At HETT23, our Partnerships Director, Andy Kinnear, spoke to Steve Brine MP about Integrated Care Systems, the digital healthcare agenda and NHS funding.  

Here are his reflections on a conversation with the Chair of the Health and Care Committee. 


My ever-growing list of interesting moments for inclusion in the film about my life (John Cusack plays me, by the way) took a fascinating turn last week when I got to have a fireside chat at HETT2023 with Steve Brine MP, Chair of the cross-party Health and Care Committee. There was no fireside and our chat had been planned to letter by a very enthusiastic comms team, but Steve and I share a healthy disrespect for being stage-managed and so we soon headed off-piste to touch on some interesting topics.  

Steve comes across as a big-thinking, straight-talking fella with a likeable manner and sharp moral compass not fitted as standard on all Tory MPs. He was keen to stress his role as Chair of the Health and Care Committee, a powerful group of cross-party MPs who can commission inquiries on health and care topics that then serve as feedback and guidance on government policy. His attendance at HETT, let’s face it, an untypical act from a sitting MP, was prompted by his eagerness to invite the frontline NHS digital voices to engage more effectively with the Committee’s inquiries.  

The latest on the autonomy and accountability of Integrated Care Systems was the subject of our chat. Steve came across as a passionate believer in the collaborative philosophy underpinning the role of ICSs. In fact, he went further, pushing for more autonomy of decision making to be devolved to health community level and for ICS organisations to be held to collective account for the services they delivered. He noted this wasn’t without challenge and spoke eloquently on how the ‘power’ needed to shift. His view is that the big jobs, big titles and big responsibilities were currently sitting in the provider world, and the top leadership talent is far more likely to be drawn to roles in a big acute trust than in the ICS. But this would need to change, and by changing and ceding power in the ICS then we might, actually, begin to see improved integrated care at health community level.  

I came into the NHS on 11 March 1991 and, whilst it was far from perfect, the system that existed then felt more like what Steve was describing. Replace ICS for Local Health Authority and you are not far away. Whether this is finally the end of the purchaser: provider competition dogma and a move to something more public serving and collaborative time will tell, but it was encouraging to hear Steve describe his hope that it would at least drive a more collaborative approach to the delivery of vital public services across local geographies. 

On the digital agenda, we talked about the two topics closest to my heart:  leadership and money! 

On leadership, it was quickly clear that we shared a belief that digital transformation was possible within healthcare, and that we could emulate the major transformations witnessed in other industries like retail and banking. But it was going to be a challenge with ICS Executive Boards who too often lack the necessary digital transformation skills and knowledge to make it happen.  

This is certainly something we have recognised at Ethical Healthcare and prompted us to launch our digital board development service to help boards to improve their digital knowledge and confidence – and harness the advantages of digital transformation.  

I felt duty bound to mention the talented CIOs leaching out of the NHS right now; high-calibre digital leaders often frustrated that the transformation they seek to drive is stifled and underfunded. We also talked about the challenge of bringing top talent into the NHS digital space when we remain hampered by outdated Agenda for Change (AFC) salary caps. Steve pitched the challenge we face through the lens of a talented digital graduate facing a choice between joining the NHS on AFC band 4/5 or joining Apple or Google on substantially more.  

We cannot compete. Yet Mark Miller (author of Talent Magnet: How to Attract and Keep the Best People) wrote years ago that top talent is drawn to great leadership, an important mission and a place of personal development. Salary is largely a hygiene factor that cannot draw talent in alone but will send them away if inadequate.  If we can sort out the salary, then we know we can attract great leaders to our important mission who will develop their top talent. #simples 

I was candid with Steve about the money. I assert that there is not enough in the NHS right now full stop, and certainly not enough to deliver the digital transformation required. Industrial action from low pay offers, tired physical estate in need of repairs, and an inadequate digital landscape are all evidence of lack of investment. Perhaps more worrying though, is the cumbersome and labyrinthine processes being put in place to stifle the spending of the budgets that do exist. The recent announcements on ministerial sign-off limits and the continuing slow delivery of Frontline Digitisation monies to the frontline are both examples of the way slow process, not inadequate funding, is stifling spend and thus transformation.  

Overall, this was a great conversation. Our 20-minute stage slot lasted 34 minutes. We had a politician listening to our views and offering us the ‘vehicles’ to make these views in an even more assertive fashion. Steve’s final comment was to espouse the power of the Health and Care Committee, a group who have huge influence on health and care policy, and to encourage us to engage in their inquiry process. If digital health and care is to be a profession of which we are proud (and many of you know how much I bang that drum) then we must engage professionally. Steve is their Chair, an active and engaged listener, so let’s share our expertise and experience and help him and his colleagues help us!