Developing System Leadership for Integration in the UK Health & Care System

Background: Health and care systems across the UK face persistent challenges of fragmentation, despite years of strong policy direction toward integration. Achieving integration clearly requires more than policy and structural reform. How do we create the conditions for systems leadership, rapidly and sustainably?

 

The Leading for Systems Change (L4SC) programme was designed to develop system leadership capability to support implementation of the Long-Term Conditions (LTC) strategy in Leicester, Leicestershire and Rutland ICS. Delivered between late 2024 and mid-2025, it aimed to accelerate collaboration by strengthening relationships, systems thinking, and collective action.

 

Audience The programme engaged a diverse cross-section of leaders and practitioners from across the health, local authority, and community sectors. Participants ranged from senior executives and clinicians to operational managers and voluntary sector leaders. In total, well over 120 people committed to the programme.

 

Approach: L4SC was delivered through six whole-system workshops between November 2024 and June 2025. Each session was grounded in living systems principles, adult learning theory, and reflective practice, combining expert facilitation with real-time work on the LTC pathway. The approach was immersive, experiential and experimental.

Workshops were designed to create safe spaces for cross-sector experimentation, where leaders could explore system challenges, test collaborative approaches, and develop shared understanding. Over eight months, the programme fostered a shift from organizational identity and focus toward system-level collaboration.

The evaluation drew on Menti surveys, online questionnaires, semi-structured interviews, attendance records, and facilitator observations. Thematic analysis provided insights into participant experience, learning outcomes, and emerging system impacts.

 

 

 

 

Outcome;Key Results

• Participants valued the protected facilitated space to reflect, connect, and collaborate, citing it as “energising” and “transformative.”
• Stronger, cross-boundary relationships and trust networks developed, supporting a shared purpose around integrated care delivery.
• Leaders demonstrated a clear shift in mindset, moving from “What’s my role?” to “How do we act collectively?”
• There was increased recognition of the patient and public voice as central to system design.

Lessons: and Insights

• Time and space for individual and collective reflection are essential to foster new behaviours and collaborative leadership.
• Systems leadership requires unlearning – letting go of traditional hierarchies and embracing distributed power.
• Emerging roles such as convenor, connector, and coordinator are often poorly-defined.
• Connection is both means and outcome: increasing cross-system contact builds the “weak ties” that drive innovation and adaptability.

Food, administrative support and a sense of humour are real, and under-recognised, elements of the conditions precedent for systems leadership development.

Impact and Sustainability

 

The L4SC programme catalysed a narrative shift in the LLR system from siloed to collaborative ways of working. Participants built shared language, trust, and systems awareness — essential preconditions for integration. Early ripple effects include strengthened cross-organisational teams, use of system tools within local teams, and new joint initiatives.

Sustaining this momentum requires continued investment in network facilitation, coaching, and reflective spaces, alongside embedding patient and citizen voices in future work. The L4SC model offers a replicable framework for developing system leadership capacity across ICSs nationally.