We are building a fundamentally different kind of organisation. Our role is to design and shape the healthcare of our system so that it consistently delivers better outcomes, reduces inequalities, improves quality and operates within its means while being clearly and consistently clinically led. This means we:

• Define the model of care the system will deliver.
• Align resource to that model, using planning, contracting and investment decisions.
• Set clear expectations on quality, access, outcomes and productivity.
• Use data and insight to understand variation, target intervention and track impact.
• Hold partners to account for delivery, intervening where performance falls short.

We work through partnership, but we are unambiguous in our role; we set the direction, we create the conditions for delivery, and we assure that the system delivers for our population.

Everything we do is anchored in a single system model, known as our four layers of care. These are not conceptual. They are the framework through which we design services, commission pathways and measure performance.

• Primary care – the foundation of the system, providing consistent, accessible, relationship-based care, with a strong focus on prevention, continuity and long-term condition management.
• Neighbourhood care – multidisciplinary teams working at scale around defined populations, bringing together primary care, community services, mental health, social care and the voluntary sector to proactively manage need and reduce inequalities.
• Intermediate care – services delivered at scale in the community to improve flow, maximise recovery and independence, prevent admission and support timely discharge.
• Acute care – a coordinated system of hospital care, operating with shared accountability for safety, quality, access, productivity and outcomes.

Our role as commissioner is to ensure these layers operate as a coherent system rather than a set of disconnected services.

Kent and Medway faces a set of long-standing and structural challenges:

• Significant population growth and ageing, with the 85+ population projected to grow rapidly.
• Increasing prevalence of multiple long-term conditions, strongly linked to deprivation and wider determinants of health.
• Persistent health inequalities, with substantial variation in life expectancy.
• Rising demand across all parts of the system
• Fragile performance across key services

These challenges require a different response: not incremental change, but a system that is designed and led differently, with a clear model of care and a strong, disciplined approach to commissioning.

To deliver this, we are deliberately shaping a different kind of organisation. We expect:

• Clarity and accountability – individuals take ownership and operate with pace and discipline.
• Rigorous use of data and insight – decisions are evidence-based and outcomes-focused.
• Constructive challenge – high standards, open debate and continuous improvement.
• Multidisciplinary working – clinical, operational, analytical and commissioning expertise working as one.
• Strong relationships – working in partnership with providers, local government and communities.

We will invest in digital capability, automation and modern ways of working to reduce administrative burden and enable our teams to focus on leadership, influence and delivery.

• Presence matters: We expect all teams to be office-based at least twice a week, with executives on site more often, to build trust, cohesion, and collective ownership echoing the team-based innovation practices of leading design, technology, and consulting organisations. We would expect there to be changes in where we work over time, but we will explore that in the first year of the new organisation.
• Self-sufficiency is expected: We will support colleagues to operate with autonomy, clarity, and accountability mirroring successful professional services cultures where personal ownership is the norm. This also encompasses minimising the time and administrative burden created by leaders and communicating that to teams. Senior leaders are expected to effectively employ modern IT techniques to model the digital revolution within the NHS.
• Time is precious: We will invest significantly in automation and artificial intelligence to reduce administrative burden freeing our people to lead, influence, and deliver.
• Challenge is welcome: We will embed a culture where feedback is candid and constructive, where challenge is expected and taken in the spirit of improvement, and where psychological safety and high standards go hand in hand.
• Behaviours are key: We will ensure that our most senior leadership consistently exemplifies inclusive behaviours, setting the standard for integrity in language, tone, and conduct always. This includes addressing challenging behaviours as they arise to ensure that the credibility of the leadership is always maintained.
• Multi-disciplinary working: We will embed a culture of collaboration across professional boundaries, ensuring that teams operate as integrated units rather than isolated functions. This approach will enable us to draw on diverse subject matter expertise, improve decision-making, and deliver more innovative and patient-focused outcomes. In practice, this means prioritising shared accountability, open communication, and collective problem-solving. As executive leaders will play a key role in modelling this behaviour, fostering trust and psychological safety so that challenge and constructive feedback are welcomed. Over time, MDT working will become a cornerstone of how we operate, supporting agility and resilience as we transition to the new organisational model.

Our leaders are expected to model this consistently, creating a culture that is both high-support and high-accountability.