Hello PPMA members and friends

Mike Emmerich, Founding Director at Metro Dynamincs and previously CX of New Economy in Manchester and central to the Manchester devolution deal, writes our blog post this week. Mike looks at the important role of distributed leadership in tackling the challenge of health and social care.

“I would be very surprised if there is a bigger or more frequently discussed challenge in public service than the integration of health and social care. And yet until quite recently, the balance was very heavily skewed towards talking with precious little actual integration to speak of save a few small local pilots. This is going to have to change. There are reasons for optimism that it can.

The advent of devolution may be one of the catalysts for unlocking reform. For the first time in the careers of most, council chief executives are now working across their boundaries, often using models of decentralised leadership and cooperation to forge newly devolved service and funding models in ways that would have seemed impossible just a few years ago. This is not just an activity for officers but for members too. The practice of distributed political leadership, one of the lesser known features of the Greater Manchester model is finding favour in other areas too as a way of developing common solutions to shared problems, creating new and powerful alliances, overcoming traditional enmities in the process.

It is a small leap from this into using the same models of working across health and local government leadership teams. The idea is a simple one: that the leadership roles are divided by portfolios or themes; leaders take responsibility for developing and implementing proposals in different areas once agreed by all parties; and, as a result, each council and NHS organisation has some skin in the game of all the others. By definition it forces each of the parties to own the problems and constraints of the whole. It isn’t easy. It requires confident politicians and Trust Boards, public service leaders with vision and commitment along with a good deal of time and effort.

It isn’t just that there is an opportunity. There is a financial need too. For the first time ever, integrating health and social care looks to be both necessary and the line of least resistance. There has never before been a need great enough to make the pain involved worthwhile. The usual approaches: spot purchasing care and sweating the NHS asset are not open in the way they once were. Care budgets are tighter than anyone has ever known them with the NHS in record deficit.

All across the country NHS and local government leaders are looking at how to maximise the effectiveness of spending. Unsurprising then that integrating health and social care features heavily in Sustainability and Transformation Plans (STPs), is on the shopping list of areas looking at devolution, and for most council finance directors is the Christmas present they dream of as they contemplate the next round of council cuts. But without fresh thinking we’ll end up going round the same loop again.

So distributed leadership looks like an approach that could work and the need is there to make it worth the effort of trying. But integration is not going to be easy. Viewed too simplistically integration requires that councils or trusts give up their legal duties to one another whilst retaining legal duties and risk. This is clearly difficult territory for any accounting officer.  But distributed leadership is a means both by which such issues can be aired and for organisational boundaries to be renegotiated in more subtle and sophisticated ways. It is a way for councils and NHS organisations to identify quick wins as well as planning longer term change.

Centrally driven programmes of change haven’t delivered what’s required. What’s needed is practical action on the ground. And I think the conditions precedent are coming into place. Local government devolution, the advent of STPs and the rather more devolutionary NHS Five Year Forward Review alongside a profound and ongoing budget crisis all make change possible and necessary.

But from what I’ve seen in the places across the country where we’ve worked in this way, distributed leadership holds real promise for catalysing the change we so very much need to see in practice.”

Mike Emmerich

Founding Director at Metro Dynamincs