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Lessons in leadership: Nursing leadership in an ICB

Lessons in leadership: Nursing leadership in an ICB

With integrated care boards establishing themselves as central to healthcare provision, ICB director of nursing Tricia D’Orsi tells Katherine Price how there could be an opportunity for nurses to be at the forefront of their development

Tricia D’Orsi is in her first months as director of nursing at NHS Norfolk and Waveney Integrated Care Board, at what is a pivotal time for ICBs and integrated care systems (ICSs).

Ms D’Orsi brings to the role a decade of experience as chief nurse for two different clinical commissioning groups in the region, and two years as alliance director at Mid and South Essex Health and Care Partnership. But she was keen to get back to her ‘nursing roots’.

Q: What can nurses expect from ICBs? 
A: ICBs are all about collaboration, building on what is already there in the integrated space. There isn’t a blueprint, it’s about working with your local stakeholders and partners to find the best way of working in your area.

I’m working to ensure we have a new mental health transformation plan to support people across the system rather than just focusing on secondary care services.

Another huge challenge for us is the number of people who are turning away from domiciliary care roles. We’re working with our local authority partners on what we can do to encourage to people come into that profession. 

How do we make Norfolk and Waveney an attractive destination for nurses? And how can we work as anchor institutions to grow our own staff and look at career frameworks to encourage people into healthcare and also into social care professions?

Q: How are you finding your new role? 
A: I’m loving being back in the nursing family. From an ICB and ICS perspective, one fantastic development is the new relationship with the voluntary sector. Now we have a board member from the sector, they’re at the table. There are many wonderful volunteers out there, very skilled people who can help support individuals and empower them to remain in their own homes. I’m really pleased to see the existing relationships already in Norfolk and Waveney, but how we can build on those at pace?

And we need to move away from a task-focused service to a more holistic provision, and practice nurses can drive that forward. They know their families, they know the rising risks. They are very sighted on a number of challenges that people are facing.

Q: What is your advice to primary care nurses from your position? 
A: I would say, stay strong. Look after yourself, from a physical and mental wellbeing perspective. And ensure your views are being heard, because you’ve got a lot of value to bring to how we’re going to deliver care pathways differently for the future. But you have to be proactive – don’t wait to be invited to local area discussions if you think you have something important to contribute.

Nursing is a wonderful profession. It’s exceptionally tough at the moment but we need to be resilient, because the skills we have are essential to ensuring people get the best opportunities to have the best outcomes for their health. I really want nurses to recognise just what a valued part of the workforce they are.

Q: Do you see ICBs as a real opportunity for nursing leadership to shine? 
A: I think there is a huge opportunity. I think we’re at the start of a journey, but the benefits of this role are working with all our directors of nursing in each of the provider organisations and strengthening that collective voice of nursing in the ICBs. 

I still think there’s a lack of strategic thinking. People very much understand what an ICB is, but there is a need for a communication strategy and also organisational development for multidisciplinary teams. 

We have the opportunity to reduce some of the bureaucratic burden and get people delivering the services that they want to deliver. And what is going to make a difference is closer working between historically siloed teams to deliver those services more effectively.

Q: How can ICBs help to address workforce problems? 
A: I’ve established a group of colleagues from across the system and said, ‘create something that’s going to make it easy for staff’. That is being driven by feedback from the discharge teams, it’s very much ward to board.

Nurses have always been leaders, and I think this is a great opportunity for nurses to be at the forefront. One thing I would ask is for us to be able to encourage more people to consider the benefits of nursing. We need to be ambassadors. That is not easy with the current pressures but it’s vital if we want to build a workforce for the future.


Integrated care systems and integrated care boards

What are ICSs?
ICSs, which became legal entities in July, are partnerships in England that bring together NHS organisations, local authorities and third-sector bodies to take on responsibilities for the resources and health of an area. There are 42 ICSs across England, covering populations of 500,000 to three million.

They have been tasked with improving outcomes in population health and healthcare; tackling inequalities in access; enhancing productivity and value for money; and helping the NHS support broader social and economic development.

What are ICBs?
Each ICS has an integrated care board, which is responsible for developing a plan to meet the health needs of the population, managing the NHS budget and arranging provision of health services in the ICS area.

NHS guidance recommends that ICBs have four executive director roles, including a director of nursing, alongside independent non-executive roles, partner members, and representatives from contributing organisations.

Source: NHS England. Integrated Care Systems: design framework. June 2021.

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