System leadership viewpoints: Victor Adebowale

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Lord Victor Adebowale CBE is Chief Executive of Turning Point, a health and social care organisation providing services for people with complex needs, including those affected by substance misuse, mental ill-health and those with a learning disability.

This interview is taken from our report on the practice of system leadership.

Do you see yourself as a system leader?

I am in a system and I’m a leader of it, so I suppose I am applying system leadership as I understand it. Turning Point operates at some 206 locations in England and Wales and we employ some 3,800 people, most of whom do not work in my office. They work in drug treatment, mental health, primary care, commissioning and we do some employment work, and they do it in a huge variety of locations from prisons to police stations to hospitals to hostels to people’s homes. So we are a system. We are legally defined as an organisation, but we are really a system that has to work with others. And in my view, a huge amount of it depends on the values of the person who is called chief executive, and how they act out those values, and how their colleagues act them out.

What do you understand by the term 'system leadership'?

My view is that we are in the foothills of system leadership in health and social care.

The NHS has a wonderfully coherent and sometimes effective, but more usually over-intellectualised and over-complicated, view of system leadership that does not have very much impact on the day-to-day.

There is some really excellent leadership across boundaries in health and social care. In Brighton, for example, where the police work really well with social services and the NHS on mental health, or in Stockport, where there is good leadership across health and social care. But they are rare, and they are too few when we need to be doing this at pace.

A lot of it comes down to the people. It is always the people. Sometimes it is accidental that the leader happens to have developed a certain understanding intellectually and emotionally of what system leadership is. So if you look at the Bromley by Bow Centre, which everyone goes to, you clearly see system leadership – the ability to attract the willing, work with the willing and grow that with the team of the willing so that it impacts on the system. It is also the ability to change oneself from the inside so you can impact the outside, and constantly doing that, so that it is fully focused on citizen and patient care and the outcomes, rather than the elegance of organisational design or professional boundaries.

You can achieve this by reflection and training. I don’t think system leadership is as rare as people say it is and it is perfectly possible to train and develop system leaders, though it can be a difficult journey for the individual, both emotionally and intellectually. We don’t do enough of it.

We do spend quite a lot of money in the NHS – some £120 million – on leadership and leadership development of some kind or another. But I wonder how far it has a real impact.

There are some excellent examples of leading across boundaries in local government, but that’s because it is almost the nature of local government. If you are the chief executive of a county council, you may have responsibility for a whole series of direct services to individuals, but those individuals will also assume you have influence over others. And indeed since the Health and Social Care Act that has become more and more apparent. So there is a need for local government, if it is to be effective, to lead systems and think across organisational boundaries if they are to have any value. But the same goes for the NHS. And I am so conscious of the tensions – sometimes personal – between local government and health that it does not help to get into an argument over who is better than who. There is a plague on all their houses if it is not done.

But it is being done. The Forward View has all the arm’s length bodies getting together to recognise that this is a system, that NHS England, Public Health England, Health Education England, Monitor, the Trust Development Authority [NHS Trust Development Authority] and CQC [Care Quality Commission] are all roped together. That is an act of system leadership in defining the context in which we are operating and therefore defining what needs to happen next. There are implications in the Forward View for the type of leadership needed to deliver it. It underlines the need for system leadership. So the question now becomes, how do we accelerate that, and ensure that system leadership is the way things get done around here?

That will involve a shift in the way we allocate and design with the resources available and that is not a question, in the first instance, of more resources. And I’ve just read the excellent piece of work by The King’s Fund on leadership and leadership development, which looks at the evidence base, which is the way we need to be going.

What motivates you to do this work?

In terms of successful work I’ve been involved in, I suppose changing the Met Police’s response to people in mental health crisis is one that others have said has worked well. I judge the outcome on what it has done for the punter rather than what I did. But I can point out a shift in what happens at police stations, in section 136, and in what happens to black and ethnic minority people in London. I am not saying it is perfect. But I know we have shifted the experience of very vulnerable people as a result of that work, which involved working across the police, social services, health, ambulance.

What skills does it take, and what qualities are needed?

I have been at Turning Point long enough to know that longevity of leaders and leadership in organisations is important. I think the evidence backs me up on that. It is important because you learn as much by failing as by succeeding, and you have to be there long enough to do the learning.

At Turning Point I have made attempts to understand the organisation and the context in which it has operated, and apply my understanding of leadership, and it has worked.

I've been here long enough to learn from mistakes, pick up the learning, apply it in different contexts and carry on.

The work on connected care, where I was trying to create a methodology which supports communities in designing and creating integrated health and social care… It was gleaned from my learning in working in failed regeneration systems in London and other places. And my first attempt to invest in it and deliver it failed because basically what I learnt was that power matters in local government and health and people hang on to power sometimes even in the face of being presented with the means to do things better. And so you have to take into account the politics of power. And in health and social care the people who wish to do the greatest good do not take into account the motivations of people who – it is not that they don’t want to do good – but they don’t want to lose power.

How do you overcome that? You have to put the people on the receiving end of services in the centre of the room so that you make it very difficult for people to hang on to what is not of use to those people. So one of the pieces I am keen to develop with NHS England, and Malcolm Grant, the Chairman, had been kind enough to support this, is the NHS Citizen process. So that we develop a means for having consumers in the largest consumer-facing service to the public – ie, the NHS – develop a means of having them hold a mirror up to our core business, and say ‘well, you said you were going to do this… And it ain’t happening, or it is happening, or how are we involved?’ That is one of the ways we force power to take account of its purpose – to provide health and social care that makes a difference to the people of this country. That forces a change in the culture.

Watch Nick Timmins' interview with Victor

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