15.01.16
Successful integration demands leadership continuity
Source: NHE Jan/Feb 16
Shirley Cramer CBE, chief executive of the Institute of Healthcare Management (IHM), discusses the challenges facing leaders in these integrationist times.
The drive to achieve integration of health and social care services, the goal of successive governments over several decades, is finally gaining momentum. While it is clearly too early to judge the achievements of the appointed pioneers, a heterogeneous group with varying ambitions, evidence of commitment to innovation abounds.
Overcoming the historical barriers between the two sectors is now seen as vital to addressing the needs of an ageing population but it presents ever-evolving challenges for health and social care leaders if its primary goal of improving outcomes for patients is to be realised.
It is not difficult to see what these challenges are. The latest reforms of the NHS health and care system, enshrined in the Health and Social Care Act 2012, mean that services are commissioned and funded separately and that varying governance, accountability and regulatory regimes apply to them. This fragmentation makes the task of bringing services together at an organisational level a complicated task.
The best chance of achieving meaningful integration – which is more than just the sum of co-ordination and partnership working – would be to create a stable environment in which it can develop and flourish. Unfortunately, stability in either health and social care has been notable by its absence for many years. And given the enormous financial pressures both face, a stable future is likely to remain a pipe dream. The £1.5bn of extra funding promised to support integration through the Better Care Fund by 2019-20 will help, but is still likely to leave the UK firmly toward the bottom end of the OECD league table of care spending.
As the system creaks and groans, further risks to progress are presented by a workforce that is becoming increasingly resistant to the idea of doing more for less. GPs fleeing abroad or retiring early, practice managers looking for jobs outside health, junior doctors striking…and all of these (among others) with an important part to play in the integration agenda.
This is the world in which health and social care leaders must work together to create better services for their populations. To create a vision, trust and shared values, to break down traditional silos and change cultures. Continuity of leadership will be vital to the success or otherwise of integration.
However, as a recent IHM snapshot survey revealed, this continuity is under serious threat. Half of 18 CEOs from its membership were considering quitting their post within the year. Of these, only one was looking to find an alternative position within the NHS, with the remainder seeking alternative employment in another sector or private healthcare, or taking early retirement.
The message is clear. Leaders need more support if they are to stay the course and make integration, among other priorities, a reality. Risks will need to be taken, failures accepted without blame and greater recognition given to those who lead the way.
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