Samantha Jones

Following posts as chief executive of both Epsom and St Helier University Hospitals NHS Trust and West Hertfordshire Hospitals NHS Trust, Samantha now works independently with the care sector supporting the delivery of high-quality population healthcare. Samantha was also the director of the new care models programme until 2017, leading on the implementation of the new care models outlined in the Five year forward view. 

Having worked nationally, I am now in the privileged position of working with colleagues in different parts of the country.

Over the last few months, people are starting to work out how best to operate together across their systems to identify and address the health and care needs of their population.

For example, Oldham has been doing really interesting work with their local authority leaders, taking responsibility for commissioning, with a strong focus on the wider determinants of health and working closely with a range of local providers including the voluntary sector.

Nottingham’s ICS has strong primary care leadership and the partners in Nottingham have been working together to understand how the variation across the local population can be addressed in practice. As a result, they are giving significant thought to how the health economy can deliver improved care.

Technology, data and variation

I’m slightly frustrated that this work is not moving faster, particularly around integrating technology. I recently visited Israel and they are much further ahead in this regard. They use a model of care with effectively four similar-sized health maintenance organisations, underpinned by strong technology. All Israeli citizens have their health data on their phones and there’s a 'single source of truth' patient record. They use this technology to address care variations.

Over the last few months, people are starting to work out how best to operate together across their systems to identify and address the health and care needs of their population.

   

In Israel, healthcare is predominantly primary care-driven. Nurses can easily move between organisations depending on their personal circumstances and the environment and systems positively enable that to happen.

My personal learning is to invest in the data. Once you can target this variation, then your work to address it can start.

You need to understand variation at system level, and target resources around it, it can't be done any other way. This work needs leadership, consistency and an understanding that it’s hard and our current system infrastructure and architecture does not support it. Asking supporting staff to do this is a significant leadership challenge.

 

Collaborative leadership; collective working

Be confident you've got the right partners around the table – not just trusts and clinical commissioning groups but local authorities, carers and the voluntary sector. Don't get caught in arguments about governance, organisational form and templates, but do be clear how decisions will be made. If you’re clear about this, people in your system can have confidence.

You need trust to be fundamental to your system’s relationships, with everyone understanding that all parts of the system have their part to play, and able to articulate what that part is.

What gets partners on board to work as a collective? In my experience, it’s resilience, leadership, focus and having the courage to know that you’re doing the right thing.

As a leader, you need humility to understand you don't have all the answers. You need to be confident enough challenge up the line when what is happening is not consistent with the messages given.

When I was an acute trust chief executive, I didn't know what I didn't know – where was the support to show me with data and shine a light on things? Humility is going out and finding that support, but you have to start with knowing what you don't know.

Conversely, what continues to draw people back into organisational silos tends to be a lack of clarity on the purpose, and having no single source of truth as those with vested interests in a system don't want one.

 

You need trust to be fundamental to your system’s relationships, with everyone understanding that all parts of the system have their part to play, and able to articulate what that part is.

   

Getting the incentives and enablers in place

There’s a lot to do to shift the NHS towards a coherent set of incentives for collegiate behaviour but we’re getting there.

A few examples:

• look at where we need to be from a workforce perspective – staff will need to be able to move in and out of NHS and local government/social care organisations seamlessly and without being penalised on pay, terms and pensions
• similarly, primary care needs investment to strengthen it and reduce fragmentation – all parts of the system have to be strong, with the end game in mind of better care.

The future

What will this look like in five years time? I really hope we are not talking about these issues of data and integration in five years. I hope we will be able to show that we’ve made great strides in fundamentally changing the way we work together and improving population health as a result. That is the important thing and I think we’ll get there, whatever the structure and architecture is called. I hope we will be able to show we fundamentally changed the way we deliver and commission care.

Looking across the system, the use of data and technology will be ubiquitous to detect UTIs or predict cancer with artificial intelligence. We have all this ability now. The arc of history means that we need to shift how and where we provide care even further on the basis that technology will fundamentally change the way care is provided.