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Don’t forget the workforce

Source: Public Sector Executive Feb/Mar 2014

The Centre for Workforce Intelligence (CfWI) has launched a new report, ‘Think integration, think workforce’, encouraging service providers to consider the workforce perspective when integrating health and care teams. PSE heard from report author Zoë Dodd. 

There are three key steps to workforce integration, according to a new report from the CfWI. First, be clear about the
local integration agenda; second, address the integrated workforce management challenge; and third, implement successful workforce change.

Since most analyses come at integration from the perspective of the patient or service user, or of the transformational leaders driving change from above, we asked report author Zoë Dodd why it is so important to get a workforce perspective. She told us: “We don’t think integration will work without a clear focus on the workforce implications, as it is the workforce that is responsible for delivering the changes required to improve outcomes for the people using the services. The combined health and social care workforces number over 3 million, with 1.5 million people working in adult social care in England alone. This does not include unpaid carers [This group is estimated at around 5 million]. These numbers speak for themselves in showing the importance of ensuring we are able to get the right people with the right skills and behaviours in the right place at the right time. This is even more important given the economic and quality implications.”

Although integration tends to be seen as better for the patient or service user as it helps join-up care, and better for the institution as it cuts costs while improving quality, what about the typical worker in a team about to be ‘integrated’? 

Dodd said: “The reaction of the workforce to integrated working depends very much on the model of integration being implemented, as well as the communications approach taken to engage with the staff and people using the service affected. For example, when developing integrated teams, involving operational staff in early discussions about planned integration is one way to overcome misconceptions about new services. Regular meetings provide an opportunity to develop policies and procedures. Meetings also offer a setting to resolve problems and review practice.

“In addition, when developing integrated management and governance, allowing time and resources for organisational development work that develops shared goals and values is more likely to lead to successful mergers.

“Building a model where staff are put at ease over the changes to traditional service delivery and everyone is keen to work in a joined-up fashion requires a number of building blocks to be put in place.

“Integrated working tends to be met with positivity where there is: an agreed model; a clear approach; defined roles; clear and continuous leadership; early and continuous engagement with staff affected; development of a common language between health and social care staff; support through integrated learning and development.”

The report says a “just-do-it approach will be imperative” to prevent progress being slowed. An organisational development manager at a clinical commissioning group quoted in the report backed this idea, saying: “Just do it, just do it – that’s what our experience suggests from integration locally. Planning takes you so far, but it’s the relationships that are key to overcoming challenges and barriers.”

We asked whether emphasising ‘just do it’ rather than planning could be risky, and Dodd said: “Good relationships and a shared ambition between workforce leaders who collaborate to integrate services are crucial to overcoming challenges and barriers that include competing priorities and traditional silos.

“Planning is important, but a determined ‘just-do-it’ approach, as one of our stakeholders suggested, is imperative to making integration real on the frontline. This would signal a real commitment to achieve integrated care and support from all workforce leaders involved. This way of thinking is equally significant to actually achieve effective integration that delivers better outcomes for the people using the services, from older people to people with learning disabilities.

“Working towards integration in this way prevents people from retreating into comfortable workforce silos, for example those silos associated with traditional financial arrangements. Developing integrated approaches to workforce commissioning, education and training also becomes easier.”

Dodd emphasised that there is no ‘one size fits all’ approach that can work for everyone. “Success looks different each time”, she said, from Airedale NHS Foundation Trust’s approach to telehealth to Kent’s partnership approach between the county council, community health trust and its social care partnership trust; and from Cambridgeshire’s integrated discharge care pathway to
Torbay’s integrated care trust.

“In some cases it has proved successful to take a bottom-up approach and in others there has been an inspirational leader driving the change. It is more about ensuring that the changes made improve outcomes for the people using the service; this needs to suit the locality, so it inevitably varies.”

The report provides plenty of practical advice to service commissioners and providers, including the importance of a person-centred approach to risk, and the need for the right size workforce with the right training.

Dodd concluded: “The integration agenda has a history that stretches over many years. It has long been an ambition of governments, policymakers and planners to achieve better integration of services. Yet never before has there been the appetite to make this happen at such a scale and pace.”


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