Who Owns Change? Exploring Collaboration, Adoption, and Culture Across ICS Systems

The "Keynote Opening Panel: Who is the Owner of Change? – Exploring Collaboration, Adoption and Culture Across the ICS System" at HETT Show tackled a critical question in the evolving healthcare landscape: who truly drives change within Integrated Care Systems (ICS)? The panel explored the cultural and operational shifts necessary to deliver collaborative success, particularly in a system traditionally focused on competition.

The panel for this session featured:

• Andy Kinnear, HETT Steering Committee, Former NHS CIO & Independent Consultant  
• Helen Gillivan, SRO – Adult Social Care, Kent ICS (Kent County Council)
• Steve Peddie, Care and Improvement Adviser (National, Digital), Local Government Association
• Anthony McKeever, Non-Executive Director, Sutton PCN
  

The Transition to Collaboration in Healthcare 

One of the most discussed topics was the shift from competition to collaboration. Historically, the NHS has been driven by competitive practices—whether between providers for services or among organisations for funding. A key observation made during the panel was that ICSs are now tasked with fostering collaboration across health and care providers. This represents a profound cultural shift, given that most healthcare leaders have spent their careers navigating a competitive environment. 

Panelists highlighted that the challenge of moving from competition to collaboration is not simply a structural issue but one of mindset. The panel raised a fundamental question: how can individuals and organisations that have been trained to compete now be expected to collaborate seamlessly? This cultural change is at the heart of the challenges faced by ICSs today. While there is a shared understanding that collaboration benefits the system as a whole, getting there requires a transformation in thinking at both the organisational and individual levels. 

Examples of Successful Collaboration 

The panel provided examples of how collaboration has already started to take shape within the ICS structure. One success story was discussed by Steve Peddie on the social care sector, where providers have increasingly worked together with local authorities and health organisations to deliver integrated services. Digital social care records, for instance, have become a prime example of a collaborative initiative that has helped streamline care, reduce duplication, and improve outcomes. However, the panelists acknowledged that while collaboration is happening in pockets, it remains "patchy" across the broader health and care system. 

Helen Gillivan, a panelist representing Kent ICS, emphasised the importance of co-producing solutions with individuals receiving care. By placing the patient's voice at the center of innovation, Kent has managed to push past many of the traditional barriers to collaboration. This people-centered approach has been critical in driving the adoption of new technologies and systems that better serve the needs of both healthcare professionals and patients. 

Overcoming Barriers to Collaboration 

One of the major barriers to effective collaboration, as discussed by the panel, is the persistence of siloed thinking. Many healthcare organisations still operate with a narrow focus on their own interests, leading to fragmented service delivery. The panelists stressed the need to break down these silos by encouraging organisations to think beyond their own immediate goals and instead focus on the broader picture of patient care. 

As Helen pointed out, the financial landscape in which healthcare organisations operate often reinforces this siloed mentality. The competition for resources and funding between different parts of the healthcare system, from hospitals to social care providers, can make true collaboration challenging. Panelists agreed that a key step toward overcoming these barriers is changing how budgets are viewed and managed. For instance, they suggested that local health systems adopt a "pooled" budget approach, where resources are allocated based on the needs of the population rather than being restricted to individual organisations. 

The Role of Leadership in Driving Change 

A key theme throughout the panel was the role of leadership in facilitating the transition to a more collaborative culture. The panelists agreed that leaders must be willing to "give away power" by decentralising decision-making and empowering local teams to collaborate more effectively. This, however, is no easy feat. Leaders must strike a balance between providing clear direction and allowing autonomy at the local level. 

The panel also discussed the importance of involving a diverse range of voices in the decision-making process. As Helen mentioned, many healthcare systems are led by the same individuals who have been part of the system for years. This can sometimes lead to stagnant thinking and an inability to embrace new ideas. To address this, leaders must make a concerted effort to include fresh perspectives from a variety of stakeholders, including patients, carers, and community representatives. 

Moving to True Collaboration 

Anthony McKeever acknowledged that the language of "collaboration" has become more prominent in healthcare, members of the audience were quick to point out that many organisations still pay lip service to the idea without fully embracing it. One panelist remarked that there are currently few consequences for failing to collaborate, meaning that some organisations can "dodge" the hard work of building true partnerships. 

To address this, the panel called for a shift in accountability. Collaboration, they argued, should not just be a buzzword but a measurable outcome tied to performance and funding. By introducing financial or operational consequences for failing to collaborate, the panel suggested that healthcare organisations would be more likely to commit to meaningful partnerships. 

Trust and Power Sharing: The Keys to Effective Collaboration 

Trust emerged as a critical factor in the success of collaboration efforts. Panelists highlighted that trust must be built both between organisations and with the public. Healthcare professionals need to trust one another to work towards shared goals, while patients must trust that their care will not be compromised by system-level changes. 

The panel also touched on the concept of "shared power" as a key to fostering collaboration. True collaboration, they argued, can only happen when power is distributed evenly across all stakeholders. This means giving patients and communities a real voice in shaping healthcare services and ensuring that decisions are made with the end user in mind. 

Lessons from Austerity: Innovating Through Adversity 

Another significant point raised was how organisations, particularly in social care, have managed to innovate despite severe budget cuts. Andy Kinnear noted that while the NHS has faced financial challenges, social care has been hit even harder, with some organisations seeing cuts of up to 70%. Despite this, many social care providers have found ways to innovate and deliver services efficiently. 

The panel suggested that the NHS could learn from the resilience and innovation demonstrated by social care providers. The ability to adapt to financial constraints and still deliver high-quality services is a testament to the creativity and resourcefulness of those working in the sector. 

Moving Forward: Collaboration as the Future of Healthcare 

As the session concluded, the panelists were optimistic about the future of collaboration within ICSs. While the journey is far from over, they believed that the shift toward more integrated care systems is the right approach for the NHS. The panel emphasised that the key to success lies in continued collaboration, shared leadership, and a commitment to putting patients at the heart of every decision. 

As the NHS and social care systems continue to evolve, the lessons from this panel are clear: collaboration must be more than just a word. It requires a fundamental change in how organisations operate, how leaders lead, and how resources are managed. Only by working together can healthcare systems deliver the outcomes that truly benefit patients and the wider community. 

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