Developing compassionate, inclusive and collective culture in integrated care systems

SCIE, the Social Care Institute for Excellence, recently hosted a webinar from the System Transformation Team at NHS England on developing compassionate, inclusive and collective culture in integrated care systems. The session is part of an ongoing ICS webinar series examining ICSs and the multifaceted challenges they face.

The session featured a wealth of prominent female voices in the medical industry including: Dr Ronke Akerele, director of culture and transformation at NHS England; Jenni Douglas-Todd, chair at Dorset ICB;
Stephanie Crow, head of culture transformation at NHS England; Alice McGee, chief people officer at Leicester, Leicestershire and Rutland ICB; Bina Kotecha, associate director of systems leadership and OD at University Hospitals of Leicester NHS Trust; Ruth Lake, director of adult social care and safeguarding social care at Leicester City Council; and Emma Challans-Rasool, director of OD, culture and talent at Nottingham and Nottinghamshire ICS.


Dr Ronke Akerele explained that the webinar would explore “the approaches of our ICSs in developing cultures, to deliver against the expectations set by the ICS framework.”

Ronke acknowledged that a “one workforce approach” is needed along with shared principles in order to foster a more inclusive culture within local authorities. From a “wide academic and evidence based” perspective, she said, culture plays a significant role in staff engagement and the quality of patient care.

“There have been approximately 156 public enquiries into the NHS,” Ronke continued, and “the consistences and the failures of the findings suggests that lessons are not always learned – and that recommendations are either not properly implemented or misapplied.”

She noted that the most common enquiries tend to revolve around weak and incompetent leadership; dysfunctional working relationships; poor communication between colleagues; disempowerment; marginalisation; and victimisation of staff and patients.

In light of this, the panelists recognised the need for systemic cultural change.

Culture and ICSs

Stephanie Crow went on to discuss the NHS Culture and Leadership Programme (CLP) and the insights and impact it has had so far. She described how the programme was borne out of enquiry, resulting in The King’s Fund and the Centre for Creative Leadership developing a programme to support the trusts’ cultural change journeys.

In 2021, an evaluation took place examining the implementation of the NHS CLP across 35 trusts, compared with those who had no CLP at that time. For those with a CLP, the results showed that staff engagement increased by 7 percent and the turnover of reduction in registered nurses was 1.41 percent.

The basis of the programme, Stephanie explained, is based on six cultural elements. These elements include: vision and values; goals and performance; learning and innovation, working together across the ICS to develop quality improvement and innovation; support and compassion; equity and inclusion; and teamwork, ensuring long-term focus on contact, conflict resolution and mutual support across the ICS.

Stephanie noted that the NHS has been working with organisations, including ICSs, to develop a cultural strategy development journey. A series of synthesis activities will be taking place to create opportunities for collective meaning from all of the work being done across the ICS and beyond.

“Collective meaning is what will get us to those shared, cohesive objectives and focus across the ICSs – understanding different perspectives and different sources of data,” she added.

Stephanie emphasised the importance of establishing a diverse change team and the need to ask a “diagonal slice across the system” to participate to ensure inclusion of different positions, hierarchies and representations of the organisations. As she summarised, “Change is led by the people who do the work.”

Inclusive culture and leadership in Leicestershire

The discussion moved on to work taking place in the Leicestershire region, with contributions from the ICB’s Alice McGee, University Hospitals of Leicester NHS Trust’s Bina Kotecha and Leicester City Council’s Ruth Lake.

In order to make the region’s ambitions a reality, they described how the ICB has implemented a dedicated equality, diversity and inclusion taskforce which comprises reverse mentoring, an active bystander programme, ICS staff networks, a cultural competency programme and inclusive decision making framework.

They also offer inclusive talent management which includes BAME nursing and midwifery, an inclusive approach committed to ‘making change happen’ and developing a diverse leadership within the workforce.

Bina provided more detail about their approach and highlighted where they currently are on this journey. In practical terms, she said, the plan can be broken down into three phases: the discovery phase, involving date gathering and stakeholder interviews; the design phase, where findings are shared and solutions co-designed; and the delivery phase, where co-design focus groups lead the implementation of the solutions.

The ICB held a synthesis event at the end of last year which reflected on findings around the six elements from the CLP, outlined above, and allowed them to “work through geographical differences.”

“We recognise that wider partner engagement is essential,” Bina noted. As such, they will be running webinars and engagement events focusing on working through their combined findings and agreeing priorities.

One of the region’s newest initiatives is the social media initiative campaign #MoreGoodDays which aims to promote a happy and healthier work culture.

Bina said: “To create more good days for the people that we support who are living with health conditions and disabilities, and to deliver against our priorities, we need to support staff with ‘more good days’ and work together across boundaries.”

Nottingham & Nottinghamshire ICS OD, Culture and Leadership 

Emma Challans-Rasool, director of organisational development at Nottingham and Nottinghamshire ICS, then discussed her ICS’s experiences in culture and leadership.

Emma began by emphasising that they are aiming for a one workforce approach and that “each day the journey is growing and evolving.” The ICS has undertaken independent synthesis of their system and Emma highlighted how they are “taking responsibility for our culture at every level.”

Additionally, Emma talked about “readiness for change” within the ICS, which she describes as “cultural in itself”, as organisations are continually moving towards a more integrated way of working.

Emma shared details around their concept framework for cultural change, with key points centring around a shared vision and commitment to high quality and compassionate care. Examining the cultural elements and leadership behaviours which shape the workforce, Emma said, helps in building a more inclusive and cohesive relationship across all sectors.

Moving on, Emma highlighted the role of the ICS’s community of practice, which “really did bring organisational development, culture change, leadership, talent, equality, diversity and inclusion, freedom to speak up, quality improvement and – most importantly – colleagues together all in a room.”

Emma said: “We created open spaces and workshops which have enabled us to come together and have conversations that help us explore our community assets. We created spaces where we were clear about our purpose, fostering a creative space and a practical space where we can deliver, add value and make a difference.”

The community continues to thrive and grow with colleagues meeting virtually and face-to-face on a regular basis, Emma added. “Every session is focused on one aspect of our culture and leadership journey,” she said, which has helped them to build a foundation of cross-organisational knowledge and “put in some deliberate interventions and directives moving forward” as a community.

Looking ahead, Emma expressed the ICS’s desire to continue working collaboratively to identify the core elements and objectives – building a culture of kindness, good leaders and equity at all levels.