in Integrated Care Systems Systems Leadership in Integrated Care Systems Ewan King, Social Care Institute for Excellence LeadersFest 7 November

Agenda Key messages from the research, including how to work effectively with social care, VCS, and citizens. Group work around scenarios to explore how leaders would respond to different systems leadership challenges. Identify key practical next steps for local systems leaders

About the research The NHS Leadership Academy commissioned SCIE to undertake this research to further expand the understanding of systems leadership and leadership of integrated care systems. This research will inform the Leadership Academy’s long-term plans for supporting leaders in integrated care systems. Literature review - 52 sources of evidence Interviews with 18 ICS systems leaders. Research explores: Barriers and facilitators Features of effective systems leadership Examples of good practice How to access support and resources.

Supercharged systems leadership In ICSs, systems leadership that has been ‘supercharged’ – encompasses more complexity, broader span of influence and stronger focus on longer term. “Locally, good system leaders are ‘translators’, making sense of disparate policy drivers, legislation, performance requirements, regulatory systems and funding mechanisms.”

Different areas of focus Increased span of influence - housing, social care, VSC, primary, mental health Growing expectation that citizens shape local plans Re-emergence of place-based thinking Requirement for expertise in large-scale change and scaling innovation Increased emphasis on sharing resources and financial risk Need to deepen systems leadership- Bringing the next two tiers of management along on the journey Issues even more wicked than before - estates planning, out- of-hospital, workforce, prevention, winter pressures

Building strong relationships with other leaders “System leaders probably spent ten to twenty per cent of their time on partnership activity ten years ago. Now it needs to be fifty per cent to focus effectively on collective aims.” David Pearson, Lead Greater Nottinghamshire ICS

Establishing governance structures across complex systems Leaders must also be able to establish governance structures which drive faster change, rather than being beholden to complex arrangements no longer fit for purpose. People spoke about the need to sometimes break up existing structures when they are not performing, and go where the energy is strongest or where there are governance structures that work well already. “It is important to recognise that ICSs have no basis in law and are entirely dependent on the willingness of the organisations involved to work together. NHS trusts and CCGs [clinical commissioning groups] have their own statutory duties and members of their boards may need reassurance that these duties are not being compromised by ICSs ... Different accountabilities in the NHS and local government may also cause tension.”

Having a strong focus on outcomes and population health The focus on population based outcomes has become an important part of the systems leadership role, with a shift away from simply tracking hospital metrics, towards patient outcomes. “If you start with the person and the place, you arrive at a different place to when you start with organisational KPIs. You can enable people to see the value in a shared endeavour”

Setting the overall outcomes and expectations on behaviours Systems leaders are adept at building shared visions and plans that bind organisations and individuals together around shared goals. “I think the biggest breakthrough is getting everyone into a room – mental health, social care, VCSE, citizens – to develop a shared vision for the ICS. The ICS will only work if we can develop joint strategies for tackling problems”

Simplifying complexity Leaders spoke of how important it was to be able to translate complexity into well understood plans for action. Logic modelling was seen as an essential skill. “We should be able to communicate our vision, actions, and achievements on one page.”

Coproduction and citizen engagement Effective citizen involvement to build supportive coalitions and find solutions to wicked issues will become a more critical skill for systems leaders. “The best results are achieved when the engagement process begins at an early stage of planning service change and is maintained during implementation.”

Supporting system leaders skilled external facilitation, to help deliver complex programmes the creation of ‘safe spaces’ for leaders more opportunities to learn from other professions and sectors systems leadership development for middle managers masterclasses on: co-production theory and practice finance and risk-sharing scaling innovation understanding local government and social care large-scale and large-group facilitation working and influencing across multiple layers of governance.

Next steps Final report will be published in late November NHS Leadership Academy, NHS England and SCIE webinar at 1 – 2pm, 6 December. Book here https://www.eventbrite.co.uk/e/systems-leadership-online-webinar-tickets-51965704822 Twitter: @ewandking

Scenario 1 What are the barriers? How would you overcome them? You want to introduce person centred care plans for 15% most frail older people in the community. There are disagreements between GP practice, social work staff, and community health services who are arguing that they don’t have the resources to support more than 5%. What are the barriers? How would you overcome them?

Scenario 2 What are the barriers? How would you overcome them? Its December. A major incident has been declared in a local hospital which has had an outbreak of the flu. Unexpectedly, two nursing homes have had to close down. You have a lack of beds in hospital settings and you need to create more capacity within community settings. What are the barriers? How would you overcome them?

Scenario 3 What are the barriers? How would you overcome them? You are working in a large rural area. You want to close two community hospitals, and shift outpatient services to three new integrated community care centres. The council and voluntary sector are clear to support, but are worried about the backlash from communities. What are the barriers? How would you overcome them?