Nick Ville reflects on the “engine room” of developing STP/ICS partnerships, their fragility and why they are too important not to be properly resourced

Sustainability and transformation partnership and integrated care system partnership working is an odd thing. Very quickly, you are working in a space that is entirely outside of the job description you were originally employed to do.

This requires leaders and committed public servants who can rise to the challenge. People who believe they can make a real impact on our local communities by working differently together.

Senior programme directors

However, as important as those leaders are there is another group of people who really make partnerships work as well. STP/ICS senior programme directors, who the NHS Confederation is providing ongoing support to, are described as the “engine room” of partnership working.

They might include an energetic programme management director, a strong communications and engagement role, a finance specialist, a PMO lead and a range of other people committed by the partnership in support of whole system working.

While the values and behaviours of the partnership leadership team are important, this “engine room” is the resource that does much of the actual work in those early stages. Staff develop a unique set of system working skills around stakeholder engagement and influencing that we’d normally expect to find in more senior roles.

Without reasonable investment in this team, we are backing the horse of place based working without giving local partnerships the resources they need to do the job

They develop knowledge of the patch, of the key issues that the partnership faces and needs to address. They need to be nimble and responsive, and happy to change direction and strategy quickly when things go wrong to keep the partnership moving forward.

Most importantly they develop the personal relationships and trust across all sectors of the partnership that is essential to collaborative working.

This group of people, critical to the development of partnership working, take a huge career risk in coming to work in this way. It’s much safer to take a traditional role in a trust with a clinical commissioning group or regulator and there is little or no traditional career path associated with partnership roles.

Employment contracts are often piecemeal, with 12 or 24 months placements common. The Confederation has spoken to one senior leader, for example, who had worked in limbo out of contract for several weeks whilst the whole system scrabbled round to fund his post.

This is no way to resource a set of roles that are so critical to our overall strategy.

There is a disconnect, then, between the importance of these roles to the NHS long-term plan’s ambition for whole system population health partnership working, and where we are currently putting our investment.

In established partnerships, it may be that their importance is being recognised and funding is made available from across the system in support of the “engine room”.

Even in these systems, however, we know that ICS leaders are concerned about the potential loss of acquired system knowledge, trust and relationships from their core teams as each year they are faced with funding uncertainty.

Less developed partnerships, meanwhile, are stuck in a chicken and egg situation: behind the curve of ICS development, without the relationships, investment and momentum that comes with success but targeted with challenging five year planning requirements that they will need to sell hard to local stakeholders.

In these environments, this core “engine room” is just too important a resource and needs proper investment. If our strategy is based around place based whole system working, then creating stability for the core group of people who have the knowledge, skills, relationships and system knowledge to facilitate partnership working is essential.

Without reasonable investment in this team, we are backing the horse of place based working without giving local partnerships the resources they need to do the job.