Blog post

Diversity on ICS boards is key for NHS success

A more robust recruitment process is needed to ensure equality in recruiting to ICS boards.
Angelie Balalingam

11 March 2022

Representing the diversity of our populations through our workforce is crucial for the best patient care. Crucial too is diversity in NHS leadership. Angelie Balalingam writes on the aspiration of having diverse ICS boards and how we can get there. 

The NHS is its people. Getting its recruitment and culture right is therefore integral to delivering the best services and outcomes. Integrated care systems (ICSs) will play their part by setting out system workforce strategies in the push to build ‘one workforce’. However, as the NHS People Plan notes, leadership diversity is integral to building a better healthcare system, one that properly addresses the needs of communities, improves patient experience and helps avoid the occurrence of group think. While there were encouraging, early signs of increased diversity within chair recruitment, this was not reflected in the CEO appointments, with just one designate identified as coming from an ethnic minority background.

Leadership diversity is integral to building a better healthcare system

Given the importance of this agenda, the NHS Confederation has been working with NHS England and NHS Improvement (NHSEI) to provide recruitment support to the new ICSs to help achieve greater leadership diversity. This support has included practical seminars that provide leaders with a clear understanding of NHSEI’s expectations for effective recruitment to integrated care boards, which has led to some insightful observations.

What can you be doing?

One of the key messages across the seminars was that systems should be prepared not to appoint. If those who are shortlisted and interviewed do not sufficiently cover all the competencies, especially on understanding the importance of addressing health inequalities, then recruitment panels are encouraged to start again rather than progress with those they have interviewed. While this may be unsettling in the short term, finding the right candidate will yield better outcomes in the long term.

It is imperative that we challenge recruitment firms to take more risks

Being willing not to appoint also links into uncomfortable conversations about equality, diversity and inclusion (EDI) in the recruitment process. While we recognise that not everybody will have the privilege to call people out, it is important that we are challenging individuals or panels that do not appropriately value the importance of EDI. For systems working with recruiters, it is imperative that we challenge recruitment firms to take more risks, holding them to account so we avoid scenarios such as all-white shortlists or selection panels lacking in diversity.

ICSs have been marked to be a very different type of organisation for the NHS, with closer roots to communities. So there should be more incentive to ensure we build diversity into systems from the very start. There should be an active lookout for candidates from outside the sector, ones who acquire the broader skills that are necessary for system leadership roles. We have started to see some evidence of this, with some appointed ICS leaders coming from other countries, provider and community mental health trusts, the voluntary sector, and senior local government positions. This positive step gives us the opportunity to depart from the traditional organisational-interest-driven leadership styles and move towards more collaborative leadership that seeks to enable the success of partner organisations.

Resources and support

The NHS Leadership Competency Framework is one tool that attempts to level the playing field. Designed to help systems recruit board members, the framework provides a common set of competencies applicable across the country, helping to source individuals that can both operate effectively across the system and change it for the better. It focuses on disruptors who have experience with making a real difference, with the ability to operate collaboratively and transform the workforce. However, it is equally important that those who interpret the framework prioritise the people and partnership competencies and do not simply view it as a governance concern.

The NHS Confederation’s EDI programme also offers support in recruiting ICS chairs and CEOs. Fully funded by NHSEI, therefore at no cost to systems, the team offers tailored support for whichever stage systems are at in relation to non-executive and executive recruitments. This practical offer for local areas aims to collaborate with workforce leads and recruiters to co-produce a package that will ensure diverse talent across boards. For further information about this free support package, please contact

All of the above will not only help to signal a shift in our cultural understanding, but will build for a better future, supporting the pipeline for more diverse leaders to come through the ranks. People look to leadership structures when considering employment, and if the NHS is serious about recruiting the best and the brightest to address workforce shortages, then it must continue to compete by showing that it is an inclusive, forward-thinking and dynamic place to work. ICSs present a renewed way of working which requires us to build on progress around EDI, actively challenging systems on the work they are doing to achieve diversity and what this means for the future workforce. They present an exciting, ambitious shift in the way the health and care system is organised; this ambition must be mirrored in recruitment, ensuring that new leaders reflect the staff and communities around them.

Angelie Balalingam is team coordinator of the ICS Network