Most people agree that the NHS and social care need to find radical solutions to enable services to develop in a way that offers real prospects of being sustainable. Small scale changes can help, but on their own they will be insufficient.

What we are crying out for is more radical, clinically led solutions across health and social care systems. Change at scale is now essential – and at a pace that provides space to build organisational and professional trust on the one hand, and a sense of urgency on the other. A shortage of time is a big enemy.

Neil McKay

‘Leaders need a clear vision: a sense of purpose that acts as a beacon’

Integrated and out of hospital care will undoubtedly deliver benefits for citizens and make an important contribution towards cost containment. If you’re not sure how to go about it, or if you need more persuading, then consider the Geisinger approach. It’s textbook in terms of the technical means of delivering a set of integrated solutions for health and social care, but it also reminds us of key leadership characteristics that are hallmarks of great change programmes.

Leaders need a clear vision: a sense of purpose that acts as a beacon. In the more organisationally fragmented system we have now, vision can’t be the preserve of an individual – it needs to be shared and articulated by others. There needs to be single-mindedness and determination to see things through.

Just great leadership

And it needs leadership that parks institutional and professional interests in favour of the achievement of system-wide gains (and a recognition that risks and benefits need to be shared).

It’s sometimes hard to see how radical models of integrated and out of hospital care can be delivered within our existing organisational structures. This is not the beginning of an argument for more forced structural change but recognition that there are ways to integrate commissioning and provision which will deliver greater integration. The Geisinger approach is a great one for us to emulate.

Imagine an organisational form that is bold enough for statutory organisations to cede power to it; in which clinicians and other professional staff are given real authority to transform and provide services based not just on their expertise but data they trust; where incentives and payment systems focus on the quality of outcomes; where staff from different organisations sit together in the same place and are managed through one reporting line; and where there’s a single heath and care record and an integrated IT system - now there’s an idea.

The leadership of Geisinger is showing what is possible. This may imply an accountable care organisation – but for many it’s just great leadership.

Sir Neil McKay is a former chief operating officer of the Department of Health, former chief executive of Leeds Teaching Hospitals Trust and former chief executive of the East of England Strategic Health Authority

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