1. Registered Managers’ Networks in the South West: Leadership Event Part 2: Leading in the Local System – leading beyond your organisation Debbie Sorkin National Director of Systems Leadership, the Leadership Centre Emerson’s Green Village Hall, 24 th October 2014 Debbie.sorkin@localleadership.gov.uk

2. Introduction: Clenton’s story

3. A response: integration of health, social care and other services The Care Act 2014 – emphasis on prevention, re-ablement and the person at the centre – i.e. joined-up services The Better Care Fund National Reviews: Barker, Oldham, Kingsmill Health and Social Care Pioneers Systems Leadership – Local Vision projects

4. New structural support for integration New responsibilities for Local Authorities: market- shaping; prevention; assessment; information provision; and funding of self-funders Clinical Commissioning Groups Health and Wellbeing Boards The Role of Public Health

5. What this might mean for you in terms of leadership You are looking to lead in an external environment characterised by increasing complexity and difficulty Everyone is struggling to match growing demand with smaller resource pot: e.g. £3.53bn taken out of social care budgets 2010-14; (ADASS survey 2014) At the same time, you are having to build new working relationships with different commissioners, or with people who see the issue as one of procurement rather than commissioning And you are having to navigate changes to the system and a mass of new organisations whose function is not always clear So the kinds of issues with which you, as leaders in social care, have to contend with are WICKED issues, not tame ones...

6. Tame and Wicked issues Tame Issues: can be managed o Relatively straightforward o Known, familiar o Use established methods already proven to work o Can be solved Wicked Issues: need leadership o Complex o Not familiar – no ‘right’ answer o No tried and tested methods o Can‘t be solved, only progressed

7. The basis of leadership: behaviours Not just about authority at the top of organisations It’s a practical understanding – and awareness – about how you do what you do, and the impact on others So it’s about behaviours, and taking responsibility for them And it’s everyone’s business – people working at all levels in all sectors “People do not experience our values, they experience our behaviours” Bill Mumford, CEO, MacIntyre

8. The model extends beyond social care – it’s the basis of a culture that works across systems Social Work Public Health Social Care Health

9. Hence Systems Leadership – cross-sector, shared, ceded, partial, transformational About leading: when you’re not in charge when you need to ask when it’s complex when you have no money Systemic – i.e. not piecemeal or divided into silos - and based on shared ambition Participative – i.e. involving many people’s energies, ideas, talent and expertise Emergent – i.e. allows for partial/clumsy solutions, able to work with uncertainty...and based on trust/relationships – So back to behaviours

10. So….who is in your local System? Starting point: what a System is, and isn’t

11. So….who is in your local System? On your tables and then on the outline map: Which bodies, organisations or initiatives do you know of that might be involved in your local System? E.g. Clinical Commissioning Groups Health and Wellbeing Boards System Resilience Groups Pioneers

12. The Systems Leadership Programme: research, leadership development, practice Research: Systems Leadership: Exceptional leadership for exceptional times Leadership Development: Leadership for Change; Future Directors Practice: Systems Leadership – Local Vision Support for Pioneers/BCF

13. Lessons from Systems Leadership for you and your teams Base ideas of leadership on behaviours and honesty Start small and use what you have – often more than you think Use influence – you don’t always need formal power Make connections; build relationships; think beyond traditional roles Think beyond your organisation or service – focus on outcomes for the person using services, and aim for collective ambition across a place Develop your people Just look to make progress; allow for time and keep going No crouching!

14. Lessons from Systems Leadership research: Your workforce – things to look for Willingness to align around a shared purpose or ambition Able to build engagement/relationships and really listen Preference for outcomes over processes Not being bound up with role and with a willingness to take risks Able to work reasonably well with conflict and uncertainty Having a strong commitment to a service in a particular place

15. So a lesson from Systems Leadership research for your service is: develop your teams If leadership is for everyone, and is a craft to be developed Think about who might have be suited to Systems Leadership, at any level Try it out – set people a wicked issue and ask them who might be in the system, what might work, what they might see Focus on behaviours/relationships Use coaching and support networks

16. Lessons from Systems Leadership practice: Systems Leadership – Local Vision National programme 35 projects around England Projects focus on integration or wider wellbeing issues Topics also include mental health, inter-generational obesity, alcohol abuse and social isolation Support via Enablers on the ground; access to networks/ information; extended to Pioneers

17. Example of outcomes from a Systems Leadership - Local Vision Programme Dorset, Bournemouth and Poole: “Better Together” programme to develop coherent local system commitment to shared vision and pooled budgets, involving commissioning and provision Looking at multi-disciplinary locality teams and working with LEPs on workforce issues joint resource planning bid for integrated social care record system

18. Lessons from Systems Leadership for your service: Get involved Systems Leadership – Local Vision projects in the SW: Wiltshire – multi-agency 24/7 response – includes looking at social care staff recruitment issues Bristol – addressing economic/health inequalities Torbay – creating dementia-aware high streets Cornwall – addressing food poverty Glos – reducing inter-generational obesity Dorset etc - integration of health and social care More projects in the pipeline – working in partnership with NHS Leadership Academy Local Development Partner in SW – www.southwestleadership.nhs.uk Match-funded projects – embedding Systems Leadership and sharing learning

19. Lessons from Systems Leadership for your service: Get connected Connect with your Clinical Commissioning/wider Systems Groups: position social care as part of the solution, working with healthcare: Wiltshire:Looking at longer partnerships with voluntary sector W Cheshire:LA supporting social care providers to strengthen community links, to reduce social isolation Work with LA/Emergency Services to use data for predictive value DCLG:Role of fire services – duty of wellbeing W Cheshire:Springboard programme Connect with your Health and Wellbeing Boards: Suffolk:public support for reformed mental health services

20. Lessons from Systems Leadership for your service: Go direct Connect with NHS Trusts and other stakeholders directly Example: Shropshire Partners in Care, working with local NHS providers and health/social care commissioners: Development Days Direct transfers between hospitals and care homes Funding located for GPs to visit care homes with emphasis on prevention Care providers brought into planning process for winter pressures Social care as source of innovation: Health hotels Community links Social assets and social capital

21. Lessons from Systems Leadership for your service: Public Health is your friend New role of Public Health – focus on “the health of the public” New base in Local Authorities Key role in brokering, facilitating and supporting relationships Working with social care providers on public health initiatives – e.g. Coventry Local Vision programme to raise levels of physical activity in the city PHE as data source: Older People’s Health and Wellbeing Atlas – http://www.wmpho.org.uk/olderpeople atlas/default.aspx

22. Lessons from Systems Leadership for your service: Measure something across a place/service Wiltshire Council Systems Thinking Unit: Children’s Service Review Police Service Review Link up with Academic Health Science Networks/Education Remember, measure something interesting and you’ll find something interesting South West Peninsula AHSN: www.swahsn.com West of England AHSN: www.weahsn.net

23. Summary: be a Systems Leader, and build your leadership beyond your organisation Base ideas of leadership on behaviours Use leadership frameworks to underpin behaviours and drive culture Use Systems Leadership approaches to go beyond your organisation/sector Start small and use what you have – often more than you think Make connections; build relationships; think beyond traditional roles Develop your people Just look to make progress; allow for time and keep going No crouching!

24. Trying it out: Systems Leadership in your own System On the basis of what you’ve heard: Think of one way in which you’ve already been practising Systems Leadership, in your local System. Then think of one additional way you’re going to extend it, or try something new.

25. Systems Leadership – more information www.localleadership.gov.uk Debbie.sorkin@localleadership.gov.uk The Future will be Improvised - http://www.localleadership.gov.uk/docs/Revolution %20will%20be%20improvised%20publication%20v 3.pdf http://www.localleadership.gov.uk/docs/Revolution %20will%20be%20improvised%20publication%20v 3.pdf