The Role of Local Political Leaders in Shaping the Planning and Implementation of Health and Social Care Integration: a Case Study From Scotland

This thesis examines the role of local political leaders in shaping the planning and implementation of Health and Social Care integration (H&SCI) in Scotland. H&SCI is intended to improve the quality and efficiency of care for individuals accessing both health and social care services, as outlined in the Joint Act of 2014. Within the Integration Joint Boards (IJBs), local councillors are an integral part of the broader 'integration network' responsible for overseeing H&SCI. However, the role and contribution of local councillors in H&SCI has not been subject to a sufficient level of research in this area. This study provides a comprehensive analysis of the role and participation of councillors in IJBs, the leadership styles and approaches they employ, and the political context and environment that shapes their choices and actions. It also investigates the relationship between political representatives within health and social care areas and senior bureaucratic actors (such as chief officers and planners). A casestudy approach was adopted to examine and refine the theoretical claims of the study. The study uses a qualitative approach, based on content analysis of policy documents and semi-structured interviews with councillors and other key stakeholders (senior officials) involved in H&SCI in eleven case study areas in Scotland. The study uses an analytical framework that guides the analysis of the role of local political leaders in public sector reform initiatives. It draws on the theories of contingency and situational leadership, which suggest that political leadership styles articulate a choice of action that is influenced by their surrounding context. The analytical framework of this study integrates the literature on leadership styles and political context and uses them as lenses to explore and identify the main frames, themes, sources, and tones that the participants use to describe their roles, responsibilities, and leadership styles in H&SCI in relation to their political context. This allowed for the identification of the potentially relevant leadership styles and political contextual factors that could help to better understand the subjectivity of local political leaders' leadership approach choices within modern governance settings. The research finds that local political leaders play a key role in the strategic decision making of H&SCI and they adopt different leadership styles that vary along the dimensions of cooperation, vision, teamwork, inclusivity, result orientation, direction, and initiative, depending on the political context and their personal preference. The research also finds that councillors face various challenges and opportunities in exercising their leadership roles within the IJBs, such as managing the conflicting interests and expectations of different stakeholders, coping with the financial and operational pressures of H&SCI, and navigating the complexity and uncertainty of the reform process. The thesis contributes to the literature on the politics and leadership aspects of public sector reform in Scotland, and offers new insights for improving the governance and performance of H&SCI. The thesis also has significant implications for the integrated/collaborative governance literature, as it can inform the development of new theoretical frameworks and practical guidance for integrated governance.