This week’s leadership message comes from Carol McKenna, Place-based Lead for Kirklees

Hello, my name is Carol

Over the last few months, I’ve told many people that in January this year I hit the milestone of 30 years’ NHS service. The same month also marked 22 years since I started work in Kirklees – for the Huddersfield Central Primary Care Group to be exact. In January 2000 when I began work in Kirklees, society was breathing a sigh of relief that our worst fears about the Millennium Bug had not come to pass and we could sail into the new decade with our information systems intact. In writing this, I realise that many of our younger colleagues may have to reach to Google to find out what the Millennium Bug was, which only illustrates further how long I have been on the patch!

Apart from the fact that 30 years’ service is a decent achievement by anyone’s standards, the main reason I have been in reflective mood recently is that once again we find ourselves in the throes of organisational change. Looking back over my years in the NHS and in Kirklees I realised that I have been through approximately eight such reorganisations, generally going from smaller to larger organisations and back again. Most significantly, when I joined the NHS in 1992, the internal market was the new show in town, and the ‘commissioner provider split’ was seen as the answer to the challenges we faced. Several decades on, it finally feels like we are bringing this period to a close, and that our experiences over the last couple of years have demonstrated once and for all that it is collaboration, not competition that yields results.

Since September 2021, I have had the privilege of undertaking the role of senior responsible officer for the West Yorkshire COVID-19 vaccination programme and this spirit of collaboration has been instrumental to our success.

In Kirklees, we considered the evaluation of our Community Champions Programme recently. Community Champions in Kirklees have worked to promote COVID safety and increase vaccine uptake within identified communities – Black African Caribbean, South Asian, other ethnic communities, unpaid carers, living with a disability. Over a six-month period last year, they held over 20,000 conversations with local people, connected with 58 voluntary organisations, and undoubtedly contributed to increases in vaccine uptake in some of our most deprived and ethnically diverse communities. Many of the learning points described – the importance of trust, being flexible and adaptable, building strong relationships – are fundamental to effective collaboration.

However, back to the subject of organisational change. 
As ever, any change is complicated. During our NHS careers, most of us have only ever worked in the internal market environment. Moving from old habits and thought processes takes time and we need to constantly challenge ourselves. Like several of my colleagues, I have spent many hours in the last year or so discussing how this new world will look, how things will work and how it will differ from our current organisations – and most importantly for local people. It’s important to stress that in Kirklees many of the characteristics of a place-based partnership are already present and this feels like evolutionary, not revolutionary change as we approach the 1 July. Nonetheless, there is a question I have been asked several times – by colleagues, partners, and patient representatives – and that question is ‘so who is the commissioner?’.

It's a great question, and the more frequently it is asked, the more I think about what lies behind it.  I often think that what I am really being asked is ‘who is in charge?’ or ‘who will make the difficult decisions when we don’t have consensus?’ 

Over time, it feels like our view of commissioning has become increasingly aligned to the notion of a single organisation – a clinical commissioning group or a council for example - who has this as their job. I think that what is important to return to is the idea of commissioning as a set of processes – needs assessment, delivering services to meet these needs, continuous quality improvement based on evidence and experience, whilst ensuring best value for money. All these elements should be everyone’s business, not just the remit of the person with a particular name badge. That is one of the strengths of integrated care systems (ICS) and place-based partnerships – we all take shared responsibility for the decisions we make collectively, creating the conditions for mutual accountability and building an environment where we can tackle the difficult questions together. So, whenever anyone asks me the question ‘who is the commissioner?’ my answer is ‘we all are’.

To operate effectively in this new environment will require high levels of trust, openness, and transparency. Of course, there will still be contracts and memorandum of understanding between organisations, however we can expect to see these agreements being used more as enablers, for example to support the objectives of provider collaboratives and alliances both in the ICS and our places. Likewise, a collaborative way of working does not mean we lose the need for good governance, of which I am a strong advocate. Getting the governance right means we do business in the right way, we make decisions openly and transparently, and by doing so we build trust across our systems. 

In Kirklees, we held first shadow meeting of our integrated care board committee in mid-April. After all the months of hard work to bring together our new place-place based partnership, it was fantastic to see everyone together in the new committee. Kirklees is a very diverse place, made up of many care providers, and it was clear to me when we met that there is a strong commitment to working together for the benefit of our residents. We spent some time getting to know each other and understanding our new environment. We also heard some sobering messages about the health inequalities faced by local people and the very real risk that these are worsening because of the current cost of living increases and other economic factors. We know that there are huge challenges ahead, but one thing was clear – our population will remain at the centre of all we do, and we will hold onto this as we move forward. Oh, and I am very pleased to report that no one asked who would be doing the commissioning!

Have a good weekend

Carol