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Looking ahead, what can health and social care systems learn from the covid response to strengthen leadership and governance?

Croydon Health Services is part of the One Croydon Alliance, one of the first integrated care partnerships in England, servicing a population of 400k. Croydon was one of the hardest hit London boroughs seeing over 200 COVID inpatients at the peak of the crisis. Although, still in the middle of responding to COVID, Michael Bell, Chair, shares some thoughts on governance and leadership to date.

In conversation with Michael Bell, May 2020

What was your experience in responding to the current crisis?

Our staff and partners have been amazing in these difficult times. Initially, the leadership was focused on the surge planning. This involved repurposing the services across our local system to meet the covid demand. It was a huge amount of work. Critical to this was our work in building partnerships over the last few years. This paid dividend in responding to the crisis.

We brought significant amount of changes with astonishing speed. For example, we ‘digitised’ 40% of our outpatient activity shifting to online consultation within 5 days. We had been attempting this for 2 years! The catalyst for change was the common purpose shared by all – addressing the crisis and saving lives.

As leaders we are ensuring there is transparency in decision-making, strong communication, mitigating national risks such as availability of PPE and testing, maintain a focus on the long-term system vision and provide visible leadership to support and boost staff morale. There is still much to do.

What have been the key lessons for the leadership?

  • We need greater resilience in our services to respond to events like covid. We cannot run at 100% utilisation as we have been for over a year.
  • A decade of underfunding in public health has left us exposed particularly in terms for testing capacity and health intelligence. This needs to be fixed as a priority.
  • Capital underinvestment in IT has impacted our ability to pre-empt and respond quickly. Also, getting information governance right in the good times is critical. We do not want to be doing this in the middle of a crisis.
  • The just in time supply chain and logistics model is no longer good enough. We need to fix this to respond better to future crises.
  • On a more profound level what covid has highlighted is our lack of progress in addressing health inequality both in terms of provision and the wider determinants of health.

As we reset the system, what positive changes leadership teams need to take forward?

  • There has been a real change in attitude amongst management and staff. We had much faster decision-making, a can-do attitude, greater trust, and teamwork.
  • We introduced multi-disciplinary approach working across traditional organisation silos and stronger relationships with partner organisations.
  • There has been more collaboration rather than competition amongst providers, primary care, social services and the third sector, overcoming the usual tribal behaviour.
  • The change has been driven by a common purpose in responding to covid and the will to do the best for patients and colleagues. This needs to be maintained and channelled.

Looking forward, what is the focus of the leadership team?

  • Vigilance: we know a vaccine will not be available for a while. We need to plan accordingly implementing interventions to control the spread of the virus.
  • Resilience: We need to make sure that we are using the latest research and public health intelligence to plan for potential further surges.
  • Capacity: The NHS is not a national Covid service but a national health service. We need to ensure we also meet the health and wellbeing needs of the rest of the population.
  • Transformation: we have introduced so many changes in how we deliver services and the culture we operate in. We need to rethink transformation in the “new normal”.
  • Proactiveness: in responding to covid we identified vulnerable people more susceptible to covid and implemented interventions to protect them. This is an example of proactive health management which should be the norm.

What does this mean for governance and leadership of health and social care?

  • Partnerships deliver! We need to accelerate partnership working and the integrated care system agenda which is more focused on the population health and wellbeing.
  • We need to move away from single institution governance to a wider system governance model. Improving health and wellbeing outcomes of the population needs to be at the heart of governance not just an individual patients’ interest.
  • Good relationships lead to effective action, effective action requires good governance structures, and good governance can deepen relationships – a virtuous circle. We need to keep these three pillars balanced.
  • The adversarial commissioner provider model is no longer fit for purpose. In responding to covid, it was rapidly dropped. If it does not work in an emergency, why should we continue in business as usual?
  • Leadership models and incentives need to change to move away from individual organisation performance to improving population health and wellbeing.

"Covid has illustrated that partnerships work and we need to shift from governance of individual institutions to systems."

At Strasys we are working with healthcare systems across the world, providing tools and insights to help navigate through this crisis.  If you would like to discuss the ideas presented in this article or would like to learn more,  get in touch.