From silos to systems: the role of inclusive leadership in integrated care

Reflections on the ALLIANCE Integration in Action: Inclusive Leadership event.

People don’t experience their lives in silos; so why are our services still designed that way?

We hear time and again how frustrating it is to be passed from pillar to post, having to repeat your story every time you interact with a new person. Nobody experiences their health, wellbeing, or support in neatly separated categories. This is especially true for people living with long term conditions or disabilities, who often have to navigate multiple services, health care professionals, and systems. Yet too often, health and social care still operate through organisational boundaries rather than around the realities of people’s lives.

The consequences are all too familiar. Disjointed care causes inefficiencies, frustrated practitioners, and costlier care down the line.

These challenges sat at the heart of the recent Integration in Action: Inclusive Leadership event, that we hosted alongside IFIC Scotland. Bringing together professionals, third sector organisations, academics, policy makers and people with lived experience, the event explored what inclusive leadership looks like in practice and how it can help create more integrated, person centred health and social care systems.

We heard the same thing throughout the day; inclusive leadership is not about hierarchy. It is about people. More specifically, it is about creating cultures where people are heard, valued and empowered to shape decisions that affect their lives.

That starts with how we think about leadership itself. Speakers consistently challenged the idea that leadership belongs only to those in senior positions. Instead, leadership was described as relational, compassionate and shared.

Stewart Marshall reflected on leadership as both service and role modelling. His reflection that leadership is about enabling others, listening actively and being visible highlighted the importance of creating cultures where people feel valued and empowered. His willingness to acknowledge when he had overlooked a team’s contribution and openly learn from that feedback demonstrated how trust is built through authenticity.

The importance of listening to lived experience was another recurring theme. Roseann Logan shared a powerful example from her work supporting people moving from hostel accommodation into community living. Rather than designing services around assumptions or existing systems, she started by listening to the people who would use them. Their views shaped decisions about their homes, support and daily lives. It was a reminder that meaningful co-production requires us to share power and trust people to be experts in their own lives.

The example highlighted an essential truth about integration: people are experts in their own lives. When services are designed with people rather than for them, support becomes more relevant, effective and sustainable.

However, speakers were also clear that meaningful involvement requires more than just consultation Susan Douglas-Scott spoke honestly about the risk of people being “consulted to death” without seeing real change, while Alan Webb highlighted the danger of tokenism; treating lived experience as a box-ticking exercise rather than ensuring it genuinely influences decisions. Inclusive leadership is not simply about having diverse voices in the room; it is about making sure those voices shape outcomes.

Another key takeaway was the need to challenge the cultures and structures that keep services fragmented. Speakers highlighted professional silos, rigid processes and organisational boundaries as barriers to truly person-centred support. A particularly striking example showed how frontline workers often have the deepest understanding of people’s circumstances.

Jenny Bruce described how a maintenance worker identified financial abuse during a routine visit because he took the time to notice, listen and act. Integrated care is as much about mindset and relationships as it is about organisational reform.

 As the event drew to a close, participants collectively developed a leadership manifesto centred on curiosity, courage, humility, transparency and shared power. These values reflected the central theme of the day: if we want services that are truly integrated, we must start by seeing people as whole individuals rather than collections of separate needs.

Ultimately, inclusive leadership is about creating the conditions for connection. Whether we are practitioners, managers, policy makers or community members, we all have a role to play. If we can lead with curiosity, compassion and a genuine commitment to sharing power, we will be much better placed to build the integrated, person-centred health and care system that people deserve.

People do not experience anything in silos. Our services should not expect that to either.

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