Approach 2: Leadership of place for whole system change

June 2025 teaching template, slide 40

Approach 2 Leadership of place for whole system change

Creating a system that works.

June 2025 teaching template, slide 41

Approach 2: Leadership of Place for Whole System Change

Introduction: Positions the council as a key partner in a shared system, not the central controller, focusing on whole-system impact.

How to move toward: Use shared evidence and cross-organisational learning to build coherent joint working.

What to do: Build trusted relationships, promote co-commissioning, and align vision across partners.

What not to do: Don’t rely on shared plans alone—ensure changes affect frontline practice.

Risks and issues: Can be undermined by weak governance, relationship breakdowns, or overfocus on strategy.

Commissioning skills and structure: Needs senior-level influencing skills, governance literacy, and blended commissioning capabilities.

June 2023 adult social care pre-reading, approach 2

Strategic Commissioning Approach 2. Leadership of place for whole system change

Creating a system that works.

Introduction to this approach

This approach is paired with the ‘relationships and organisation across the system’ commissioning aspect and is all about achieving that capability. It begins with a view that since communities are complex and their needs are constantly changing, often in unanticipated ways, the best way to deliver good results is to understand the whole system, intervene collaboratively and disrupt compassionately. It also requires an understanding that what is often referred to as a ‘system of care’ may not be – and often is not – a functioning, purposeful system at all.

The council is not at the centre of the system but is one of the core, and most critical, building blocks. This approach sees the role of the council as working in partnership with all the other players in the place, and commissioning based on a shared understanding of what makes the difference to local social outcomes, particularly regarding joined-up pathways and effective referrals between different organisations. Commissioning is therefore focused upon identifying a rich mix of services, support and involvement in the local social economy to achieve pragmatic results. This approach is associated with the relationships aspect of commissioning because it depends heavily on formal and informal relationships at various levels to succeed.

The approach is likely to be called for when community need is in a state of flux, and both provision and service need are diverse and challenging. It is important that political leadership is comfortable with uncertainty and ambiguity and that there is a focus on appreciating the whole while pursuing what works, and the ability to collaborate effectively and learn through experience.

How to move towards this approach

Like whole system design, this is also an approach which requires time and broad capability. A good way to begin is by providing concrete evidence of where costs can be lowered, and outcomes improved through making the system more coherent. If different organisations can learn to work together more effectively, the case for working as a single system becomes stronger. Beyond that, good relationships are needed to ensure the recognition that interventions paid for in one part of the system, which create savings elsewhere, are important for the whole system. There are huge opportunities to engage with frontline staff, carers, providers and service users to identify opportunities for improved coherence. Clearly, integrated commissioning and funding would also be a logical step forward in this regard.

Work on shared culture, identity and vision will be valuable and necessary to progress this approach. It is also important to recognise and work with professional boundaries and the threat that a joined-up approach can pose to organisational leaders by destabilising their power bases. A strong, shared vision about how care should work in your place, with processes for learning, will, however, go a long way to support this.

What to do, and what not to do, when you are pursuing this approach

It’s important to understand that this requires working across boundaries and the ability to cut through to honest conversations, confront issues productively, and to find the mechanisms which will allow a shared view – often bringing people face-to-face with the citizen experience, or demonstrating the overall savings available through a joined-up approach (along with managing the discussion about how these savings are shared). In the long-term, the drive will be towards co-commissioning with single funding pots across wider scope and organisational boundaries. This is the espoused goal of Integrated Care Systems and so it is important to engage both constructively and critically with plans and governance – it may or may not be appropriate for councils to ‘put all their eggs in the one basket’ of ICB governance, as it is likely that much joining-up will still be achieved outside of the formal structures. All of this means there is a need to manage the balance between national politics and nationally driven change, and local change. All kinds of providers, the community, the voluntary sector, and other services outside the scope of the ICS will also be critical.

It is important not simply to pay lip service to real joint working, ignoring the challenges of incompatible funding and performance drivers, and not to be drawn into the avoidance tactic of producing beautiful analytical shared plans which do not actually change practice on the ground.

Specific risks and issues

This approach can be derailed by poor governance, relationship challenges (between organisations and even individuals), being distracted into other urgent ‘whole system’ challenges, and a focus on strategy, planning and governance at the expense of practice. There is also a risk of distribution of time and focus, and losing sight of other vital elements of the commissioning role.

The main motivating factor here is that if extended governance is right, and based on real understanding and learning, it will be possible to guide and steer the whole system to be better. It is important to pursue a strategy of incremental gains and pragmatism.

There can be real challenges with a single large or dominant provider when you are on the outside seeking to influence it, or shape the market. There can be power imbalances between large and small providers, particularly if commissioners are driven by short-term funding streams. It can also be difficult to influence alliances as part of collective place governance, if the alliance is developed outside those governance structures.

Considerations for commissioning skills and structure

This approach requires strong internal relationships with politicians and senior leaders, and the ability and gravitas to influence at board level, as well as striking a balance between the procedural and the pragmatic – getting down to real change. There is likely to logical support for a long-term move to shared commissioning on a broad basis, so it is important that principles of, and approaches to, commissioning that reflect the statutory requirements and values of social care are embedded for the long-term.

This approach, like others, requires the ability to draw on all of the skills of other approaches. It is unlikely to be the exclusive approach unless it is already well advanced and may be blended with another approach.

Examples of this approach in practice

A popular and successful radical approach in this space is some form of ‘alliance contracting’: establishing a partnership or alliance of relevant delivery bodies with shared governance, and sharing relevant budgets across all parties with a targeted scope of interventions or outcomes (or both). This allows for various legal forms of agreement which take competition out of the picture, or limit it, and allow collaboration across a wider system to work towards shared outcomes.

• The Plymouth Alliance for Complex Needs was formed by Plymouth City Council and part of Devon CCG with a budget of £638m gross, driven by strategies for wellbeing, community, children and young people, and enhanced and specialised care. The scope covers public health, leisure services, housing services, children’s services including direct schools grant, adult social care, primary care, community health services, and acute provision. The integrated commissioning team commissioned seven provider organisations under a single alliance contract, worth £7.7m and lasting up to ten years, to work together supporting adults with complex needs. The attempt is to work as one truly integrated system.
• The charitable company Community Safety Glasgow, which from 2006 to 2019 (when it merged back into the council) was a Company Limited by Guarantee, owned by Glasgow City Council and Police Scotland worked with single vulnerable people and community safety. By encapsulating responsibility – and the budget to address it – in a single entity, the model allowed a single-minded outcomes focus.
• A London borough brought together its community and voluntary sector funding into a single outcomes-based contract which it specified had to be delivered by a local alliance. The local umbrella body led a successful bid for the contract and the alliance as a whole – which needed significant support and put significant effort into developing its own governance, bid, and outcomes measurement capability – is now working in partnership with the council to deliver.

One thing to read

Place-Based systems of care: A way forward for the NHS in England. The Kings Fund (2015) https://www.kingsfund.org.uk/publications/place-based-systems-care