In a previous blog I asked whether NHS leaders should model their behaviour on Margaret Thatcher or Birgitte Nyborg, prime minister of a coalition government in Denmark in the TV drama, Borgen.
‘Finding common cause with partners and being willing to share some sovereignty is the first lesson highlighted in our paper’
In a similar vein, it is worth reflecting on whether our leaders should be more like Nick Clegg or Nigel Farage. Mr Clegg’s commitment to the European project stands in stark contrast to Mr Farage’s defence of the UK’s independence. NHS leaders face a similar choice: should they focus on what is in the best interests of the organisations they lead, or should they be willing to share sovereignty and work with others to deliver better outcomes for the populations they serve?
This is one of the questions we raise in our new paper, setting out the practical actions that need to be taken to make a reality of integrated care. The paper draws on the King’s Fund’s work with NHS organisations, local authorities and the third sector to identify 16 lessons we believe need to be heeded if integrated care is to be more than a distant dream. Many of these lessons depend on leaders being willing to work in partnership with their peers in other organisations, even if this means giving up some independence.
One of the challenges in acting on these lessons is that many of the policies currently in place were not designed to facilitate the development of whole-system working. The way in which NHS foundation trusts are regulated is an obvious example. Foundation trusts that agree to sacrifice some income as part of a local commitment to establish more care out of hospital may find themselves in difficulty with Monitor if their financial performance is affected adversely. Perverse incentives like this need to be tackled if new models of care are to gain traction.
Sharing sovereignty
However, the magnitude of the financial and organisational challenges facing public services means local leaders cannot wait until ministers remove all of the policy barriers to integrated care. That is why leaders in many areas are already looking beyond their own organisations and reaching out to their partners. In so doing they are motivated by a belief that whole-system working, rather than organisational self-protection, holds the best hope of public services adapting in the tough times that lie ahead and delivering benefits for service users and the public.
Finding common cause with partners and being willing to share some sovereignty is the first lesson highlighted in our paper, but on its own it is not sufficient. Other requirements include articulating a persuasive vision to describe what integrated care will achieve, creating time and space to develop understanding and new ways of working, and identifying services and user groups where the potential benefits of integrated care are greatest. A leadership style based on Birgitte Nyborg’s coalition-building skills rather than Margaret Thatcher’s conviction politics is also essential.
As Nigel Farage has found, making the case for independence is one way of increasing your popularity − as shown in the recent ICM survey for The Sunday Telegraph. On the other hand, sharing sovereignty may bring bigger benefits if this can be done without countries feeling their interests have been fundamentally weakened. The European project underlines the challenges involved in doing this and the need to put in place appropriate governance and leadership arrangements able to deliver these benefits.
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