‘Don’t try to do our jobs’, trust CEOs warn ICSs

The CEOs were speaking at a round table to mark the publication of HSJ’s annual ranking of the NHS’s “top 50 trust chief executives”.

The chief executives were especially adamant that integrated care boards or systems should not seek to interfere with the working culture of their trusts.

Northumbria Healthcare Foundation Trust chief executive and NHS England’s elective recovery director Sir Jim Mackey said that ICS should not tell chief executives “how to run hospitals. Don’t tell us what band people should be getting paid at”.

Sarah-Jane Marsh, chief executive of Birmingham Women’s and Children’s FT, said there were tasks that were “distinctly” the responsibility of providers or “strategic commissioners”, and “then the bit of overlap, which is I think where we should be working together”.

She continued: “There is some tension between what the responsibility of a provider is and what sits in the overlap.” Ms Marsh stressed that issues such as how people are managed and rewarded were “profoundly cultural and perhaps not something which can be centralised in an ICS”.

Caroline Clarke said she felt “really strongly” that as the chief executive of a group of hospitals – the Royal Free London FT – it is “my job” to manage the local “labour market and rates” for temporary staff. However, she added, “some people think that actually that’s an ICS role”.

University Hospitals of Bristol and Weston FT chief executive Eugine Yafele said: “There’s a real tension between the opportunities that create [longer-term] solutions to today’s problems and the challenges of quality, and how you manage risk. And I don’t see my board, I don’t see myself delegating that [latter] responsibility to anyone else.

He said his trust was playing an “active part in the system” as it helped address “some of the issues that we’re grappling with”. But he added this sometimes created tension with “dealing with the ambulance queues, the safe handovers and everything else that we’ve got to do.”

Croydon Health Services Trust chief executive Matthew Kershaw called for “benign ICSs” which would add value by supporting local organisations to deliver, rather than “malign” ones which over-reached themselves. “I don’t think it [the ICS] should be doing my job every day.”

The CEOs also expressed concern that ICSs have spent too much time on governance.

“When I look at the focus on governance around the ICS, that’s been taking up 80, 90 per cent of the time”, said Joe Harrison, chief executive of Milton Keynes University Hospital FT.

Glen Burley – who runs three trusts across two ICSs – said: “I’m trying to isolate some of my team from that [the development of ICS governance], fearing they would become “distracted”.

The birth of ICSs is, however, meaning trusts are having to operate differently.

“I am having different conversations with my board and my direct reports because I no longer feel that just managing my financial situation will deliver us what we need at the end of this year. I need to have half an eye on what’s happening in my other provider colleagues, because if I don’t, we’re not getting any capital,” said Mr Kershaw.

And Julian Emms, chief executive of Berkshire Healthcare FT, which is part of two ICSs, said: “In two ICSs you can spend a lot of time in systems reading papers on all the rest of it and I’ve changed my approach to it. And I think my best asset in the ICS is energy – and energy on something that will make a difference. So I’m doing something around the temporary workforce staffing across both ICSs because I think it will actually deliver something.”

Beccy Fenton, partner and UK head of health and human services at KPMG – which sponsored the roundtable – added there was a lack of clarity around what roles ICSs were meant to fulfil. Were they regulators, commissioners or some form of strategic health authority?

“There’s a huge variation in people’s thinking,” she said. “They all seem to be very consumed in the governance, which a lot of people have been saying is just going to create an additional layer of decision making.”

Angela Hillery, who runs two trusts in the Midlands, suggested the best ICSs would look at themselves as an ecosystem rather than an organisation: “They will facilitate and empower providers to do what they need to do, and they’ll understand where they add value,” she said. Provider collaboratives were also important, she added, and were often leading work on transformation.

Steve McManus, chief executive of the Royal Berkshire FT, said: “How we frame the organisational strategy is completely intertwined with being part of a wider system. How I work with other providers around particularly elective recovery is a big shift, There’s definitely an acceleration of things like mutual aid and collaboration.”