Successful working across systems……the role of Trojan Mice Deborah McKenzie Director of Organisational and Workforce Development 17th March 2016

Trojan mice are….. small, well focused changes introduced on an ongoing basis in an inconspicuous way small enough to be understood and owned by all concerned their effects can be far-reaching collectively a few trojanmice will change more than one Trojan horse ever could With thanks to Peter Fryer at trojanmice.com

The NHS challenge Presentation title - edit in Header and Footer Potential gap Source: Adapted from Nuffield Trust presentation 3 Presentation title - edit in Header and Footer Strategic Review

Public Health is part of the answer, as is integration with NHS The Local authority challenge Within 20 years, councils will be unable to provide any services except adult social care and children's services From Barnet Council Driven by an ageing population which is not ageing healthily, and increasing expectations Public Health is part of the answer, as is integration with NHS 4 Presentation title - edit in Header and Footer

Our world is increasingly complex

Thinking about systems: making sense of what we see A system: a set of individuals, organisations or bodies working together or interacting in some way as part of an interconnecting network; a complex whole

A few interested people…..

24th July 2012: Our seminar http://www.nhsconfed.org/Documents/Shared%20L eadership%20for%20Health%20and%20Wellbeing. pdf

Shared endeavour…..

An idea….. To create the conditions in which system wide leadership can flourish

Thinking about leadership: making it practical through the way it’s defined Not just about authority at the top of organisations It’s a practical understanding – and awareness – about how you do what you do, and the impact on others So it’s about behaviours, and taking responsibility for them And it’s everyone’s business – people working at all levels in all sectors It therefore enables you to lead across organisational boundaries “

Systems Experiments: our hypothesis: Real development happens when we work with leaders in their community on a challenge that matters to them Enabler “Wicked issue” Clumsy solutions Leadership across the community/Place Behaviour matters…….. OUTCOMES Presentation title - edit in Header and Footer

First wave, September 2013

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Examples of progress from Local Vision Programmes Cornwall: outcomes include: Much more connectivity; multiple initiatives to help people cook and eat well on a minimal budget, e.g. cookery classes in food banks; more allotments and food networks; developing a skills-based food curriculum for schools In Cheshire West and Chester, a Local Vision project that started out as focusing purely on older people and social isolation expanded, through their going directly to local communities, into a much broader project, with at least 12 different groups of people identified as facing isolation and loneliness. Joint approaches and involvement of housing associations, faith-based groups, local schools and local businesses led to their playing a central role in the project, and to the development of a new umbrella programme, ‘Our Place’ to take the work forward – in other words, this was about a local authority ceding leadership to those better able to take it forward on the ground. Similarly, in Cornwall, where the Local Vision programme was about how to alleviate food poverty in a place where agriculture and fisheries were the main activities, there has been real engagement – again, driven by Public Health – with communities, with much more connectivity between producers and consumers, and between different groups working on the ground, along with a drive to develop food knowledge and cookery expertise for people living on an absolute budget.

Examples of progress from Local Vision Programmes Wakefield: outcomes include: Development of integrated model of health and social care across population; new multi-professional and multi-disciplinary team based around GP practice populations; single point of access and care plan; new network hubs established Wiltshire: outcomes include: Health and social care coming together in overall Systems Resilience Group; three demonstrator sites for integration starting; looking at longer-term partnerships with vol. sector and better T&Cs for social care Not all the Local Vision programmes have worked, but the vast majority have seen progress on some seemingly intractable issues, and some have really motored. Wakefield is now establishing and rolling out its integrated model of care, with network hubs based around GP practice populations and multi-disciplinary teams. In Wiltshire, similarly, they are trialling integrated care across three demonstrator sites; have a new model of home care that is enabling the local authority to fund permanent contracts, better salaries and pension contributions for care workers; and are looking to establish longer-term relationships with the voluntary and community sector, with three-year contracts and clear outcomes agreed. Wiltshire is also an example of where the Director of Public Health has played a central, driving role in getting this in place.

How it feels to be a systems leader

What makes a difference? Values driven – align around shared ambition Drive to deliver outcomes Humility, passion to learn Courage to experiment Seeking diverse perspectives, build engagement, cede power Suspending certainty, embracing uncertainty Taking adaptive action

Start slow to go fast….

Alliance for Systems Leadership

Conclusions…… It’s complex! Shared purpose matters Relationships matter Trust matters It’s complex!

Systems Leadership – more information www.localleadership.gov.uk http://www.localleadership.gov.uk/docs/The%20Art%20of%20 Change%20Making.pdf The Future will be Improvised - http://tiny.cc/revolution Virtual Staff College research - http://tinyurl.com/VSCSEC Pioneers One Year On report: http://tinyurl.com/olfozgx Leadership for Change – www.leadershipforchange.org.uk

The Future…… “We are now in the midst of a quiet but powerful revolution….” “Up and down the country more and more places will be exploring and prototyping the new model for systems or place leadership - tackling old problems in new ways together” Martin Reeves, MJ May 2013