June 2014
CCGs at present are rounding the final bend, getting ready to jump the final hurdle in submitting their five year plans. Some might see this largely as an administrative exercise, but for two CCGs we've been working with, (Chorley & South Ribble and Greater Preston, sharing a joint management team) they see this as 'the only show in town': an opportunity to radically challenge the status quo. They consider this process to be one of the biggest opportunities in years to re-imagine what healthcare might look like in their area.

Let's not underestimate the challenge. This is whole system reconfiguration at a time when demand shows no signs of decreasing, whilst budgets are, and press scandals flank all sides. This does not show signs of being an easy ride.

Such profound redesign of a whole health economy needs to start with harnessing will, followed swiftly by building a shared understanding of each other's realities, and focussing efforts around a common cause. A small, perfectly formed alliance emerged of CCG leads with big ambitions, GE Healthcare Partners offering OD and strategic input, with NHS Midlands and Lancashire CSU acting as 'mission control'. We recognised the need for the whole system to get in one room to start that journey together. CCG commissioners, strategists and clinicians were joined by acute and community trusts, public health, GPs, specialised commissioning, private providers, the local area team, local authority and patient representatives; a group of approximately fifty.

We partnered with the CCG leadership in the careful design and delivery of this visioning workshop, who in turn tapped into their network of relationships to mobilise this broad and diverse group of people. Being clear with contributors around the intent of the event and their potential contribution was an important part of this, to ensure that all parties felt that they had a fair opportunity to share their visions, challenges and opportunities as they saw them. Listening to them side-by-side made the realities and aspirations of contributing partners patently apparent, as well as revealing a common theme that weaved through of the intent to improve the health of the population they serve: "to move from a reactive hospital based system of unplanned care to a preventative, anticipatory, whole person approach to care".

A patient representative offered the challenge: 'These are fine words... so what are you going to do?'; a perfectly timed intervention that emphasised the accountability that each and all organisations have to their communities.

An exercise was used which enabled a multi-agency focus on supporting the members of a fictitious struggling family (each member representative of the health and social issues of the area). This helped to shift thinking beyond organisational boundaries to 'what are the real needs of this person?'. Spotting that the solutions being proposed were stepping in the trap of a 'deficit' model where individuals need 'rescuing', the group realised they would need to identify what support structures each family member already had in place. The multi-agency response would then consider 'what could our collective contribution be to them?'. There was recognition that agency hand-offs confuse, present risks, waste patient and professionals' time, and obfuscates a clear joined-up view of need and appropriate intervention.

On the one hand this was simply an event. People ate together, talked, and went home. On the other hand, this was a symbolically significant departure from an isolationist approach to organisations 'doing their bit'. This was the first time the whole system had come together, shared openly and honestly about how they saw their individual challenges and views of the future, and formed around their core collective purpose.

This collaboration started the formation of the strategy, which was forged out of a collective sense of what is needed to be done. The maturity is present to recognise that radical change is possible, recognises it will be challenging, and needs to be done in a way that doesn't destabilise the health economy.

Using the CCGs' PMO infrastructure, with CSU support will enable the translation of intent into tangible plans. We, GE Healthcare Partners will continue to offer support and challenge in terms of whether the BCF, 2 year plans and 5 year strategy are collectively coherent, and whether that level of system-wide leadership and accountability to the local population continues to be evident.
What has emerged from these 2 CCGs, demonstrated through inclusive action and catalytic intervention, is the powerful role they can play in the transformation of their health and care landscape: that of facilitative leadership.

About the author
Edward Parkes is a senior consultant at GE Healthcare Partners with over fourteen years of experience leading change within healthcare, and five years of experience in the private healthcare market. Edward specialises in organisational development; co-production; management and leadership development; staff, service user and public engagement; as well as performance and service improvement.
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