The Rise of Collaborative Leadership in the NHS

By Andy Kinnear, former NHS CIO and now Independent Consultant

Andy Kinnear, former NHS CIO and now Independent Consultant, sees signs for optimism as the NHS moves into 2025. There are an increasing number of examples of collaboration which seem to be replacing the competitive environment of the past. Could these build the foundations for joint successes and improvements which will finally deliver the transformation demanded by the Government?

I spent over 30 years of my career working in the NHS in the West of England and in this time often saw different organisations going it alone on key decisions, approaches and technology, all striving to be the best. The feeling was that a degree of competition would drive up standards for all. Looking back I don’t think that this strategy did actually best serve the public and the nation.

I now see a growing number of projects where collaboration is coming to the fore. I think examples of collaborative leadership and unified ways of working should be celebrated and adopted further as the default in 2025 and beyond. It’s what’s needed to enable the transformation and productivity improvements which will enhance delivery and secure future investment in the NHS.

Collaboration is growing

Suddenly collaboration seems to be everywhere. I’m seeing it first-hand; reading about it online; and hearing it discussed at healthcare events. Collaboration is taking many forms but is often starting locally rather than being pushed top down. For example, several hospitals in Devon spanning 3 Trusts including Exeter and Barnstaple, Torbay, and Plymouth have coalesced around their choice of EPR which will bring benefits for staff and patients alike. Clinicians will be able to move around the different organisations and hit the ground running. Similarly, the use of the same EPR enables patients to be transferred between hospitals more easily, improving the patient experience and quality of care.

In many cases innovative individuals are leading the drive to collaboration. Over the last 18 months I have been lucky enough to work alongside Carlos Trigoso from NHS England, a truly inspiring character who has recognised 3 key things:

  • Bringing national and local people together to collaborate will help NHS England better understand the challenges of the frontline staff.
  • We must transcend silo thinking to address technology challenges that cross boundaries.
  • True innovation happens by working with industry and vendors, by allowing them inside the NHS tent and working with them to develop solutions collaboratively.

Carlos has focused on Identity and Access Management (IAM) but this is just one of several areas where the top-down 'vertical' thinking has in the past been at odds with the need for cross-system 'horizontal' solutions. To enable a new collaborative approach Carlos has created the IAM Community of Practice and works with industry in the IAM Forum and Lab. Such initiatives should be applauded.

Why is the time now right for collaboration?

So what’s driving the move from competition to collaboration? Ongoing financial pressures are obviously a major incentive to drive collaboration. If several organisations come together to share costs and knowledge all the way through projects, from identification of needs to the selection and implementation of solutions, they can maximise the return from the joint financial outlay and better manage the demand on resources. Organisations can share the burden and the risks, hopefully reducing both, while increasing the leverage that larger projects have with vendors.

Another big factor driving collaboration is in the people now in the positions to take decisions and put them into action. For example, Bristol, which has two acute trusts which in the past have been fiercely independent, announced in July that Maria Kane would become the joint CEO of University Hospitals Bristol and Weston Foundation Trust and North Bristol Trust. The Trusts have also developed a joint clinical strategy.

The prevailing mood is becoming collaborative rather than competitive right across England. For example, the East Midlands Acute Providers Digital Design Collaborative (EMAP DDC), which includes Trusts from Chesterfield, Northampton, Derby and Burton, Nottingham and Leicester. The Trusts have proactively come together with the stated aim “to strategically plan and collaborate on their collective digital transformation journey, with the ambition to strategically operate as one health care system”. Major elements of this strategy are the use of a single EPR solution; shared mobile device management to enable clinicians to work across all the Trusts, and some roles recruited to service the whole region. This is a groundbreaking approach which will be needed throughout the NHS as the Government demands transformation as a condition for investment.

Programmes like OneLondon or Once for Wales are also driving a new wave of collaboration. It is heartening to see.

Increased funding… with conditions

Without being party political at all, any new administration will always bring a fresh impetus and energy to addressing the challenges of the NHS. The trick is to turn the rhetoric and best intentions into actual momentum and incremental improvements. I can discern a step-by-step process in action which will likely drive the need for even more collaboration in the healthcare sector.

First the independent Darzi Report on the state of the NHS laid bare the issues and made the case for change. Then the autumn budget allocated increased funding to the NHS but with the underlying message that this must drive transformation and productivity improvements. The NHS 10 Year Health Plan is expected to be published in spring 2025 which will lay out the path for the future, underpinned by 3 big themes or shifts: hospital to community; analogue to digital; sickness to prevention.

Then the healthcare sector really has to be ready to move into the delivery phase to turn the plan into reality. The collaboration I’m already seeing bodes well to increase the chances of success in the delivery of change, especially in the area of digital transformation that must deliver tangible benefits to the frontline rather than just meet the objectives of a centrally driven initiative.

Back to the future?

I’m old enough to remember that in the early 2000s there was the National Programme for IT (NPfIT) which aimed to digitise NHS England by introducing electronic patient records and reforming the NHS' use of information technology. The project scope was to connect 30,000 general practitioners to 300 hospitals and provide authorised health professionals with secure access to patient records.

The programme ultimately failed in large part due to a lack of engagement with the frontline. The programme was driven from the top down, without enough consultation with clinicians and other NHS staff. This led to a mismatch between the system's design and the needs of the users.

Could today’s increase in collaboration in practice, coming from the local level upwards, provide a more fertile ground for the use of joint solutions which will ultimately reduce costs and risks; enable better integration across primary, secondary and social care; and deliver the transformation needed to increase productivity?

I firmly believe that collaboration is the way forward and that collaborative leaders will be the ones to drive change from the grass roots, bottom up. The future of the NHS is in our own hands.