Gaining trust from the workforce in an integrated care system

19 January 2023

Building the kind of collaborative culture needed to make ICSs a success at a time of great challenge for the NHS will take time and focus – and trust.

Two NHS England announcements last week highlight the extraordinary challenge facing healthcare leaders.

The first referred to the ‘significant pressure’ hospitals are under, with bed occupancy at the second highest level recorded in this toughest of winters.

The second was to reduce its own headcount by 40 percent through a voluntary redundancy scheme targeting the transformation, training and education and strategy directorates, including the communications function.

Neither of these announcements will have come as any great shock to those following NHS fortunes. But they do serve to highlight the challenge facing ICS leaders as they work to bed in the new systems, structures and culture of integrated care. This perfect storm of shrinking resources and growing demand during a period of fundamental change will not be easy to weather.

In a recent article for Healthcare Leader, Professor Nora Colton, Director of UCL Global Business School for Health, suggested that the Hewitt Review into ICSs (which GGI has contributed to) offered some hope, saying it represented an opportunity to ‘to break away from old habits and find long-term solutions to the problems in our health system’.

She listed three areas of focus that the review should consider – one of which was giving healthcare leaders space to think. She wrote: “Many influential commentators have talked about the need for a new approach to leadership within ICSs. For example, The King’s Fund has argued that change cannot be achieved through simply ‘imposing new structures’, but requires ‘organisational development and culture change’. Healthcare Leader’s own report into the end of CCGs also noted the importance of training in medical leadership. As one interviewee poignantly commented, with reference to ICSs, ‘How can GPs suddenly run a billion-pound organisation?’ Taking stock and investing in the long term is crucial.”

It's a theme that surfaced during an online panel event last week, hosted by GGI and change specialists MaST Evolution and chaired by Cathy Elliott, chair of West Yorkshire ICB, to explore workforce learning, engagement and support in integrated care systems.

If you can’t unlock the truth don’t bother to enter the room

One of our panel members, Admiral Sir George Zambellas, former First Sea Lord of the Royal British Navy, said ICS leaders should include their own capabilities in that stock-taking process. He said: “Institutions grow and develop on the basis of what their needs are; but as those needs change leadership qualities are not necessarily right for the new challenge. […] The most senior levels of leadership need to be honest with themselves and ask ‘have we got the right people and skills to promote belief in this concept from the bottom up? And if we haven’t, we need to be quite radical, quite aggressive’. If you can’t unlock the truth don’t bother to enter the room.”

Another panellist, Edna Boampong, Director of Communications and Engagement at Shropshire Telford and Wrekin Integrated Care System, said those essential leadership skills must include communication, relationship-building and genuine engagement. She said: “We need to ensure that people feel that it isn’t just a tick-box exercise. We’re not just doing this because it’s our statutory responsibility, we’re doing it because we genuinely want to hear people’s views and opinions. And they must see how their views and opinions have made a difference.

“It’s crucial that you have the right people talking to the right groups in the right way and building relationships. Relationships are the most important thing – it doesn’t matter what kind of communications or engagement strategy you have, because without mutual respect, nothing happens.”

This point was echoed by Dr Katy Baboulene, Clinical Director of Psychology Sussex, who was also on the panel. She said: “As human beings we want to feel listened to. The key ingredient to feeling listened to is that the other person can empathise with the experience we’re going through. It has to be felt. From there we can develop a collaborative approach.”

Francesca Hunt, Managing Director of our co-hosts MaST Evolution, said the event provided a ‘clear sense of the points of focus’. She said: “It all goes back to this idea of trust. You need to transfer your own belief, so people believe that it’s worth following you. And that’sall about listening – making people feel as though they’re part of it. It’s not a one-way process, it’s a conversation.”

But developing these important skills required for integrated care leadership, and building those vital relationships with staff to create a genuinely collaborative culture all takes time and needs focused attention. And leadership time is another resource that’s in short supply in today’s overstretched NHS. So how do leaders liberate the time they need to focus on these priorities? That is GGI’s focus area for February – so please stay tuned and, if you haven’t already, subscribe to our mailing list.

GGI has worked with 18 of England’s 42 ICSs so we’re seeing these challenges play out first-hand. We’ve partnered with MaST because of its expertise around engaging in new and innovative ways to support ICSs. If you want to discuss how we might be able to help you, get in touch.

Daniel Taylor

Engagement Consultant

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Martin Thomas


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

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