The aim of Integrated Care Systems (ICSs) is to provide integrated care across a range of settings. In doing this they link hospital and community-based services, physical and mental health, and health and social care in partnership. The ambition is in doing so to deliver the best possible outcomes for communities, citizens and service users and reduce health inequalities. It is a laudable ambition that makes great sense, in the abstract at least.
How this will be achieved is not yet known. However, research and conversations into the experience of the Covid-19 response offer tantalising evidence of what can be achieved when organisational and professional boundaries are transcended – and collaborative working is achieved. This crisis response, under huge pressure, offers glimpses of what may be possible and is not something that can be sustained. Nor would we want to replicate such extreme conditions and we know that gains and achievements made in this time are in some cases felt to be slipping away. What will it take to achieve the ICS ambition in a long lasting and healthy way?
There is no blueprint for realising the ambition of ICSs, no right answer or silver bullet. Every area has its own challenges and potentials, each service its strengths and vulnerabilities and each community its active players and marginalised voices. Across the different approaches, practices and cultures at play across the health and social care landscape there is great breadth and depth, and simply stating that these have a ‘duty to collaborate’ is just a beginning in achieving successful collaborative working that makes a difference.
For ICS leadership, the challenge is complex and nuanced. To play a part alongside others to surface and combine the assets each partner brings to address health and social issues in a joined-up way will stretch even the most experience senior leader. It will mean building vision that holds meaning for all parties, developing working practices that actively respect and value difference and creating robust decision-making forums that deliberately acknowledge and disrupt traditional power structures.
These ways of working will undoubtedly lead to, and have already led to, uncertainties and anxieties that can be stifling and lead to behaviours, beliefs and feelings that are not conducive to the greater openness, trust and sharing that partnered working requires. Partnership is hard at the best of times. The long term and more recent strains on health and care may have created fragmentation of relationships as well as provision.
Real partnership, with genuine shared responsibility, requires a capacity to think up and out across a wide unwieldy picture; it requires knowing and seizing our influence whilst relinquishing control and giving space to others; and it may well require us to be willing to acknowledge and work through the stories and anxieties we bring to our interactions with others we aim to collaborate with.
Hard work and, potentially, hugely fruitful. The impassioned stories of achievement throughout the Covid-19 response and the many stories of hugely impactful work done in communities and partnerships show us the great potential for improving services, reducing inequalities and shifting mindsets on what health and care provision means and looks like.
While none of us hold the answer for how to ‘do’ ICSs well, there is much we can learn from our own experience and that of others, as well as practical theory-based models, skills and techniques to build connection and make progress, together, from a place of ambiguity and uncertainty. In doing this together we practice and develop our capability to work in partnership while developing relationships, ourselves and our community, first identifying the best questions to approach before seeking answers from elsewhere.
The Kings Fund Masterclass series aims to create space for those stepping into leading in the ICS partnership space to acknowledge and explore the challenge ahead, sharing and learning with senior people from across the integrated system.
The Kings Fund Masterclasses for NHS England and NHS Improvement Executive Suite
Unlocking partnership potential: creating new possibilities through (or in?) ICSs
As the legislation for ICSs goes through the associated leadership challenges – and opportunities – come into sharper focus. Leaders across the health and care system are faced with the unrelenting demands of their own organisations coupled with the need to create and refine new models of working in partnership with those beyond, at a neighbourhood, place or wider system level.
This masterclass series creates space and sheds light on the key considerations for those in executive or senior roles within the NHS, Local Authority and voluntary organisations, wanting to get clearer on the mindset, skillset and behavioural shifts required to:
- notice and balance the tensions of leading an organisation and bringing impactful leadership to a wider system
- build robust and effective partnerships based on a genuinely shared vision
- acknowledge and use power collectively with others to create the conditions for new possibilities to surface, and old patterns to be broken
The series is best experienced as a whole however each masterclass can also be booked individually.
Masterclass 1: Systems leadership in practice
- We will revisit key thinking about systems and more importantly identify and reflect on the core capabilities needed to effectively make the shift from might be something of an ego-system to an eco-system. We’ll make time to consider individual priority areas to pay attention to as leaders.
Masterclass 2: Generating collaborative possibility
- Here we will focus on the behaviours and practices that support meetings and other interactions to be conducive to generating new thinking and action collectively. We’ll identify how we can build shared awareness of how we are engaging in discussion and benefiting from different perspectives. We’ll also consider steps for positively disrupting stuck patterns of communication.
Masterclass 3: Balancing power and influencing in partnership
- This final session will consider the complex and nuanced territory of power and genuine partnership as we explore how leaders can create the conditions for sharing power within and beyond meetings in Partnership Boards, for example.
Co-hosted by consultants from The Kings Fund, each two-hour masterclasses will include a combination of models and concepts as stimulus for peer-based reflection and discussion alongside practical insight and activities.