System board development

28 February 2022

GGI executive director Mark Butler sets out our thinking on an effective system board development programme for ICSs.

Over the past couple of months, we’ve been having conversations with ICS leaders who are starting to think seriously about the board development requirements of their system. Both about the immediate needs from familiarisation, relationship building and the fundamentals of system leadership to longer-term developmental requirements focused on building greater and deeper system understanding.

They have been helpful conversations, giving us an insight into the needs of ICS leaders as they see them while we develop our system board development offer. Here is what we have learned.

Leading systems is different: a new type of board development

Systems are entirely new constructs with complicated governance configurations and large numbers of stakeholders. Leading systems requires entirely new skills, mindset and the melding of various organisational cultures into something new. ICS chairs and CEOs need to act with emotional intelligence and exert their influence quickly and effectively if the disparate parts of their systems are to be effectively coordinated. 

There are aspects of crossover but system board development is different and distinct from trust board development. For one thing, it’s as much about looking out as it is looking in.

Our work with ICSs all over the country shows there is value in honing the attributes of the board, especially looking at system leadership skills and behaviours: 

  • how to lead through influence and applying system thinking
  • developing leadership and fostering relationships between leaders from different organisations in the system
  • synthesizing mission and values in a complex multi-agency environment
  • patient-centered clinical and public health leadership
  • insight on the social and economic importance of equality
  • modelling disturbing developments – disaster scenario planning.

These key leadership skills and behaviours need to be integral to, and honed throughout, any system board development programme.

A whole board programme

As entirely new constructs with a specific purpose broader in scope than CCGs, NHS providers or local authorities, ICS board development needs to align with and be driven by its four fundamental aims: reducing inequalities, improving population health outcomes, enhancing productivity and value for money and supporting social and economic development.

A system board development programme needs to touch every aspect of the board structure, with components for the ICB, ICP, whole board, the chair and chief executive, the executives and the non-executives. There needs to be the right balance between and focus on collective and individual development, and the needs of the whole board and also groups and individuals with specific functions.

For the board to be successful there needs to be trust, excellent communication, a shared vision, clear understanding of roles and responsibilities, agreed ways of working and a collaborative mindset. As we’ve said before, a good place to start would be to discuss:

  • What does success for our ICS look like?
  • What is our role in that and how can we best facilitate this success?
  • What are the stages on a critical pathway to maturity?

The initial whole board sessions should prioritise building relationships and trust among board members. They should be about setting the board up to work together and focus on consensus building, collective decision making, constructive challenge and how to have disagreements. They should also incorporate building understanding of the system and the role of the ICB.

The ICB is a new and unique board structure, with the addition of partner members, and as such the purpose and function of a unitary board should also be a part of the initial board workshops as well as managing conflicts of interest and understanding system risk and assurance.

As the system is established these workshops should mature to focus on wider governance development activities to ensure the foundations for strong and effective systems leadership are in place.

Two at the top

In addition to the whole board workshops, a skills and relationship development programme for the chief executive and chair should be a core part of the board development programme. The success of ICSs will be heavily dependent on the relationship and working dynamic of the two at the top.

These 84 leaders will eventually be responsible for organisations delivering services accounting for 40% of all public expenditure. Much like with the whole board, for the two at the top to form a successful working partnership there needs to be trust, open and honest communication, a culture of constructive challenge, a shared vision, clear division and understanding of roles and responsibilities, agreed ways of working and a collaborative mindset.

Now would be a good time to focus on building or developing the working relationship between the two at the top. One idea that will pay long-term dividends would be to bring in someone with relevant experience and expertise to provide tailored coaching, mentoring and developmental support with honing the skills of effective system leaders.

Many will already know each other well, but others will only have worked indirectly with each other or not at all. No matter the baseline, all ICSs will be new organisations established in a new context. And they are emerging during a period of great stress for our health and social care systems, with many staff close to burning out and in real need of support.   

These important senior relationships will need to be recalibrated, or formed, with all of this in mind. And that requires an investment in development.  

But it’s not just about developing individual leaders. It’s about developing the whole board in a way that equips them to work as a unified group in a multi-faceted system comprising many organisations. 

Finding the right provider

The board development work needs to be led by a team with the appropriate experience and expertise. They must have a thorough understanding of the broader policy, legislative and operational context as well as a good grasp - and demonstrable experience - of working with systems in a best-practice context.

This is crucial on a practical level but also with regard to ensuring that the boards respect the input of those providing the support. Experience in board development at provider level would also be essential.

It should go without saying that the system board development programme must be informed and developed in line with a deep understanding of your ICS’s operational context, specifically:

  • the public sector the broader partnership landscape
  • the dynamics and relationships of the organisations it comprises
  • a broad understanding of the population health profile, health inequalities
  • the provider set-up and acute pathways (primary health, community care, mental health etc.).

This knowledge would enable the provider to better recognise the work done to date by the executive team and take a developmental approach to the board development programme that builds on this.

The provider should also have a good knowledge of your ICS’s system development plan (SDP) and vision. A grasp on the strategic direction of the ICS isn’t just important context but should fundamentally inform the content and emphasis of the board development programme.

Finally, the provider should be aware of the context of the two at the top, the Chair and CEO - when they were appointed, their backgrounds etc. - as well as of the broader ICB and ICP membership.

Here to help

We have contributed to the national conversation on integration and are leading the thinking on system board development. We can see its potential, understand how it can be achieved and bring years of experience as one of the most trusted providers of trust board development. No one understands core NHS governance better than us and we have good understanding of the partnership context.

Our trusted, experienced, independent consultants can add real value at a time when it is needed. And we are ready to help.

If you’d like to find out more about how we can help, please get in touch.

Dr Usman Khan

Managing Director

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Mark Butler

Executive Director
(Partner)

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