Integrated NHS care: health reforms present new leadership challenges

A shake up designed to join the dots between health and social care is taking place at a time of low NHS staff morale and major funding constraints, says Partner & Head of our Healthcare and Life Sciences Practice SJ Leatherdale.

As we are all well aware, the NHS has been through a tough couple of years, exceedingly tough. The COVID-19 crisis put immense pressure on resources and many employees across hospitals and community settings understandably feel exhausted and dispirited in the face of long hours, understaffing and waiting lists for treatment hitting an all-time high.

Clapped as pandemic heroes they may have been, yet the day-to-day reality is rather different. Despite giving their best, they bear the brunt of patient dissatisfaction, understaffing and systemic strain. “Burnt out” NHS hospital staff have taken 8 million mental health sick days in the past five years. Something has to give, change is urgently needed.  

Against this challenging backdrop, significant new health reform designed to improve collaboration between health and social care to the benefit of patients is set to come into effect. The aim is to deliver on some longstanding aspirations for closer integration.   

As Nuffield Trust noted in its December 2021 research report the integration of health and social care has long been a policy priority for each of the four countries of the UK, driven by the needs of a population that is living longer and with more long-term health conditions. “However, the extent to which integration has been achieved in any of the UK countries – and what benefit, if any, that has had for patients – is open for debate.”

Which is why a lot is riding on the introduction of Integrated Care Systems (ICSs), new partnerships between the organisations that meet health and care needs across an area, to coordinate services and to plan in a way that improves population health and reduces inequalities. The intention is that the 42 new ICSs in England will provide support by removing traditional divisions between hospitals and family doctors, between physical and mental health, and between NHS and council services.

But there are real worries as to how this will play out in practice. In a recent, candid interview, a highly respected long-serving former NHS chief executive expressed concerns that political targets may drive “unhelpful behaviours” which would lead to the NHS being unable to truly deliver integrated services. “I think regulators understand the importance of system working, but the trouble is system working doesn’t give the immediate results that the politicians need,” they said.

NHS leadership is often caught on the backfoot when patient tragedies occur, and that extends to helping clinical managers and their teams deal with distressing events of this kind. The Shrewsbury and Telford Hospital NHS Trust maternity scandal showed how terribly things can go wrong and underlined the pressing need for change, with the Ockendon report concluding robust and funded workforce plans for England are urgently required to prevent serious failures of care.

New kinds of leadership will be needed to deliver change and tighten up governance across the NHS landscape, while at the same time improving the working lives and motivation of employees. It’s a tall order and interim management talent is and will undoubtedly continue to play an important role in the highly demanding months and years ahead. Up and down the country, organisations will from time to time require quick access to relevant expertise while developing and implementing a mixture of transformation programmes.

Returning to the new ICSs, the Government has indicated that it wants all of them to produce a strategy by the end of the year. Ahead of this, the Integrated Care Boards (ICBs) created to oversee each ICS are set to become statutory bodies on 1 July. 

There will be no end of challenges for them to get their teeth into, not least the onerous that every ICS should break even in 2022-23. There will also be potential conflict of interest scenarios to consider. As this interesting NHS Confederation piece ponders, how does a partner member of an ICB board behave when their organisation is affected by a decision to direct significant financial investment to one trust in preference to another; for example, from one region to another or to a mental health trust from an acute trust?

There is no doubt that joining the health and social care dots at a local level is the right thing to do. But quick fixes are unrealistic. It will take time for the ICBs to find their feet, resolve governance and financial balance issues and work out just how dynamic they can be in delivering much-needed solutions.

Pertinently, transformation will occur amid tight funding constraints and widespread weariness and frustration among NHS staff. If it is to succeed, a prescription is called for: considered, realistic, empathetic and inspirational leadership across the board.

For more information, please contact SJ Leatherdale.