Thursday morning: the fortnightly meeting of the Blithering ICS strategic projects team. The usual faces flicker into life on the video call: Sir Trevor Longstay, executive chairman of the NHS Blithering University Hospitals Foundation Trust; Liz Wanhope, careworn accountable officer of the endlessly restructured Blithering CCG; Dr David Rummage, acting director of public health and proprietor of PPE and ventilator start-up Rummage Covid Solutions; Bev Heaver, chief transformation officer and founder of the Blithering Leadership Academy; Linda Hu, chief people officer and head of workforce planning; and Martin Plackard, director of systemwide strategic communications and place-based messaging.
An unreserved apology
Sir Trevor makes apologies on behalf of Blithering Council leader Alan Spume and hospital chief executive Karen Pike.
“Karen can’t be with us for obvious reasons,” he says, gravely.
Plackard winces at the memory of photos of a clearly inebriated Pike surrounded by partygoers at a local nightspot. The Mail headline had haunted him for weeks: “Hospital boss flouts Covid rules on birthday night out”.
Ms Pike had gone on to make an unreserved apology in which she blamed others, claimed to be a victim of bullying and harassment, and referred inaccurately to a “previously unblemished record of service to the NHS and the people of Blithering”. She would be on sick leave until the fuss died down.
It was all Plackard could do to keep a shirtless Councillor Spume out of the press. In one shot, Spume is clearly visible in the background, taking part in a yard-of-ale contest and juggling what appear to be scotch eggs.
His narrow escape from disgrace is all the excuse the council leader needs to duck out of ICS meetings. He doesn’t even bother to send a deputy.
Thrown to the wolves
Plackard tunes back into the meeting just in time to hear Sir Trevor Longstay say: “And so it gives me great pleasure to introduce Joy Hunter.”
A vaguely familiar face fills the screen. It has piercing eyes and an effortless smile. Plackard is reminded of Rummage’s favourite saying about animals that charm their prey before killing them. He imagines that many of them look like Joy Hunter.
“As you know,” continues Longstay, “Joy will be carrying on the great work done by Nigel Bland and leading the ICS to bigger and better things.”
Rummage’s attempt to stifle laughter is apparent even over the shaky internet connection. The ICS, currently known as the Blithering Them and Us Health and Care Partnership, has had six or seven leaders in the past three years. Most of them come to grief within a few months, usually after discovering that Sir Trevor, despite his non-executive protestations – “I like to think of myself as a hands-off leader” – is unwilling, if not pathologically unable, to loosen his grip on the reins of the local health economy.
Nigel Bland had lasted nearly a year – a record for Blithering – but only because he attended the same minor public school as Sir Trevor and they sometimes played golf together.
The Pike affair broke just as a manufacturing fault was discovered in the Rummage Breathe-Easy 2020 ventilator, the purchase of several hundred of which Bland had approved. It had been with his customary “great regret and not a little sadness”, that Sir Trevor had thrown his old friend to the wolves.
Joy Hunter is speaking. “A little bit about me,” she says, beginning a ten-minute monologue. Joy describes herself as a system leader and park runner – “though I’m very slow”, she adds. For Joy, integration is a journey, not a destination. Compassion is the thing that gets her out of bed in the morning, the force that spurs her on, her mission in life. Not for Hunter the simple desire to get up and go to work to avoid being fired.
She has always relied on a brilliant team, and though she can’t take the credit for their achievements, she makes it clear that she would if she absolutely had to. It’s what leaders do.
Hunter’s modest account of her sporting interests sparks a memory in Plackard. A quick Google confirms his suspicions. Three years ago, during the Blithering Fun Run, one of the participants, a woman with piercing eyes, is leading the field when another runner trips and falls into the canal while attempting to overtake her on the towpath.
Plackard recalls the incident because he is one of a group of stragglers who pulls the faller from the water, where she has become snagged on a partially submerged shopping trolley. Fortunately, Rummage is on hand to administer the kiss of life, his first overtly medical act in several years.
The half-drowned runner alleges foul play, but a stewards’ enquiry is inconclusive. The winner is exonerated. She is Joy Hunter, a former county middle distance champion. The local press pictures her clutching her winner’s medal. An accompanying quote expresses her gratitude, humility and surprise at the outcome.
Kinder bus lanes
Plackard drags his attention back to the call, where Joy is still “sharing insights” about herself.
Early in her career she is seconded to the Greater Manchester devolution project, where she is responsible for Be Nice Day, a multimillion-pound celebration of intergenerational hugging. Later, when she moves to Blithering Council, Hunter is the driving force behind the Kinder Bus Lanes initiative. She goes on to lead the community trust where she inaugurates the Blithering Earth Summit, an annual event dedicated to finding local solutions to problems of climate change, health inequality and global poverty.
Despite himself, Plackard is impressed. Hunter’s appetite for expensive, eye-catching projects appears to be insatiable. Her ascent of the career ladder is dizzying.
As leader of the ICS, Hunter has even bigger plans. She acknowledges Sir Trevor Longstay’s achievement in making Blithering internationally recognised as one of the most challenged health economies in the world, but now she wants to make it the most fully integrated. When Hunter asks “What does integration mean to you? What would it mean to your children, your parents, your neighbours, your pets?” Bev Heaver is visibly moved.
Hu, what and when
Hunter spreads her hands, palms upward, in a messianic gesture that declares her to be open for business and ready to take questions.
Linda Hu would like to know how the ICS will tackle the local workforce crisis. Joy Hunter reassures her that there will be a credible plan, building upon and indeed flowing from the national plan, a definitive version of which, she assures Hu, is “if not imminent then in the final stages of imminence”.
Liz Wanhope, head of the soon to be redundant CCG, asks what is to become of the hundreds of staff who work in commissioning when ICSs finally become legal entities. “We’ll still need a CCG-like function operating at a strategic level. Don’t think of it as a reorganisation, think of it as an opportunity,” Hunter replies, skilfully avoiding anything that might be construed as an answer.
Rummage asks about rumours that the ICS will take over primary care. “Absolutely not,” replies Hunter. “No one wants to run NHS dentistry, not even dentists, but we do see general practice operating at scale with PCNs as strategic care hubs, perhaps with the ICS taking over the day-to-day management of contracts to leave GPs free to develop portfolio careers, take up new hobbies and retrain as population health managers,” she says.
“So, some bits will be integrated, others not so much,” says Rummage. “What about community pharmacy, district nursing, mental health, social care?”
“Details, Rummage, details,” says Sir Trevor, sending a clear signal that there is a time and a place for searching questions, but it is not on a strategy call and never this close to lunchtime.
Hunter, unaware that Sir Trevor’s patience is in shorter supply than Rummage SnugFit face masks, isn’t finished yet.
“No doubt you are all wondering what immediate changes we plan to make to the ICS,” she says, posing the question on no one’s lips.
“After exploring new branding ideas with focus groups and an experienced patient leader, we co-produced an identity that properly reflects the ambition of all the key stakeholders in the system.”
Hunter pauses to give her words time to sink in.
“The people of Blithering told us they wanted to be consulted, involved and empowered,” she continues, before revealing a colourful logo bearing the legend “All of Us in Charge”.
Sir Trevor nods approvingly as Hunter explains how the childlike drawing represents the inclusive nature of the new ICS board and its commitment to listening. Bev Heaver’s eyes are shining; she appears to be on the verge of ecstasy.
Longstay concludes the meeting with a personal pledge of support for the new head of the ICS. “I’m sure I speak for us all when I say we will be right behind you, every step of the way,” he says.
Plackard smiles to himself. Sir Trevor might want to hang back a few paces if they’re going anywhere near the canal, he thinks.
(c) 2021 Julian Patterson