The introduction of Integrated Care Systems (ICS) across the UK – a key part of the Government’s 2021 Health and Care Bill – risks exacerbating psychological safety risks for frontline staff within NHS and social care services, according to findings from an NHS programme being published today.
The Psychologically Safe Leadership Programme was delivered by NHS Horizons in partnership with Harvard Business School Professor of Leadership, Amy Edmondson, and our client, UK psychological safety expert and Chief Executive of the Soircas Consultancy, Rachel Cashman, during the second wave of the Covid-19 pandemic.
Rachel argues that whilst the concept of ICSs is undoubtedly right, the programme findings highlight how careful consideration must be given to their construction.
The call to action for legislators, regulators and aspirant ICS leaders is to think not just of the roles that need to be created but also the leadership styles and behaviours that will be valued and rewarded in order to promote psychological safety throughout the NHS and social care services.
This is especially important in light of growing concerns about staff burnout – as the increased complexity and uncertainty that accompanies system change increases the risk of psychological harm and burnout.

Programme findings & practical guide
Over 80 senior leaders working in the NHS and local government took part in the Psychologically Safe Leadership Programme. The programme found that:
- The introduction of ICSs risks increasing the ‘VUCA’ climate that frontline staff are working in – a term first coined by the US Army to identify situations that risk avoidable psychological harm and prevent healthy, high performance.
- At a senior level, the NHS is perceived to be an environment in which it is unsafe to be in a minority of one, to speak the truth and challenge conventional viewpoints.
- There is a lack of mutuality and trust between health and care organisations.
- To be more effective, the NHS needs to move away from the ‘hero leadership’ of one manager or executive and the ‘learned helplessness’ of others, and instead adopt ‘humble leadership’ behaviour that empowers individuals and teams to speak up, share ideas, challenge convention and ask questions, safe in the knowledge that their voice is valid and their contribution is welcomed.
The Soircas Consultancy and Novartis UK have worked with NHS Horizons to produce A Practical Guide to Psychological Safety in the Real World of Health and Care
It includes practical advice for leaders on creating an environment of trust and openness in which staff feel safe to speak honestly, including when teams are working virtually.
The Guide also covers what all individuals working in health and care can do – as psychological safety isn’t just the job of the boss, they set the tone but everyone has a part to play.
To find out more about Rachel’s recent work with NHS and local government leaders, read her blog here.
"Addressing psychological safety in the workplace is the wellbeing equivalent of providing a hard hat and reinforced boots for workers on a construction site. It’s about providing people with PPE for the mind"
Rachel Cashman, Chief Executive of The Soircas Consultancy
