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Swimming together or sinking alone: Health, care and the art of systems leadership

It is difficult to believe, but there has never been a better time to be a healthcare leader. However slowly and imperfectly, the NHS, local government and their partners
are beginning to rebuild the health and care system around the needs of patients and communities rather than institutions and bureaucracies.

Under the Sustainability and Transformation Plan (STP) process announced in December 2015, leaders are coming together to take on two big challenges – shaping services around local needs, and doing so in a way which is financially sustainable.

This collaborative approach has profound consequences for leaders throughout the system. Increasingly they are required to move away from organisations and hierarchical structures to operate in networks across their local health economy. Barriers between primary, secondary and community care are becoming ever more permeable and, for the first time since the creation of the NHS in 1948, local government is a major partner in shaping and delivering care.

While the central bodies still wield control, the STP process has given local leaders the collective responsibility and at least some of the power to decide how they should best respond to the challenges of demography, the changing nature of illness, increasing patient expectations, the opportunities provided by technology and the constraints of public spending.

STPs are the moment when health and care leaders have begun to think of themselves as working in patient-focussed systems rather than isolated institutions. The demands of patients and the financial requirements of government will keep pushing leaders down this road. This Institute of Healthcare Management report is designed to help leaders understand the values, culture and skills they need to survive and thrive in this world.

Written by journalist and policy expert Richard Vize, Swimming together or sinking alone is based on interviews with experienced NHS and local government leaders. Through their insights we have analysed the difficulties these new, highly pressured networks are experiencing, and identified how healthcare managers need to think and act differently to make systems leadership a success.