17 September - non-executive directors webinar

19 September 2021

This week’s session began in conversation with Sir David Nicholson, former chief executive of the NHS and of NHS England, and currently chair at Worcestershire Acute Hospitals NHS Trust and Sandwell and West Birmingham Hospitals NHS Trust.

Sir David said: “In our integrated care system, our fundamental building block is the community we serve. Getting integration right is really important. Often people start at the top by establishing the ICS board etc. but it should actually be the other way around. Once you have established the neighbourhood care level and got this right you can build up from there. […]

“Working with local government during the pandemic has been much deeper and much more sophisticated than we’ve done before. If we start to build on the back of this, we stand more chance of building something sustainable. […]

“If we think about integrated care and the way in which the legislation is being proposed and plans are being made, there is quite a big tension between, on the one hand, a top-down performance management system and then on the other side a much more neighbourhood-based system trying to throw out at the community. Both are dangerous – top-down because you can kill the relationships that we need but also neighbourhood as there is a suspicion that if you’re interested in local systems then you’re not focused on reset and recovery.

“The great danger now is that we will be showered with guidance from the top and we’ll end up recreating a system that we really don’t want. We are never going to get full autonomy in our roles, but we must decide what to do with the direction coming down and how to apply it in the best way for our context. […]

“From the centre’s perspective for the next few years driving down the waiting lists will be the only game in town. We all know however that there is a whole lot of wider responsibilities that we need to focus on.”

Also overheard during the webinar:

“If waiting lists are going to be the only game in town, how are we going to release the resources to really focus on prevention? Without which we cannot achieve improved outcomes in population health.”

“Unless we really truly take prevention seriously, we are going to go back along this journey we’ve come. There needs to be a fundamental mindset change both in the NHS and local authorities and I fear that we won’t be able to succeed in the outcome of population health.”

“The aspirations are great and true integration is the only way to address population health, prevention and improved outcomes but I fear the only way we will see this happen is with a very different mindset amongst the ICS leadership - if the chairs and CEOs are predominantly from NHS backgrounds, do we need to encourage appointment of NEDs who can bring that wider and bolder thinking to help drive the required mindset for real change?”

These meetings are by invitation and are open to all NHS non-executives directors, chairs and associate non-executive directors of NHS providers. Others may attend by special invitation. For further details, visit our events page.

If you have any comments, questions or suggestions about these webinars, please contact: events@good-governance.org.uk

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