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Grampian – leading across systems

We supported system leaders in Grampian to work together to address shared challenges in their local health and care system. 

The issue

Like the rest of Scotland, Grampian is bringing together the NHS and local authorities to integrate health and social care services. This work is led by the chief officers (COs) of Grampian’s three health and social care partnerships, new organisations established in 31 areas of Scotland to deliver integrated care. It is a complex and evolving environment. 

The COs wanted us to support their senior leaders to work collaboratively across their local health and care systems as they moved from leading separate organisations to working in partnership or system leadership roles. While these leaders were experienced in working in their separate organisations and professions, they were much less certain about how to lead and work together in local systems. What would be the shared ambitions and priorities? Were strong enough relationships in place to agree these? How would they tackle difficult, cross-system challenges?  

Our approach

We have been involved in supporting Scotland’s system leaders with the journey towards integrated care since 2017, when we worked with the new network established by COs across Scotland to help them develop their approach. For Grampian’s COs, the combination of our policy expertise in integrated care and experience of supporting the development of local systems made us a logical choice to help them establish their approach to system leadership. 

From scoping out the work at Grampian, we knew that leaders felt that they didn’t have strong enough relationships or understanding of the leadership needed to work in systems. So, our approach was to look at building relationships and trust, to focus on working in systems rather than sectors or organisations and, crucially, to embed this by applying it to a key cross-system challenge. 

“There’s no point in just offering theories about system working... support needs to be relevant to the issues actually faced by the local leaders.”


There was a clear rationale for this: ‘There’s no point in just offering theories about system working,’ explains Allison Trimble, the senior consultant who led the programme, ‘support needs to be relevant to the issues actually faced by the local leaders.’ 

Grampian’s senior leaders identified delayed transfers of care as the key issue they wanted to focus on. A principle of our approach was to recognise that there is no single solution to such a complex issue. ‘You can’t just fix these “wicked” issues – you have to make progress with them and adapt around them,’ Allison explains. 

Our approach also involved working with participants to disentangle the challenges inhibiting progress – such as how to have difficult conversations, recognise the dynamics driving relationships, reframe issues and bring fresh thinking – and spotting how they affect delivery.  

The impact

Adam Coldwells, Chief Officer for Aberdeenshire Health and Social Care Partnership, suggests that Grampian’s winter care planning has already benefited from a more sustainable approach. He believes that the Fund’s work in helping the leaders to understand systems as complex and organic, and to frame complex problems in fresh ways, has contributed to a different climate.  

‘In a system that understands each other’s position, there’s a much better sense of “actually I understand what you’re struggling with”. It’s mutual respect and a more mature understanding.’ 

The programme – which Adam says was ‘delivered with first-class skill and a real commitment’ – has helped Grampian to think differently about complex problems. ‘Rather than staying on the “too-difficult” pile, it’s about how do we get in and tackle a problem, and have collective leadership about it across the whole system.’  

Our organisational development services

Unlike other consulting approaches, OD at The King’s Fund starts from the premise that the experts in addressing these issues are the people who face them every day.

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