‘demonstrable engagement with frontline clinicians and the public’ – a view reinforced by the NHS Confederation and NHS Clinical Commissioners in a letter to Edward Agar MP, the health minister earlier this year.

In our work with ICSs we’ve seen first-hand the positive impact of developing strong relationships with clinical leaders in the system. Not only are these critical channels into place and provider collaboratives, they are also great sources of information about population health and operational challenges. It is only by bringing on board the brightest and best clinicians and encouraging them to feel bonded to the mission of the ICS that genuine transformation will be possible.

The real challenge for ICS leaders is to get clinicians to embrace the principles of collaborative working. To encourage, empower and upskill them to engage effectively with a wide range of colleagues and build consensus, be open-minded and seek out innovation. In this transition, clinical leaders will have to find ways to combine the three key skills of inclusive leadership, clinical expertise, and effective stakeholder engagement during a period of great change and intense pressure on the health and care system. To do all this, they will need development and support.

A good way to build these relationships and foster this engagement is to get them actively involved from the outset in some fundamental aspects of system governance. It will help to demonstrate effective and transparent governance to them, ensuring that decisions made by the ICS are informed by clinical evidence and good practice. And to show your commitment to making the best use of digital advances and clinical research and creating the best conditions for high clinical standards and excellent patient outcomes.

Strategic vision, narrative shaping and risk appetite

The period between now and April is vital in terms of setting the strategic vision, agenda and narrative for ICSs. We are getting to the crunch point ahead of the final SDP submission early next year when decisions need to be made by system leaders about just how ambitious they are going to be.

In ICSs across the country, we are seeing differences between ICS leaders taking a more pragmatic strategic approach around incremental developmental change and those backing bold ambition of rapid wholescale transformation. Part of this comes down to risk appetite. The best system leaders are already having candid discussions around questions such as:

• How far are we prepared to go?

• What is it that we are going to do that is going to be markedly different?

• Are we prepared to back subsidiarity?

• How much are we prepared to delegate to place and under what conditions?

There isn’t a right or wrong here, systems are at different stages of development with different contexts. Whatever the strategy, there needs to be complete alignment across system partners, with everyone pulling together to achieve system goals and outcomes. This requires a step-change in strategy and planning approaches in ICSs. System strategies need to be clear and concise, with credible plans and resources flowing with the aspirational objectives of improving population health and outcomes. Provider plans need to be more outward focused, and board assurance frameworks need to consider and align with system risks.

Part of this planning needs to be about developing a realistic timetable for considering delegation to place. There is a real risk that ICSs either go too fast, or too slow, frustrating relationships and undermining the good work done to date. A structured and measured approach to delegation, which considers both the maturity of the ICS and the place-based partnership, is an essential component of the strategy and needs the backing of system partners.

In the next part of the series we’ll look at ICB and ICP board development, community and partnership engagement and understanding population health.

In the meantime, if you have any comments or questions about this blog, please please call us on 07732 681120 or email advice@good-governance.org.uk.