Health and other public sector chief executives increasingly need to work together and leading as peers is the way to do it, says Becky Malby

Chief executives are hired because they are exceptional people who can handle the lonely pressures of the top job. But in the wake of the recession and the Total Place “whole area approach”, the spotlight is on their ability to work in company, with other leaders across their patch.

We were hamstrung by our individual governance arrangements but we felt we had to do it

It seems obvious there should be some specific development to help. In fact such help is rare.

Chief executives from primary care trusts, acute trusts and local authorities in Calderdale and Kirklees set up their own programme, Leading as Peers.

“We were hamstrung by our individual governance arrangements but we felt we had to do it,” says South West Yorkshire Partnership Foundation Trust chief executive Steven Michael. “We were facing a particularly challenging financial climate, with flat cash. And it’s coming to the fore now that you can’t see success in local communities unless there are honest relationships at the heart of them.”

The project began with five workshops involving four chief executives, facilitated by Leeds University’s centre for innovation in health management.

In a research paper for the project the centre provides a frank description of “peer working” at its worst, based on interviews with senior managers across the north of England: “It is often a euphemism for working with someone you see as inferior, but need. Mostly they think they’d rather do it alone - all peer working is a compromise.”

The paper also describes peer working at its best: “They were clear what they wanted to hold out for together, and clear about their agreed bottom line. This clarity pervaded into agreements. They were very clear about what was agreed, and they followed it through - calling each other to account if anyone strayed. They thrashed out their ‘togetherness’.”

One workshop focused on identity, for example, how “followership” - amplifying or supporting a colleague’s idea - is actually leadership. Another workshop looked at language - the four used different words, but were usually talking about the same things and shared the same values.

A further session looked at system accountability - how leaders behaved when their organisations were going through a turbulent time and they were pulled away from collaboration.

Calderdale Council chief executive Owen Williams says: “We started to tease out what we are trying to achieve, where we have common ground and where there is real difference.”

Six success criteria for the programme are:

  • shaping the regional and national agenda so that it supports collaboration
  • delivering high quality services that are fully engaged with service users and carers
  • a local system that is satisfactory to all stakeholders
  • delivering within financial resources
  • using collective resources to deliver the quality and productivity challenge
  • genuine partnership based on consistent values, and the maxim “at least do no harm” to each other.

This list has had a powerful impact. Joint change programmes which would once have been impossible are now going ahead.

One is the Transforming Community Services bid put together by Calderdale and Huddersfield Foundation Trust and South West Yorkshire Partnership Foundation Trust. Initially each planned to bid separately, but NHS Calderdale suggested they team up with each other and its own provider arm.

NHS Calderdale chief executive Rob Webster says: “I could have a conversation with the others and say as a commissioner, why don’t you think about doing it this way, and I would support you. It wouldn’t have happened without this work - the trusts would have been competing against each other. The system isn’t geared up to reward this sort of leadership, which is mature and focuses on co-operation.”

He adds: “Cooperation isn’t just giving in and being soft. But by having a place we can go and talk things through we can get issues resolved.”

Programme leads

  • Creating an Innovation Cluster Calderdale Council chief executive Owen Williams
  • Transforming Community Services NHS Calderdale chief executive Rob Webster
  • Better Care/Better Value NHS Kirklees chief executive Mike Potts
  • Care Packages and Pathways Programme for Mental Health Services South West Yorkshire Partnership Foundation Trust chief executive Steven Michael
  • Total Place Assessment Kirklees Council chief executive Rob Vincent
  • Power Mapping and Influence Calderdale and Huddersfield Foundation Trust chief executive Diane Whittingham