Collaborative leadership - the art of the possible

The shift from competition towards collaboration in health and social care services, heralded in the Five Year Forward View and continued in the NHS Long Term Plan, offers the opportunity to shape services in the context of need rather than organisational boundaries.

Organisations within and beyond the NHS are being encouraged to work together in integrated care systems, to align expertise and resources to improve service provision and address health inequality. As highlighted in Chris Ham’s recent lecture for University of Birminghams Centre for Health and Social Care Leadership, a collaborative approach can deliver efficiency savings as well as improved health outcomes. A truly joined up approach will benefit patients, carers, and staff at the point of delivery, and at the system level there is evidence, recently illustrated by The Healthier Wigan Partnership, that a partnership approach can deliver sustainable longer-term benefit for whole communities.

So for leaders in Social Care and Health seeking to achieve improved health and wellbeing outcomes, partnerships can be a means to innovate a service offer that is more efficient, responsive and relevant to the needs of the populations they serve. In fact, partnership working is now mandated. In 2016 NHS England required the development of 44 sustainability and transformation partnerships (STPs) around specified geographical areas with the aim of facilitating collaboration between NHS commissioners, providers and local authority partners to shape services and priorities. Since then, the STPs have been required to move to closer collaborations termed Integrated Care Systems (ICSs) whereby performance, resource management and outcomes become a collective responsibility. However whilst evidently beneficial and underpinned by national directive, cross sector multi-agency collaborative working is not easy.

For organisations accustomed to competition the shift to collaboration may pose structural and cultural challenges. Contract, finance and governance architecture may inhibit the propensity for risk sharing across partner organisations; individuals who are bought-in conceptually may struggle to resist the attractions of the status quo and regulators may talk systems but hold organisations to account. Collaborative working often needs to progress ahead of policy, process, legal and financial frameworks, with leaders needing to hold their nerve, understanding the line between system-wide service sustainability and organisational viability, rocking the boat but not necessarily sinking it.

For systems leaders, in particular NHS leaders accustomed to hierarchical structures, the need to establish effective partnerships requires the building of trusted working relationships based on an agreed set of principles and without recourse to traditional management controls. There may be a role for NHSI/E to pull together guiding principles drawn from best practice across the health and social care systems. Drawing upon my own extensive experience of partnership and collaboration across a range of sectors, including health and social care, I would suggest such principles could include:

  • Respecting the views of others and accepting that partners act in good faith
  • Prioritising the interests of the population ahead of the organisation and any personal career interests
  • Agreeing subsidiarity as the guiding principle for system decision making,
  • Establishing emotionally intelligent protocols, partnership values and behaviours,
  • Applying pragmatism with regards to regulatory challenges,
  • Balancing risk and reward at system and organisational level

In Walsall an Integrated Care Partnership has been developed called Walsall Together. This brings together Physical and Mental Health providers, Social Care and Voluntary Sector groups alongside commissioners to work with and understand the needs of the population through 3 strategic lenses

  • Improving health and wellbeing outcomes for the Walsall population
  • Improving the standards of care and quality
  • Meeting the statutory financial duties of all organisations

Daren Fradgley, Executive Director for Walsall Together explains that the foundation of the partnership has been established on trust and confidence making sure that the Walsall system is working together as one. The maturity of the partnership is based on three years of negotiation and hasn’t yet begun to challenge the contracting and regulatory shifts required for a sustainable future care model.

With all parties focussed on serving the population of the Walsall borough, the partnership of Walsall Together is a unifying force, aligning the efforts and resources of the Housing and Voluntary Sector in addition to Social Care and Health; thus the partnership has already seen a reduction in duplication of effort and increased quality and access for patients.

Whilst system working poses new challenges, the potential rewards are significant. System leaders will need the mind-set, skills and behaviours to establish and sustain effective relationships across a diverse range of partner organisations. Support for the development of system thinking and evidence based approaches to system leadership can be accessed via the programme of teaching modules, system interventions and research offered by the University of Birmingham’s Centre for Health and Social Care Leadership.

Danielle Oum, Chair of Healthwatch Birmingham and of Walsall Healthcare NHS Trust. Also co-chair of the Centre for Heath and Social Care Leadership External Advisory Board.