The King’s Fund, an independent think tank and charity working to improve health and care in England, has published the latest report by leading health writer Nicholas Timmins on system leadership. It is based on interviews with system leaders of Sustainability and Transformation Partnerships (STPs) and their more evolved equivalents Integrated Care Systems (ICSs).

Through interviews with 16 leaders of such systems, Timmins concludes: “Leadership in the current health and care landscape does present challenges. It is a new direction for a system that has lived with varying degrees of organisational independence and autonomy for nearly 30 years. It is a home grown effort across the country, not imposed from on high. While this is the right thing to do, it does place enormous onus on local leaders to find their own way.

One ICS leader who talked to Nicholas Timmins is Dr Claire Fuller, senior responsible officer at the Surrey Heartlands ICS. Under current plans all parts of the NHS in England are meant to have created an integrated care system (ICS) by April 2021.

Dr Fuller said: “People come to work to improve the health of the population. The hardest bit, probably, is keeping all of the plates spinning all of the time – and the derailment that you can get from the centre.

“Suddenly ‘you must do this’, when ‘this’ had not even been on your radar. A lot of it is hard. One of the harder things is working together as a system, but then still having a construct that continually pushes you away into a commissioner–provider split. So it is trying to behave in a different way, against the confines of the legislation. That is hard. Not impossible. But it is hard.”

For some leaders, whatever authority they do have comes from their longstanding personal commitment to their patch. Claire Fuller puts this eloquently: “In terms of traditional NHS hierarchy, I have no authority. Absolutely none. The authority that I do bring is that I’ve grown up in Surrey, went to school in Surrey, I’ve worked in Surrey, and my family and friends all live in Surrey.

“So I really care about how we deliver health and care in Surrey. So it’s quite personal. But I’ve spent most of my career as a salaried GP – without authority to tell anybody anything. So it has always been a case of getting there by persuasion. Getting there because it is the right thing to do.”

Other leaders contributing to the report include Fiona Edwards, lead at Frimley Health and Care Integrated Care System and current chief executive of a foundation trust; and Adam Doyle, lead at  Sussex Sustainability and Transformation Partnership and current Accountable Officer for the county’s clinical commissioning groups.