8 steps to get whole system working ...working!

With shifting demographics, growing demand and significant financial pressures facing the NHS, there is an increasing move towards integrated care and whole system working. New models of care are being developed which are focused on better outcomes delivered at lower cost, across an integrated system.

Whilst the theoretical benefits of whole system working are clear, the reality of many disparate organisations with different strategies, leadership, legal and regulatory demands requires robust yet flexible governance.

Existing governance arrangements and regulatory frameworks need to evolve to continue to provide assurance over the safety and quality of services provided by individual entities whilst also supporting the transformation and sustainability of the system as a whole. There is a need to balance shorter and longer term priorities at individual entities with the end vision for the system in order to enable the necessary investment in transformation across the system as a whole.

Significant time and effort has gone into developing, and now implementing, Sustainability and Transformation Plans (“STPs”). Key to delivering these plans and ensuring their objectives become a reality are the leadership and governance arrangements that underpin them.

Governance arrangements for systems and STPs will need to be sufficiently agile to adapt to the changes that will occur as plans are implemented and whole system working matures whilst also meeting the assurance needs of each separate sovereign body.

Based on our experience of the current arrangements and challenges in the NHS from working with providers, commissioners, regulators and STPs, and also internationally, where whole system working has been embedded for a number of years we believe there are eight principles that can support and underpin effective whole system working, as set out below.

  1. Compelling core and shared purpose: stakeholders united in shared purpose to invest time, effort and resource to work effectively across the system and achieve transformation.
  2. Strong clinical leadership: system-wide clinical leadership at all levels and investment in collective leadership behaviours and capabilities.
  3. Capability and capacity to deliver: investment in system-level resource and operational roles including training and support for NEDs, lay members and councillors.
  4. High quality interpersonal relationships: shifts in behaviour including open dialogue and trust between leaders across the system to achieve shared goals.
  5. Communication: 360 degree communication within the system feeding information up to Boards/committees and down to wards/services and individual members.
  6. Engagement and accountability: clear reporting lines and accountability routes with effective monitoring and agreement of what constitutes failure.
  7. Agreed approach to arbitration, collaboration and competition: process and mechanism for concerns to be raised at an early stage (things will go wrong along the way).
  8. Shared risks and benefits supported by robust data: stakeholders own and share risks across the system with a single dashboard to inform decision making and actions.

We are already working with organisations along the lines and these eight principles are supporting them to ensure quality, safety, finance and governance are embedded and work effectively across their systems.

We are hosting a number of roundtable events around the country for company secretaries and governance leads to discuss the practical challenges of implementation. If you would like more information about the roundtable events or system governance please contact Yvonne Mowlds.

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