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Can integrated care systems change how we work in the NHS?

By Rob Webster
29 April 2019

Relationships are important in any walk of life; whether it is in the office or in your personal life. But how much do we take for granted the close collaboration we have with others on a daily or weekly basis? Rob Webster chief executive of South West Yorkshire Partnership NHS Foundation Trust and chief executive lead of West Yorkshire and Harrogate Health explores.

Are your relationships big enough to deliver your ambitions? It’s a question I have learned to ask myself and others as a leader in the NHS. The answer will define whether you are successful or not.

This has come into stark relief over the last decade of austerity in the NHS and wider public services.

It may not be optimal work that delivers the best outcomes for the best value, but it gets done. Locations with strong relationships bring ideas, innovation, the marshalling of resources, more options for progress, a will to do something in the general interest and collective resources that help drive delivery.

Locations without good relationships with other stakeholders get mired in territorialism and rules based judgements that may only protect organisations, not services or the health of populations.

Integrated care systems are primarily built on the relationships between leaders in a place, organisations in a system and people at all levels. Wrapped around them is the governance, assurance and rules that ensure rational decisions are made.

In a recent report Kindness, emotions and human relationships: the blind spot in public policy, Julia Unwin, former chief executive of the Joseph Rowntree Foundation and the Joseph Rowntree Housing Trust set out a compelling argument for a focus on both the rational lexicon of public policy and the relational lexicon.

The former we all recognise as using scrutiny, assurance, regulation and rules to attempt to bring fairness, safety, transparency and balance to systems. Yet we have a system that is not truly fair, safe or balanced.

By using intuition, warmth, wellbeing, friendship and desire for improvement, the relational considerations add connection, hope, change and personal motivation, which addresses risks in a rational-only system and improves trust.

This has been my experience in NHS and the wider health and care system. Having good system leadership with shared goals and values was certainly a feature in all successful integrated system.

The West Yorkshire and Harrogate Health and Care Partnership has used this balance of the rational and the relational to drive real and meaningful change in health and care.

We are the second largest sustainability and transformation partnerships (STP) in the country. We cover a large area, home to 2.6 million people, 115,000 staff and 260,000 unpaid carers. We have 50 neighbourhoods, seven local care partnerships, eight councils and six locations (Bradford District and Craven; Calderdale, Harrogate, Kirklees, Leeds and Wakefield).

We are a collaboration between hundreds of organisations working across our patch: NHS organisations, councils, Healthwatch, independent care providers, charities, voluntary and community organisations.

At the beginning of this partnership, we spent a lot of time doing two things.

Firstly, setting out common points of agreement relating to our purpose, principles and approach. And secondly, being clear about what we wanted to achieve. Spending time on these foundations was essential.

Communities and institutions have engaged with issues that affect,them from world-class commissioning to health and wellbeing strategies. Work has been progressing locally for more than a decade with councils, the NHS and communities to tackle the issues that beset them.

We are not starting from scratch – we all bring our own organisation’s expertise, skills and relationships. Of course we have effective governance, assurance, financial strategies and rules. These work alongside good relationships and a high degree of trust.

We depend on one another and most importantly the communities we serve to give people the opportunity to live and age well. An important part of the work is tackling health inequalities while improving the lives of the most deprived.

Putting these ingredients together, we have galvanised ourselves to address three gaps across our area: health inequalities, variation in care and financial sustainability.  This to me is integration in the truest sense of the word and with our combined resources, we might just succeed in adding these issues.

Our partnership focuses on a different type of leadership – one based on systems and partnership, mutual accountability and collaboration.

It is not an organisation but a network that can deliver interventions and support that saves and improves lives. This approach will shape all our futures because we all work in a system.

Rob Webster is chief executive lead of West Yorkshire and Harrogate Health and Care Partnership and chief executive of South West Yorkshire Partnership NHS Foundation Trust


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