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 ofHealth and Social Care integration (H&SCI) in Scotland. H&SCI is intended to improve the quality andefficiency of care for individuals accessing both health and social care services, as outlined in the JointAct of 2014. Within the Integration Joint Boards (IJBs), local councillors are an integral part of thebroader 'integration network' responsible for overseeing H&SCI. However, the role and contributionof local councillors in H&SCI has not been subject to a sufficient level of research in this area. This studyprovides a comprehensive analysis of the role and participation of councillors in IJBs, the leadershipstyles and approaches they employ, and the political context and environment that shapes theirchoices and actions. It also investigates the relationship between political representatives withinhealth and social care areas and senior bureaucratic actors (such as chief officers and planners). A casestudyapproach was adopted to examine and refine the theoretical claims of the study. The study usesa qualitative approach, based on content analysis of policy documents and semi-structured interviewswith councillors and other key stakeholders (senior officials) involved in H&SCI in eleven case studyareas in Scotland.The study uses an analytical framework that guides the analysis of the role of local political leaders inpublic 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 theirsurrounding context. The analytical framework of this study integrates the literature on leadershipstyles 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 leadershipstyles in H&SCI in relation to their political context. This allowed for the identification of the potentiallyrelevant leadership styles and political contextual factors that could help to better understand thesubjectivity 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&SCIand they adopt different leadership styles that vary along the dimensions of cooperation, vision,teamwork, inclusivity, result orientation, direction, and initiative, depending on the political contextand their personal preference. The research also finds that councillors face various challenges andopportunities in exercising their leadership roles within the IJBs, such as managing the conflictinginterests and expectations of different stakeholders, coping with the financial and operationalpressures of H&SCI, and navigating the complexity and uncertainty of the reform process. The thesiscontributes 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 hassignificant implications for the integrated/collaborative governance literature, as it can inform thedevelopment of new theoretical frameworks and practical guidance for integrated governance.