Delivering the best for your community whilst navigating the challenges of organisational boundaries and competing system level priorities can be challenging – but it is possible!

At PCPN last year, Chief Executive and Place-Based Leader, Matthew Kershaw, delivered an inspiring keynote sharing his experiences working at the Croydon Health Services NHS Trust. During the session, he highlighted the real-world value of place-based leadership in the NHS and the powerful role it plays in driving meaningful, integrated change across health and care systems.

Here are the key takeaways from the keynote…

The importance of placed-based leadership

Kicking off the session, Matthew started by emphasising the importance of place-based leadership, and why you need to have a good understanding of your local area. ‘There are similarities right across the country,’ he said, ‘but it is also important to say that there are differences in different places that make a real impact on how you run the services that you do and how you work with the partners that make that happen.’ As we know, what works for one person, doesn’t always work for everyone. By focusing on what makes your place unique, you can deliver a personalised service, better suited to your place’s needs.

There are lots of affluent parts of southwest London, but Croydon is not one of them. Croydon has significant health challenges, including long-term illnesses, mental health issues, and obesity, so addressing health equalities was a main priority for Matthew and his team. ‘That disparity is a real factor for us and something that we have to absolutely focus our attention on in all the work that we do.’ He continued, ‘we also have significant diversity which is a huge joy and opportunity in Croydon. It’s what makes Croydon what it is. But it’s also a factor that drives some of the challenges and some of the ways that we do things is to make sure that we address the real differences that exist in some of our populations.’

Although Croydon is part of the wider South West London integrated care system, Matthew stressed the importance of ensuring local relevance before aligning with regional strategies. ‘The key message here is understanding what it is in your place that makes it different and unique. Working on those whilst also being cognizant of what’s happening in the system is really important.’

He added, ‘Part of our job is to make sure that what we do reflects that and doesn’t just get sucked up into the whole of southwest London must do exactly the same thing all the time for everybody. Because I’m not sure that is the right way of doing it. That’s not always what the politicians say. It’s not always what necessarily people up and down the chain say. But from my perspective as a place-based leader, absolutely.’

Implementing integrated in health and care systems

During the keynote, Matthew discussed Croydon’s practical steps for implementing integrated health and care systems, particularly through the One Croydon Alliance. ‘For me, it’s absolutely central to what we do. It’s a combination of organisations… That’s a group of people together that have varying different levels of responsibility. But the one thing that it does do is bring everybody together on an equal footing.’

Despite its success, Croydon still faces common challenges including, long hospital discharge times, inter-agency conflicts, and imperfect coordination between care sectors. However, according to Matthew, a strong sense of community has been instrumental when facing these challenges. ‘Never have I worked in a place where the connection and the sense of place is stronger than Croydon. And consequently, that helps us every day with some of those challenges. It doesn’t rub them away, doesn’t mean that they’re irrelevant, doesn’t mean that we’re living in a bubble that is all perfect… But we are all focused on the same thing, to do the right thing in the right way for the people that we serve, and that we believe that the best way of doing that is to do that together. And that is not something that I’ve experienced everywhere I’ve worked. And if you’re going to work at place within a system, that is fundamental.’

Driving change from the ground up

Towards the end of the session, Matthew outlined three things that underline the critical role of place-based leadership in healthcare transformation. Firstly, he talked about the impact local changes can have on a community. ‘Neighbourhoods and places are where most change happens,’ he explained. ‘Most change does not happen at a system level. Most change definitely doesn’t happen at a national level. It is too big a space to work on. A place and a set of neighbourhoods is where you can make changes. And in the current climate where we’re on ICB going forward, from my perspective, that is not where the focus should be.’

Secondly, he encouraged leaders to develop a clear, place-specific vision. ‘The opportunity to create something in place that is your vision, what’s driving you, identify the three or four things that you are keen to make a difference on and then drive your integration and your change to deliver on those objectives I think is really important today.’

Lastly, Matthew cautioned against both extremes of system-place dynamics. ‘We run a risk of systems becoming so strongly focused on driving the whole agenda that places lose out and get left behind. We also run a risk of places feeling like they can just run their own thing without any consequence of a system. Both of those are wrong. Both need to exist in parallel. They need to do the things that they’re best at doing.’

Join our future discussions

Thank you to Matthew for his expertise and thought-provoking insights on place-based leadership. If you’d like to take part in future discussions register your interest to join us at PCPN on 7-8 May!