Leadership support to the National A&E Improvement Programme

Sep 23, 2017

Over a two year period the Leadership Centre, in collaboration with NHS England, provided Systems Leadership support to places across the country as part of the National A&E Improvement Programme. The support  involved working with NHS representatives and other stakeholders from local government and the voluntary care sector on local A&E Delivery Boards across England, developing more collaborative leadership to support improvements in Emergency Care performance.

Starting in 2017, nine localities were identified (Two from each NHS Region, along with a further pilot):

  • North: Central Lancashire and North Merseyside
  • Midlands and East: West Hertfordshire, North & East Hertfordshire and Nottingham (Pilot)
  • South: East Kent and Cornwall
  • London: Imperial and Barnet & Enfield.

The focus was on mobilising whole health systems to re-imagine the way they collectively work in service of their populations. Teams of Leadership Centre Enablers began working on the ground alongside clinical and non-clinical staff, politicians, officers and citizens in places to help strengthen relationships and trust amongst key individuals, as the starting point for improving leadership capacity.

One of the biggest problems we have is around delayed transfers of care. We all know that but when we talked about it before it was all about blame and ‘it’s your fault’. The Leadership Centre helped us to change the conversation to ‘what can we do? How can we solve this problem collectively?’ We have recognised that if we sit back and just keep blaming social care nothing will change. – NHS Operations Manager

The Leadership Centre support enabled local leaders to obtain a clearer, common understanding of what the underlying complexities might be across A&E departments in England; to reveal and connect more of the interconnected system to itself, thereby deepening local understanding and relationships; and to create enough clarity to proceed to action whilst working on ever evolving issues. Throughout, the Leadership Centre worked closely with the Emergency Care Improvement Programme, to ensure work and effort wasn’t duplicated and the programmes complemented each other and added value to the places.

Leadership development support can often be too removed from the day-to-day realities, and people can struggle to find applicability to real work. Because this programme has been embedded in the actual work of the A&E delivery board, and the leadership team have actually been there, that life coaching, guidance and mentorship has been really beneficial.

Our Collective Journey

The Leadership Centre’s approach was sharply different to the traditional approaches to supporting local health systems. We were not trying to ‘fix’ the local health economy, performance manage it or tell its leaders what to do. Instead, our approach was to collaboratively develop new ways of thinking, behaving, learning and working together, in the context of their locality, so local leaders build shared trust, meaning and action to nurture the transformational change they desired. Our support ran alongside live programmes, so it is focused on building the capacity of systems leaders to work through the issues they were grappling with everyday, and the relationships that underpinned them. We periodically brought together those involved to share their learning and insight whilst developing a network of mutual support.

I was surprised at the intensity of the work and the level of resources and energy expended. This is not some wafty consultancy exercise but real work on hard-to-shift issues.” She described systems leadership as “incredibly, massively important” to strengthening the A&E system: “You can’t deliver healthcare alone – we need more connections and pathways. – NHS Chief Operating Officer

Our Learning and Impact

As time went on, and as outcomes became more visible and established across the NHS, the emphasis has shifted to broader leadership development – initially in Sustainability and Transformation Partnerships (STPs) and subsequently in Integrated Care Systems. Throughout the two years there has been clear evidence of progress, including the development of common purpose across sector and professional boundaries, different behaviours, improved relationships and new working methods. This has been further recognised in CQC reports around the ‘well-led’ criterion. Together with public policy journalist Richard Vize, the Leadership Centre has published initial findings and recommendations from the work in ‘Messages for National Leaders from the A&E Front Line’.


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