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Competing demands and incentives

Overcoming barriers to delivery
Barriers to delivery


As leaders drive forward the challenging task of redesigning sustainable services, in the course of this programme it became clear that complex ethical and economic tensions about where, when, and how resources are best allocated had frequently been encountered.

women man putting puzzle together

What is the reality? The challenges being felt by local systems

Individuals engaged through this programme referred to the fact that being a provider trust executive director and also involved in leading at partnership level introduces tensions that are not always easy to reconcile.

Directors of organisations (bodies corporate such as ICBs and provider trusts/FTs) have legal duties to act in the best interests of that organisation. Place-based partnerships are not organisations in law and so directors of provider trusts who are also part of a partnership leadership team would always retain their duty to their own trust. However, decision-making at partnership level should reflect the agreed intentions of the partner organisations’ boards, with reference back to those boards should decisions be likely to impact the provider organisation adversely, and so insurmountable conflicts of interest or loyalty should rarely arise.

There are genuine tensions to resolve between partners when making decisions that affect different organisations, and indeed patients, within any integrated care system or partnership – and so building trust and ensuring alignment of purpose is critical to ensure partners can have open, honest and at times challenging conversations. In the current context, some leaders said that at times they have little choice but to focus leadership and management bandwidth on the challenges they face that day, with little time or resource to creatively develop models of care and ways of working for the long-term.


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