White Paper event – collaboration

19 February 2021

On Tuesday this week, more than 300 senior health sector leaders from all over the country gathered virtually at our white paper event to discuss the future of integrated care.

It was heartening to see so many people - some familiar faces and many new ones - especially as the event was scheduled so quickly as part of our rapid and multifaceted response to last Thursday’s white paper, which was published earlier than anyone expected.

Our focus on Tuesday was on the opportunities and challenges presented by the white paper and, in particular, on the likely impact on governance, partnership working and collaboration. Expertly chaired by Mark Lam (chair of two of London’s mental health trusts), the session opened with a whistle-stop summary from me of the reforms.

There were excellent and thought-provoking contributions from Paul Maubach, chief executive at Black Country and West Birmingham CCG and Dr Claire Fuller, senior responsible officer at Surrey Heartlands Health and Care Partnership ICS.

In the discussion that followed there was plenty of talk about the challenge posed by the structures:

"Having local authorities on both boards is confusing - is one an operational role and the other political?"

The importance of place shaping but its lack of clarity and definition (the lack of prescription for which GGI sees as a big opportunity):

"If we're going to make this ICS thing work, the executive and leadership need to get together to create a sense of identity at the system level."

"Place is the least rehearsed part of the white paper and yet is the most indefinite."

The importance of collaboration between NHS and LAs:

“The future of the NHS will be determined by its ability to collaborate.”

The importance of citizen focus:

"What does this mean for our people in terms of their sense of direction and purposes? Identity is formed by place and community, which isn't discussed enough."

And the challenge of the acute-centric nature of the proposals:

"This potentially feels like the emphasis is on acute trusts. I am worried about mental health, community and primary care being marginalised in terms of influence - yet these are where our people spend all their time."

These themes are helping us to decide where we can most usefully focus our thought development and institute research.

We will continue to explore these key areas as we publish four bulletins of original thought each week in our Illumination series. During Tuesday’s session Sarah Morgan mentioned her own recent contribution to the series, on the implications of thinking about ‘citizens’ as opposed to ‘patients’. And we published our own initial response to the white paper as soon as it was published on 11 February. We will also be sharing our thoughts and insight on ICSs and beyond on our Twitter and LinkedIn feeds.

Alongside our Illuminations and social media activity, on Friday mornings we host peer-to-peer webinars for NHS non-executives, and every two weeks on Wednesday mornings until the end of March we will be unpicking the white paper at our webinars, which are open to all.

Our weekly newsletters bring all of this activity together in one place, providing summaries of our recent events, outlining upcoming events and sharing our latest knowledge and insight. From 28 February, our newsletter will be issued on Mondays - you can subscribe by emailing advice@good-governance.org.uk.

Reflections on the white paper

GGI is supportive and optimistic about the significant changes laid out in the white paper but making them work will require intelligent, informed and collaborative leadership. It will also really require careful thinking about the governance of the new ICSs, the new provider collaboratives and place. Here GGI can provide unique counsel.

For example, the biggest area of focus during Tuesday’s conversation was the importance of NHS and local authority collaboration. Over the coming weeks GGI will be working to think through how the governance needs to be framed to foster this collaboration. In parallel, we will be mobilising our networks and events to stimulate discussion and learning.

As a starting point, our Illumination tomorrow will be a reflection on the Local Government Association’s full response to the white paper - a very interesting insight, helpful for NHS colleagues in particular to understand.

As we move into this period of great change, GGI is committed to helping ICSs and partner organisations adapt. We can claim unique insight into how to make the governance for ICSs and provider collaboratives work. We have worked directly with nine ICSs and indirectly with all of them. If you would like to hear more about our work, or discuss your own issues, please give us or call or send us an email.

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

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