Prof Andy Brooks
NAPC Clinical Chair
You may be a senior leader in your organisation and even have the responsibility for neighbourhood development. If the latter is true, I doubt it came with a clear role description for what is clearly a new focus for the care system. It is a significant programme and will continue to rapidly evolve. If you feel that neighbourhood health will not impact you in your senior position, I advise caution. For it to be successful it will involve all health organisations, local authorities and the voluntary, community, faith, and social enterprise (VCFSE) sector. It will alter the way you do your job and those that look to you for leadership all the way to the frontline.
Neighbourhood health is embracing the need to put people at the centre of their care and supporting them with the complex interaction of their health and care needs and the communities in which they live. This is move away from a transactional cure model of health care to a relational care model of multi-agency co-ordination. It is less about linear pathway centred care and more about holding risk and person-centred care. If we simply transfer the leadership skills from one domain to the other, we will fail.
I know this having failed myself. In developing what at the time were called Integrated Care Teams, I understood that team development was important. However, I completely underestimated how vital it was and how much of it was needed. The initial result was a half-hearted and half-baked attempt to bring teams together from all the sectors above. It sort of worked but not really. I could have stood up at a national event and persuaded you it was the bee’s knees, but at the time it wasn’t. The pull was still organisations and not community with cultures from each of the sectors vying for the dominant position.
We paused and re-set. The second time around we focused not on current cultures but on designing a new common culture that all parties developed together. This was one centred on people and the community and took time and considerable team and leadership development. It paid off to such an extent that team members described themselves as working on behalf of the name of the community, rather than for an organisation. Recruitment, retention and outcomes improved, and it is still going and growing 10 years later.
What were the shifts in leadership style?
I learned the hard way about community and staff engagement, about how partnership working is more about ceding control than exercising it. A combination of insight from data and people with the courage to be flexible and agile required creative thinking, delivering through others, and building resilience.
How did I learn this? Besides reflecting on what I didn’t quite nail, I also found being part of the development with teams incredibly helpful. Both learning with others and engaging in real work rather than just theoretical frameworks made it personally satisfying and improved the model of care. Learning together also helped to create the new culture that we all owned. I also developed relationships that lasted and heard stories that I could do something about.
Please don’t imagine that that I have got the leadership competencies in some sort of kit bag. Please don’t assume that the teams were the complete package. What it has taught me is the need to be open and curious. My style moved to be less about leading from a position of knowledge, or the ability to get things done to one that recognised who I was and how I turned up.
At NAPC we are big enthusiasts of Integrated Neighbourhood Teams (INTs) and why we have put together a leadership programme for senior leaders. We are running these as open programmes with people from any system and system-level programmes for leaders within one system. Whilst there will be experts, an evidence base and a focus on outcomes, it will also be a space to help with the leadership mindset shift required for neighbourhood working. I know from experience having facilitated honest conversations with peers is invaluable. The programmes are designed to be flexible, challenging in a safe environment and pragmatic.
This is an NAPC blog so of course I am going to highlight what we offer. We have worked with many systems across the NHS and the UK. However, even if you find help elsewhere, I encourage you to re-assess your leadership competencies in light of what is needed to make the shifts from hospital to community and treatment to prevention a reality.
Find out more about NAPC’s Leadership Development Programme.
