The Group covers North Bristol Trust, University of Bristol hospital and Weston Hospital Trust. The Trusts had discussed alignment for some time as they faced fragile service arrangements, competition between the organisation for staff and capital and too much time responding to ill health rather than developing anticipatory models of care.The collaboration started initially with a joint clincial strategy, which developed into a single accountability framework that the Trust Boards signed off in December 2023. A joint Chair and then a joint CEO followed. This approach was supported by site managing directors.What made a difference initially ? 1) enthusiasm of clinicians 2) permissions to do things differently 3) focusing on the commonalities, not differences 4) proud organisations wanting to do things differently and developing joint digital approaches.The Boards developed a joint approach by describing their challenges and working on joint challenges together. This always involved putting a patient first methodology and developing a common improvement language and approach. The Trusts formally evaluated the group approach judged against the outcomes they wanted to achieve.Now the group has around 28K staff - develops work together; shares leadership approaches and have developed mature leadership teams, underpinned by a health research ethos.The Group CEO role is different to single hospital CEO roles because Maria has to be out of the detail, delegate to her teams and focus on approaches that drive the benefit of working together. This means working through what is right for the population and is already then leading to different investment decisions. Control has to be delegated to teams and data analysis has to be enhanced to ensure the focus is on the right issues.Maria describes how she had been used to a set of personal relationships and that underpinned how she worked effectively. Now she has to focus on maximum impacts; better use of data; work with teams across sites to make improvements; be non partisan; be an arbiter; narrate and manage relationships with external partners. Looking to the future, Maria see the duty to collaborate and cooperate in the public realm as being crucial. Supporting a new set of senior leaders is going to be key. As a leader you must be courageous, curious and look to improve care all of the time.
Matthew Winn, podcast host and an experienced leader in healthcare in the UK.
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46:40
Mergers and integration with Nick Hulme
Bringing together two hospital Trusts is a tough process - even more when one is under huge regulatory pressure. Nick explain the development of his Trust covering two sizeable hospitals and community heath service integration. Matthew Winn, podcast host and an experienced leader in healthcare in
the UK.
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42:03
Working as peers in a group with Glen Burley
Encompassing South Warwickshire, Wye Valley, George Elliot and Worcestershire Trusts, the Foundation Group covers three counties and provides acute and community health services.The joint working of the Trusts is voluntary, with Trusts choosing to join the Group and operate in the way that has developed. With Committees in common, joint roles for the CEO and Chair and other executive roles, opportunistic approaches have flowed from the collaboration.The Group has enabled new ways of working to be tested and sharing and adoption of this practice to be adopted at pace.The “back office” infrastructure is shared where it makes sense, but there are differences and local approaches. Glen has been a CEO for over 18 years so the joint approach builds on his experience and outlook. His approach has been to always encourage people to make change and challenges thinking. Success happens when decision making iOS devolved and people are supported in accountable structures/cultures. Importantly staff and services must be supported to take risks and learn what works. As Group CEO, Glenn has had to move to a more coaching style as he cannot be so hands on. He still needs to be able to discharge his accountable officer role properly but does this increasingly by working through others. He needs to be able to provide the ‘air cover’ for the site based managing directors, so they can do their job effectively. Looking forward - the Group is not dependent on Glen alone to succeed. All of the organisations can walk away from T he Group at any point and make their own choices.The leadership role is to convene; scale up population health approaches; work as an integrator; earn the trust of others to support better care delivery. NHS organisations don't have to provide and lead everything -but must break new ground and evolve.
Matthew Winn, podcast host and an experienced leader in healthcare in the UK.
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40:18
Local Government oversight with Mark Lloyd
Mark Lloyd was a CEO of two Councils in England and then was the CEO of the national membership organisation, Local Government Association. Macro themes from the episodes and Mark: Where there is political consensus and stability, partnerships appear to be have developed and matured more easilyWith upper tier councils spending 70% of their revenue on adult and children social care - any devolution or change, must come in this area to provide councils with the headspace and resources to fulfil their functionsDelivering 1300 separate statutory functions and 800 different services, in the light of 70% of money spent on social care - surely this is unsustainable?Large appetite to deliver services differently, but given 1300 statutory elements – this must be supported and sometimes initiated by central GovernmentWhere Councils are leading improvements for their populations holistically (equality, equity, healthy lifestyles, fairness, poverty eradication etc) there seems to be a case for giving them a broad public sector leadership role – straddling multiple sectors in the public sector worldDevolution could be a great opportunity to change and improve – but also a huge distraction if it is not focused on improving the outcomes for local residentsHuge desire to be family/person centric and it continues to be frustrating that data sharing is slow and difficult to achieve across sectors and organisations.Leadership themes:A. The relationship and trust between a local authority CEO, the leader of the council and broader set of politicians is key. This is tough balancing act for LA CEOsB. CEO leaders have very adaptable leadership styles – real balance of needing accountability; support for staff and teams; delivery and driving of improved outcomesC. LA CEOs are accountable to all elected members - not Parliament (as NHS CEO are). Therefore, across health and social care need to be more aware of the need to negotiate and find commonality – not operate with “diktats”.Some salient quotes from the episodes:“make the complex simple”“Look for the opportunities and exploit for the benefit of local residents”“CEO has to be a heat shied over staff”
Matthew Winn, podcast host and an experienced leader in healthcare in the UK.
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35:28
Introduction to series 5 - groups and mergers
reference in the podcast to the ‘Dalton report”:https://nhsproviders.org/media/1154/nhs-providers-on-the-day-briefing-dalton-review-5-12-14.pdf
Matthew Winn, podcast host and an experienced leader in healthcare in the UK.
UK