ICS challenges: systems, skills and people

17 June 2021

At first glance, the new national guidance on integrated care systems design appears to fall short of driving forward the crucial people and skills agenda – so it will fall to local leaders to find solutions.

The long-awaited national guidance on integrated care systems design has finally been published and, of course, it will take time to fully digest. Do the fundamental guiding principles for the future NHS contained within the guidance enable more creativity at local level? Or will they stifle emerging models of leadership behaviour and thinking?

This new mindset was explored at the latest ICS webinar, hosted by GGI, which turned the spotlight on systems, skills and people.

The session discussed future behavioural measures for leaders. Speakers and participants from across the NHS reflected on the skills they needed to develop, or reinforce in themselves, to be fit for the future. Many felt a decisive move away from positional authority and centralised control towards a more enabling, facilitative style was essential to making serious progress in health and care.

Empowering others

The main leadership task described during our webinar was about creating the conditions that empower others to make things happen. This fundamental shift includes acting differently and spending time brokering the kind of conversations that did not happen before as they needed to.

Now leadership, it was argued, involves taking responsibility for the shameful failures in health inequalities, discrimination and injustice revealed by the pandemic. But it also involves promoting changes to professional practices and behaviours, which the pandemic showed is not just possible, but essential for the future.

There was a feeling at the webinar that new leadership behaviours were already visible and starting to define local system and place working. But how robust are they? Will local leaders feel it is their role to resist the usual centralising forces and unhelpful metrics? Are local leaders organised enough to do so? Do they seek permission too frequently to be effective?

And whatever the positive narratives might be, will the reality be ‘more of the same’ in terms of an outdated notion of what governance means – compliance, regulation and the dominance of Treasury control, reflected in trust placed in only a handful of powerful leaders?

Rigour in thinking and doing

One thing is clear: this framing of any new leadership requires greater rigour in thinking and doing than is currently apparent. It is not going to be enough to use terms like ‘place' and ‘system’, ‘empowerment' or ‘community' – even ‘governance', for that matter – as loosely as has been the norm for years. If that is allowed to happen, these fine words will be merely self-serving, by leaders who retain their positions without changing much.

The proof of a new era of leadership must be its visibility and impact on what matters to (and has most impact on) the public, following the disruption of the last 18 months. The shock for reflective leaders may be that the public will not want to be involved or engaged with it. They may want to see a reset to ‘how things were before’ delivered above all else. This is the same agenda that will be central to the next election.

Bridging the divide between aspiration and pragmatism will require a steeliness of purpose at local level. This will require more than talk.

People and skills remain the biggest strategic risks to the social and economic sustainability of local place. They are at the core of the local agenda to improve health and care. At first read, there is far too little in the national guidance to help drive this forward, so solutions to capacity-building will require local drive, agility, bravery and leadership.


  • With the implementation guidance now out in the open, this is showtime for local leadership. Can they make the break from centralised accountability? Is there real rigour around what this means in practice?

  • The ‘people’ agenda is likely to remain the ultimate test of local impact in the coming weeks. After so many years lacking in progress, it remains to be seen whether commitment to population health will be matched by a comprehensive skills assessment. This should include community skills and assets, to break the stranglehold of old-fashioned models with inefficient professional practices.

  • Compassionate leadership - defined broadly as acting with integrity and through collaboration - is in many respects flavour of the day. But will this style deliver on the hard-edged challenges of capacity and transformation?

People in Place, a programme of work GGI is working on with Allocate UK, is looking at the underlying people agenda at the local level. It is due to report in early July 2021.

If you have any questions or comments about this briefing, please call us on 07732 681120 or email advice@good-governance.org.uk.

Prepared by GGI Development and Research LLP for the Good Governance Institute.

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