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Forget job titles and structures, influence is what matters

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One of the themes that seems most pronounced early in 2017 is that of trust. Certainly there doesn’t seem to be much at the moment between Number 10 and the NHS leadership, but how are things locally?

I was talking to a frustrated council chief recently who has spent the past few months trying to assemble a governance framework that links the many tiers of leadership across both health and care.

He was fast reaching the point at which a decision was needed on whether the relationship with the local NHS was one that was deeply embedded around a common vision or one that was purely transactional. And this was a place with a good history of working together.

Without trust not only do STPs and other forms of large-scale transformation not stand a chance but the basics become undeliverable too.

The NHS cannot control people’s health and councils cannot control people’s care. Something, or someone, needs to give

Greater operational efficiency might well be the order of the day but that’s not going to engender trust. This is where influence comes in.

If you accept you cannot control something then you indirectly accept you need to try and influence it. The NHS cannot control people’s health and councils cannot control people’s care. Something, or someone, needs to give.

Forget job titles. Forget structures. My challenge to local system leaders is to uncover those with the skills, the gravitas and the fleet of foot to best influence.

Who will make sure the right people are involved in a decision? Who will work behind the scenes to convince and cajole? Who will work across organisations, not deep within them?

It’s no good simply writing this into someone’s job description.

Find and empower the right people locally and the results will be more than the sum of your parts. Importantly, your reward will also be the development of local trust.

Ironically, the barbs being directed at the very top may prove to be a unifying force. Both local authority and NHS managers know their national leaders are on their side at least when it comes to influencing those in control of the purse strings.

Whether or not they are successful, the challenge locally remains the same: do we trust our partners to have the community at heart?

Michael Wood, NHS local growth advisor, NHS Confederation. @NHSLocalGrowth

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