There is a huge management task to get the arrangements right to deliver the expected benefits of scale and to develop appropriate governance. Provider collaboratives should ensure that the voices and skills of those working in commissioning aren't lost, particularly their ability to step back and see clearly and without bias the equal importance of all parts of the system. There is also a need to make sure that the health care system as a whole fits together clearly and to concentrate each precious part of it on the priorities that will make the biggest difference to patients.
However, while attention tends to focus on the politics of the system and who's in charge of what - which is more about power than leadership - one of the biggest leadership challenges facing provider collaboratives is to reinvigorate the natural creativity and leadership of clinical and professional leaders. Reflecting on experience with mental health provider collaboratives, which have been designing and improving services for a while, it was clinicians being given the right freedoms, resources and incentives that made the biggest difference; starting with clinicians and patients, getting into the detail and adjusting the care model pathway with and around the patient.
Yet before clinical and professional leaders can find the time and energy to lead, they need to disentangle from a spider’s web of leadership challenges - coming to terms and recovering from the impact of the past 18 months on their own wellbeing and that of their teams, the shortage of clinical workforce and the pressure of demand drawing their time into frontline care - and organisational issues - some cultures that could be more geared toward empowered clinical and professional leadership; limitations of traditional clinical roles, hierarchies and remuneration; the need for leadership to be viewed as a competency as well as a philosophy.
Clinical and professional leadership capacity will need to be purposefully created so that leaders can be involved in provider collaboration and system leadership, carving out dedicated roles, such as a lead for partnerships, and changing the expectations about what a clinical and professional leader might look like. This environment of collaboration with new roles and tasks will require new skills and approaches; a national, regional, and local support and training offer is needed to support good clinical and professional practitioners to step into complex leadership roles. This means moving clinical and professional leadership from rhetoric to reality - with all professions being given the time, space, opportunity, competencies, support, proper incentives and autonomy to lead.
The NHS is at a pivotal moment recovering from the Covid-19 pandemic – with new leadership at NHS England and a new Secretary of State, dealing with huge backlogs of care and inequalities. The system needs to move to a place where all care professions invest as much in leadership skills and development as they do in professional development. It is good to see that to inform the content of the recent guidance to integrated care systems, one of the first things NHS England and NHS Improvement has done is to listen to the clinical and care professional workforce.