STPs have to tackle the problem of organisations and staff fighting for self-preservation, Nick Hulme, STP lead for Suffolk and North East Essex, told a meeting at the Health Plus Care exhibition in London.
Hulme, chief executive of Colchester Hospital University NHS Foundation Trust and Ipswich Hospital NHS Trust, said: “For me the elephant in the room is organisational preservation and individual futures. I have sat down with every leader in the STP group and talked to them about their personal futures and their organisational aspirations, because we will be asking organisations to give up sovereignty. How do you do that?
“All the leaders are there because they have been successful for their own organisations, and we are now asking them to think differently. We want you to think about place. I found it an incredibly difficult personal challenge.”
If we continue with organisational preservation and personal futures, none of this will work
Hulme said that unless the STPs succeed in reshaping local services, “the day job becomes even more difficult, so there is something about creating that sense of a burning platform in order to get leaders into the same place – that we all recognise success will only come if we work together, and if we continue with organisational preservation and personal futures, none of this will work”.
Driving home the need to break down organisational and professional silos, Hulme added: “The NHS is perfectly designed for the people who work in it and until we acknowledge that we are stuffed.”
He called for the collaboration evident at a national level between NHS England and NHS Improvement to be reflected in how they work locally.
“Until NHSI and NHSE demonstrate collective leadership in terms of moving on from very comfortable bromances on stages at just about every national meeting I’ve sat in for two years … to changes in behaviour locally … then we are in a really difficult position.”
He said he was a “great believer” in the four hour A&E target because it forced managers and clinicians to think about the whole system: “You cannot deliver four hours in A&E without the whole hospital and the whole system coming together.”
Hulme highlighted end-of-life care, and enabling far more people to die at home, as the next big system-wide challenge across health and social care.