The National Health Service has faced formidable pressures during the Covid-19 pandemic and has risen to the challenge of providing care for the many patients acutely unwell with the disease, as well as rolling out the greatest vaccination programme in its history.
However, the pandemic has left a legacy of urgent and emergency care services in crisis, long waits for elective procedures and delays in the diagnosis of serious conditions, such as cancer and heart disease. What has been achieved during the pandemic would not have been possible without the commitment and dedication of our health and care workforce, but they are now exhausted. Covid-19 has intensified existing workforce challenges and has led to increased staff burnout and subsequent workforce shortages are affecting many services already under intense pressure.
The problems we are seeing in the aftermath of this pandemic were not caused by it, some were many years in the making. However, they have been exacerbated by Covid-19 and it has made the need for a solution to them more urgent.
The measures set out in the Health and Care Bill, currently making its way through Parliament, are an opportunity to put much-needed reforms into practice.
The move to create new structures to integrate care across systems has been welcome, and proposals in the Bill to put Integrated Care Systems (ICSs) on a statutory footing equally so, but this restructuring must be supported by the right leadership approach. Over the last eight years I have been assessing the quality of care in hospitals and it is abundantly clear that while effective governance is essential, it is not enough in itself to ensure patients receive high quality care.
The quality of the leadership and culture of an organisation is critical in determining the quality of services being delivered. This understanding is at the heart of CQC’s well-led assessment framework, which we are currently revising, and which will be central to CQC’s role in the assessment of ICSs and Local Authority assurance as proposed in the Bill.
So, the new structures must herald a new approach to leadership if we are to make progress in addressing the problems. That leadership must be transparent and open to challenge both from people receiving care and those providing it, who together face the problems of service delivery and who will often be well placed to identify the solutions.
CQC’s role in assessing ICSs will be to ensure they deliver excellent, joined-up care that meets the needs of the populations they serve.
Early detection and prevention are key to improving outcomes for people and ICSs have an opportunity to address people’s needs early on. This will require ICSs to really understand the populations they serve and to think innovatively to tackle problems, improve access and outcomes for local people. ICS leadership must be collaborative, bringing all parts of the health and care system together to build services around the needs of people receiving care.
Understanding and tackling health inequalities will be crucial and how they approach that task is an important marker of a good collaborative leadership culture. Another area that is essential for system leadership to focus on will be making sure care is as safe as it can be. Healthcare is complex and the day-to-day risks are significant, so leaders must build a strong safety culture, founded on openness and learning, not defensiveness and recrimination.
The first test for the leadership of ICSs will be repairing urgent and emergency care systems and building capacity before the inevitable surges in demand next winter. Nowhere is the continuum between health and social care clearer and more critical than in urgent and emergency care pathways. As a result, collaborative leadership, centred on the needs of the population, is crucial.
Key Points:
• Covid-19 has exacerbated existing pressures faced by health and care services and the measures set out in the Bill are an opportunity to put much-needed reforms into practice.
• ICS leadership must be collaborative, bringing all parts of the health and care system together to build services around the needs of local people and be open and receptive to challenge from people receiving care and staff providing it.
• Understanding and tackling health inequalities will also be crucial, and how ICSs approach that task an important marker of a good collaborative leadership culture.
This article originally appeared in The Leaders Council’s special report on ‘The Impact of the Health & Care Bill’, published on March 4, 2022. Read the full special report here.
Photo by Georg Arthur Pflueger on Unsplash
