from Debbie Sorkin, National Director of Systems Leadership, the Leadership Centre
If current health, social care and other leadership frameworks describe leadership behaviours within an organisation, Systems Leadership is about how you approach leadership when you’re working across organisations and/or sectors – so when you need to go beyond your own service or area of expertise and interact with others, often with very different priorities and points of view.
It’s the kind of leadership that’s particularly helpful when you’re dealing with large, complex, difficult and seemingly intractable problems; where you need to juggle multiple uncertainties; where no one person or organisation can find or implement the solution on their own; where everyone is grappling with how to provide quality with the resources available; and where the way forward therefore lies in involving as many people’s energies, ideas, talents and expertise as possible.
These kinds of complex problems have been defined as “wicked” issues: that is, issues which have multiple causes and no single solution; where there’s no real certainty or direction about what needs to be done; where you can’t simply do what you’ve done before; where there is no clear relationship between cause and effect; where there will be knock-on effects whatever you do; where trade-offs are likely to be necessary; and where questions and reflection are more important than jumping to conclusions.
Social care providers, alongside local authorities, housing associations, clinical commissioning groups and Health and Wellbeing Boards are all coming up against these issues more and more, as they work to embed service integration and personalisation across what they do, and at a time when they commonly have less money than they need; increased levels of complexity to deal with; and higher expectations than they can cope with.
Systems Leadership identifies ways of working that help providers and commissioners get to grips with these issues, and a number of social care providers are now using these approaches. There is a national programme, backed by the Department of Health, the NHS, public health, adult social care and children’s services, which is funding place-based integration and wellbeing projects across the country.
The programme is called Systems Leadership – Local Vision.
There are currently 35 funded Systems Leadership – Local Vision projects in England, including five in the South-West.
The projects cover a broad range of issues, from integration of health and social care through to more general well-being, including reduction of inter-generational obesity levels, increasing physical activity across a population, and reducing social isolation and loneliness.
In many cases, they are closely linked with organisational preparations for implementation of the Care Act; with Better Care Fund bids; and with simple acknowledgement of financial constraints across the board, and the resulting need for better use of a common public pound.
More information about the projects, as well as initial findings, can be found in The Revolution will be Improvised.
Both home and residential care providers are involved in the Local Vision programmes, and this is an increasing trend. In a new programme in Waverley, for example, the District Council, four CCGs, two foundation trusts, Surrey Care Association, a residential care provider and a training provider are looking with a range of other stakeholders at developing a local social care workforce that is skilled and ready to work in an integrated care landscape.
We are also seeing health and social care working continuing to work in partnership with other sectors, especially across the built environment. In the latest round of programmes, in LB Brent, the Brent Dementia Action Alliance, together with the local Health and Wellbeing Board, is looking at how universal services, including streets, public spaces and transport systems, can respond better to the needs of people with dementia and be more accessible to all. And in Berkshire, 10 health and social care organisations are coming together with three local authorities, four CCGs, two foundation trusts and the ambulance service to tackle integration issues and look at new uses for existing buildings.
The key thing in all this work is that all the parties recognise that they can’t do this on their own: health, social care, housing and the built environment are all seeing themselves, and each other, as an intrinsic part of the bigger picture.
Next steps and getting involved
At the same time, we are looking to set up more programmes on the ground, especially in areas where there has been little activity so far. These will be supported through a pooled fund involving the NHS Leadership Academy, NHS England and the Leadership Centre. Again, the aim is for a range of partners to come together to tackle a ‘wicked’ issue in their place, or to disseminate the learning into new places and across new sectors. As with the current Local Vision programmes, there will be support provided by Enablers, and access to networks and information/guidance from other projects and wider afield. We are also interested in seeing how we can support sustained change, for example through training more locally-based Enablers.
This will be a rolling programme, with the first projects starting in early 2015. We would welcome the active participation of social care providers in these projects. To find out more, or to discuss potential project funding opportunities, please contact me atDebbie.firstname.lastname@example.org.
Debbie Sorkin: National Director of Systems Leadership, the Leadership Centre, November 2014
Debbie.email@example.com; 0207 664 3193; 0781 3744502
 Keith Grint, Professor of Public Leadership, Warwick Business School: Wicked Problems and Clumsy Solutions: the Role of Leadership. Originally published in Clinical Leader, Volume I Number II, December 2008