Reflections on building The Union in a time of crisis

We recently invited Rob Walsh, Joint Chief Executive of North East Lincolnshire Council and Clinical Commissioning Group, to join us for our first virtual event, Transitions, to share his experiences of combining two organisations in 2020 and creating a unified COVID response to support citizens.

In 2007, North East Lincolnshire introduced the care trust plus, one of the first of its kind in England. It was a big step for the council, to delegate the commissioning and provision of Adult Social Care into the NHS. In return, public health responsibilities were delegated into the Council well before the health and social care act of 2012.

So even way back then, the appetite for change was evident and the drive to secure improved health and care outcomes for our population was palpable. Fast forward to the creation of clinical commissioning groups, CCGs, and then three years ago the next step in the evolution of our local relationship and our journey formation of the so-called Council and CCG union.

Creating The Union

From day one of The Union’s life, the question was really looking through the health and wellbeing lens, how do we combine our efforts, our capacity and our resources to best contribute to and facilitate local economic growth? Strength and resilience in the community and place wider determinants of health very much at the heart of our joint agenda?

Structurally, we formed one leadership team across both organisations and in governance terms we formed a Union Board, combining really importantly clinical and political leadership to lead the place.

That ambition, that common purpose and a long-standing close relationship across the NHS and local government here in North East Lincolnshire has really been put to the test. The Union certainly has been put to the test over the last eight months of this pandemic.

In my experience of leading change, and like all of you, I’m certainly still learning. I’ve always been a firm believer in keeping it simple, we expended a lot of energy in the early days of the Union seeking to fuse two very distinct cultures, the council and the NHS. With the benefit of hindsight, I’ll be frank, I think that was the wrong approach, at least for us.

What we soon realised is that the one thing that binds each organisation above all else was our commitment to place. That has the immediate effect of shifting both the tone and the nature of the engagement, and the change journey and it also helps to build trust and confidence.

We are at the end of the day two organisations covering coterminous geography serving the same population. How do we galvanize that collective commitment to our place to shape a way of working and an operating model that gets both the best out of our people but also gives them something to believe and remain steadfastly focused on? Especially in this really challenging environment, we’re currently operating in.

The extent to which everyone was on the bus when it came to forming one leadership team was at times questionable. That wasn’t born of malice or seeking to undermine either organisation, but simply because we were stuck in that loop of trying to fuse two very distinct cultures. What I’ve seen in the last eight months however is a complete reset, both in terms of individual focus and collective endeavour. For want of a better phrase, the fog has well and truly cleared.

Performance through COVID

Some of this is going to sound a bit corny but these are my examples of how it’s operating here and how it feels. I think it’s really powerful indeed to see your Medical Director and your Community’s Director operating together from the outset to establish local shielding arrangements, allowing quick and timely decisions to be made to support the most vulnerable in our communities.

It’s equally powerful to see your Care and Independence team placed in the CCG operate so effectively with care homes from day one, to promptly support and engage on issues such as infection control and outbreak management. It’s equally powerful to see the Council, CCG and local providers engage swiftly to commission, finance and deliver a refurbished 50-bed step-down care facility in a matter of weeks to support hospital discharge, and help to create COVID hospital bed space.

The Union approach enabled quick decisions to be made and resources to be mobilised with comparatively limited fuss and long may that continue. Public health colleagues and CCG data analysts working closely together to assess and interpret intelligence, to inform recommendations to a single leadership team operating in the midst of an emergency has really helped eradicate duplication of effort, and support good governance at a point where immediate decisions have been required to support residents, business and communities. And indeed still are.

Being able to quickly mobilise joint and targeted communications from your Chief Clinical Officer, a GP, your Medical Director and your Director of Public Health sends a really strong message of collective ownership of a very challenging agenda. No mixed messages.

If you can mobilise your workforce across two organisations to work from home, using the same platform in week one of a pandemic it certainly for me serves to reinforce to those looking in, that we have the agility and the wherewithal to operate effectively whatever the challenge.

Whilst my examples of success for the union over the last eight months might not be earth-shattering to some, they are straightforward examples of a common purpose and collective endeavour crystallizing when most needed, and being put to the ultimate test and certainly appear very significantly so over the last few weeks. Having one leadership team across both organisations with that single line of sight has helped us enormously so far.

Takeaways from the last eight months

For me one of the key takeaways when it comes to leading change in this constantly evolving and rapidly changing environment? Mine are straightforward colleagues, relationships they can’t be invested in enough. If you have trust, you have a chance. Leadership right now and forever is about the people around you. Playing to strengths and staying connected, and in this world we now operate in there’s no excuse for not being connected and using the platforms to maintain the right level and nature of connection.

Workforce, leadership visibility is essential more than ever, the workforce under immense strain needs to know and believe that you are there with them and for them. And that you’re feeling that strength too. Authenticity is not a skill, it’s about what drives you and what you believe in. Vulnerability is not a weakness, how many times has that been said recently? Place first, organisation second.

A single leadership team perspective overseen by clear lines of accountability into our political and clinical leadership remains central to our drive to support our work through this huge challenge. The foundation is equally important to supporting our recovery. For me those principles I just articulated are my design framework, it’s as simple as that.

Change is a constant

Looking ahead we know that changes remain the only constant in both the council and the NHS and that may have implications for our union arrangements locally, but what doesn’t change is that focus on place. That’s where we’ve taken our Place Board a step further bringing key sector leaders, partners and the council’s political leadership together under the auspices of an agreed outcomes framework focused on strengthening and supporting our economy and our communities.

Our focus and collaboration was never more important than it is now, whether it’s the digital agenda, the green recovery, skills agenda or supporting key sector sustainability. The place-based conversation is a much richer and beneficial one to have when there is commitment founded on collaboration, trust and partnership at the local level. The Council and CCG Union is a very important and significant cog in that particular wheel.

I’ll simply finish with this colleagues and it’s pretty straightforward, change is a constant and it’s very bumpy and it always will be. It’s how we act that matters, thank you.