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Solace blog

4th May 2017

Can Local Government Chief Executives rise to the Place Based Health challenge?

Around a year ago, we began planning a new approach to senior leadership development, convened by Solace, supported by the Local Government Association, and delivered by Collaborate in partnership with the RSA. During those initial conversations we posed the question: in a quick moving and increasingly challenging context, what will it take to lead positive change in our places?

Over the last twelve months, we have brought together a number of chief executives from local government to address that question. We have reflected on personal journeys and policy challenges at a Warwick University residential. We have deliberated on the ‘wicked problems’ with peers. And we have invited collaboration and critique from leaders outside of the sector.

We have done this with a group of peers who recognise that self-reflection and learning is the only real route to improve performance in complex times. Much of this is based on the recognition that leading real change in places means also changing ourselves. We have been delighted by the input from our peers and colleagues, and we will be sharing some of these lessons – and a framework for the future – in a report published at the LGA Conference in July.

Last month we turned our attention to health and social care – and in particular the leadership challenge of building sustainable local collaboration that can improve health outcomes at a time of great system stress. The fiscal challenge is difficult enough: The Institute for Fiscal Studies estimates that one in ten councils has already cut adult social care spending by 25%. NHS providers have argued that over 5% of cost pressures that will need to be absorbed by the health and care system by 2019 with nowhere near the commensurate level of funding to do this.

But the leadership challenge goes well beyond austerity. We know that our population is getting older, that the needs and wants of citizens are changing; and that what our NHS colleagues might call complex co-morbidity is on the rise.

These trends are a microcosm of the wider challenges facing local government. They should give us pause for thought as senior leaders, because:

(1) We have a system leadership role to play that depends upon, but goes beyond, grip and delivery in our own organisations. The view of our NHS colleagues during last month’s session was that local government understands population and place in a uniquely holistic way. Understanding how we play this role within a system takes work and requires a different and more collaborative way of understanding risk. But is vital to the sustainability of the system overall.

(2) We need to get better at understanding the world as it looks from other perspectives – the hospital CEO managing powerful clinical interests, or the GP transitioning to a new world in which security of income is a thing of the past. Where colleagues have collaborated effectively in local settings, it has been the result of creating some insulation from top-down directives, and to ask “how can I help” to build relationships at a human level. STP gives some of us the opportunity to do this; others will need to work against the grain.

(3) We need to be confident about shaping the system we want to lead within. Local government has been vocal about the problems it faces working with the NHS (and vice versa), but less so about the alternative it wants to see. We need to get better at articulating our model of ‘Place-Based Health’ with citizens, focusing especially on how we can create credible models of out of hospital care that makes our ambitions around prevention real.

Those signing up to the Ignite programme for 2017 and beyond will have the experience to shape their own responses to these issues. Our offer is a safe, creative space to think about the role and purpose of local government leadership as the climate around us changes. Our hope is that the health and social care systems in which we work will benefit as a result, and our efforts to improve our practice can contribute to place-based change that sticks in the long term. As one participant reflected, “In a world where the drivers of economy, technology, and even culture, are
subject to powerful globalising (or non-local) forces, it seems to me that our role is to reassert the domain of the local, the place, the city regional. To bring the people and communities within places into the heart of health service planning. Not just as service users but as active citizens”.

By Deborah Cadman, Chief Executive of Suffolk County Council and Solace Spokesperson – Leadership and Learning and Becky Shaw, Chief Executive of East Sussex County Council and Solace Deputy Spokesperson – Leadership and Learning.