The ICS leadership challenge - Professor Andrew Corbett-Nolan

By Andrew Corbett-Nolan, Chief Executive of the Good Governance Institute.

The last few weeks have seen a flurry of appointments made to the chief executive and chair positions of the 42 English integrated care systems (ICSs). Almost all chairs have now been appointed, as well as 28 of the chief executives, with eight more expected soon.

These 84 leaders will eventually be responsible for organisations delivering services accounting for 40% of all public expenditure.

Between now and April, when the ICSs move to a statutory footing, there is a lot to do. Plans need to be developed that deal with the backlog as well as improving population health. Key decisions need to be made, relationships need building with local authorities and other partners, governance arrangements need to be put in place, assurance responsibilities must be assumed on behalf of NHSE, executive teams need to be assembled, partnerships need developing and much more besides.

It is a crucial period that will determine the long-term success of the ICSs to meet the four aims they will be ultimately accountable for:

• improving outcomes in population health and healthcare

• tackling inequalities in outcomes, experience and access

• enhancing productivity and value for money

• helping the NHS to support broader social and economic development.

With so much to do in the first 100 days or so, prioritisation is going to be vital. So what should ICS leaders focus on?

Invest in the development of the two at the top

To a great extent, the success of the ICS is dependent on the relationship and working dynamic of the two at the top - chairs and chief executives.

There will be a great variety in existing relationships. Some will know each other well, some will have worked together indirectly, some directly and some won’t know each other at all. The key thing, no matter what the baseline, is that this is an entirely new organisation, a new context, and these relationships need to be recalibrated, or else formed, with that in mind.

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.

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?

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.

This coaching should also include supporting the top two with honing the skills of effective system leaders:

• Compassionate leadership

• Influencing

• Relationship building

Get the fundamentals in place for April

The formation of ICSs is a complex transition that needs to be led and managed effectively. Do you have the right assurance about the transition? Is anything being lost or missed?

Getting the structural governance right will provide a platform for success. The key areas we would advise ICS leaders to focus on are these:

• Developing and agreeing an executive team structure and recruiting the right people to these roles (thinking about the kind of leadership and skills they require in a system context).

• Sorting out the financial aspects - delegation to place, payment mechanisms, financial envelopes, and objectives and accountabilities around these.

• Ensuring the MOU and other governance fundamentals are fit for purpose and account for how provider collaboratives and primary care will operate and the systems relationship with them.

This work deserves just as much focus from ICS leaders as the strategic and visionary elements, we would suggest. We would suggest they ask themselves the following questions and be sure that those around them are as clear on the answers as they are.

• Are you absolutely clear how things will change on 1 April?

• Do you understand how the system will run?

• Do you know how decisions will be taken and how you will get assurance?

Cultivate the right culture

The move from competition to collaboration is as significant, not least in terms of culture, as the movement from transactional to transformational.

Time and effort on thinking about the culture you need to be successful - inclusive, compassionate, collaborative etc - is well spent. We would advise codifying it in values and exhibiting these through your behaviours from the start.

Then it makes sense to build your executive team around these values and behaviours, with skills to match. And look to proactively develop these skills. We are already being asked by the ICSs we are working with what a good system board development programme would look like. Of course these need to be tailored to the individual needs of the ICS but there are some universal elements.

• What kind of culture does your ICS need to succeed?

• What will be your key values?

• What role can you as a top two play in shaping this culture from the start?

• How can you create and develop your board around this culture?

• How can you ensure your board exhibits the necessary skills and behaviours?

Start as you mean to continue

The tone you set from the beginning - how you engage partners, build culture, develop relationships, the governance you put in place, hone skills, understand partners and the communities you serve - is important. Start as you mean to go on, set the tone, set the standard. These next 100 days will be pivotal.

In a future article we will look at the other key early actions facing ICS leaders, including investing in ICB and ICP development, setting risk appetite, developing influence and soft power, building relationships with clinical leaders, learning from others, and engaging with your community and partners.

GGI has led the national conversation on integration, and we have already worked with a number of ICSs across England. No one is better placed to guide you on the important journey to integrated care. Please call us on 07732 681120 or email advice@good-governance.org.uk.