Skip to main content

Report

Long read

Governing the health and care system in England: creating the conditions for success

Where will system leadership and partnership working fit into the new operating model, and will commitments to devolve decision-making be fulfilled?

  • Governance

Download the report $Governing The Health And Care System In England 353.4 kB

Key points

  • The NHS has evolved from an administered to a managed service with a complex overlay of competition, inspection and regulation.
  • Throughout its history, national leaders have expressed an ambition to devolve decision-making within the NHS even when relying on command and control to bring about change.
  • Performance management has contributed to improvements in care but has had negative consequences, including disempowering staff and fostering a culture of compliance.
  • There is an overreliance on regulation and an urgent need to value trust and restore respect between leaders at all levels.
  • The NHS is a complex adaptive system and there are limits to the effectiveness of command-and-control methods in bringing about improvements in health and care.
  • Central leadership is needed on some issues and local leadership on others, supported by peer challenge and support and the use of information on comparative performance.
  • The partnerships that make up ICSs should draw on intelligence about the diverse populations served and harness community power [ * ] in discharging their functions.
  • The number of staff working at the centre and in regions should be reduced substantially to enable ICSs to fulfil their potential as system leaders.
  • The role of regions should be reviewed when ICSs have demonstrated their ability to act as system leaders, with a view to streamlining the organisation of the NHS.
  • A major effort is needed to cultivate systems thinking and systems leadership and to build a ‘team of teams’ to underpin new ways of working.
  • ICSs themselves should operate on the basis of subsidiarity and foster a culture of innovation and improvement in the neighbourhoods, places and organisations that make up systems.
  • NHS leaders must engage in political management and push back on interventions that run counter to aspirations to devolve decision-making.
  • A number of simple rules are proposed to support these developments; these rules should be tested and refined in the light of experience.