Looking across the 44 footprints, with their different configurations of local partnerships and leadership, several things strike you.
The first is that, for their plans to be sustainable, the fledgling health and care partnerships will need to improve models of care and save money on such a scale that services must change in a major way.
At the same time, people must be brought along and confidence maintained. This is a tricky balance – guarding against complacency while avoiding panic.
The second is staff culture and – especially – the culture of clinical and professional staff. Roles and careers will need to change, so we need to inspire people with the opportunities this can bring for career development and service quality. We must also be honest about the scale of the challenge and recruit staff to help design a solution which is greater than their own organisation.
Coming from a culture with clear lines from board to ward and rigid professional demarcations, staff will move into a new world characterised by multiple, diverse providers working in partnership and a funding regime designed to deliver ‘accountable care’ for the population. Success will rely heavily on front-line staff working out practical solutions and collaborating effectively across boundaries.
So this is no time for spin. Communications must be geared to helping our staff raise their line of sight – above and beyond their own employer and “how we’ve always done things” – and provide the skills and support to work in new ways.
The third thing which strikes you is about trust – both of staff and of patients, and the interplay between both.
This is a long-game. There has been a 20-year reduction in trust and confidence in institutions of all kinds, particularly public bodies. While intentions have been good, the public discourse on transformation and local programmes as being about secret plans, cuts and privatisation means there is work to do.
The first and most important priority is to find mechanisms to genuinely listen to ideas and feedback, and demonstrate how concerns have been heard and workable solutions on taken board.
These attitudes and perceptions are important because in future patients and service users will be asked to play a far greater role in managing their own care and preventing ill-health. The creation of a two-way dialogue is central to enabling patients to take more control – and the stories which service users and professionals tell each other are an echo chamber which influences trust and confidence in institutions as well as behaviour.
Working in local government or health, you realise how important and powerful our institutions are. In many areas over 10 per cent of the local population is employed either by the NHS trust or the council – and many more work within their sphere of influence, such as volunteers, third sector organisations and commercial suppliers. The workforce, via thousands of conversations over the fence or at the school gate, can be the most effective ambassadors.
For system leaders, we know that the staff communications challenge is greater than the financial or the political challenge. It is especially important because in future staff will need to work across organisational boundaries, and to work differently – such as hospital consultants working in community clinics and GPs leading multi-disciplinary teams, social workers based together with nurses.