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Integrated care describes the shift away from traditional top-down, command-and-control healthcare to a future where both health and social care services are delivered in a seamless fashion, shaped around the needs of the patient. Ian Wheeler from Skills for Health looks at the workforce development needed to make this fundamental shift a success
Policy makers and workforce planners have over the last few decades been rightly imploring the sector to develop their workforces differently to deal with the demands of a diverse and ageing population. This population will present with co-morbidities which will require the combined involvement of a complex mixture of organisation. The health and social care sectors need to make significant changes and work in greater parallel in order to effectively meet the needs of patients, and the workforce who care for them. This shift will turn the traditional model of healthcare provision on its head, reshaping the way health and social services are provided.
Sustainable Transformations Programs (STPs) are currently being developed in 44 different areas across England and are a significant next step in the attempt to integrate the health and social care workforces. Each area will likely have its own individual concerns and as a result, there is not likely to be a ‘one-size-fits-all’ approach. Workforce development solutions will need to be developed within each locality, tailored towards their community’s needs and priorities.
Skills for Health has worked with a number of health providers across the UK and internationally, helping them develop their workforces to be prepared for the coming changes. We recently published a working paper, Integration and the Development of the Workforce to provide healthcare organisations with insight and guidance on how their workforce needs to adapt to support successful integration. This paper is the third in Skills for Health’s series of research papers on the health sector workforce, Our Health Heroes in Focus.
Based on this expertise, here are what we believe are the five most important themes for organisations to consider to make integration a success.
Get your principles right
Three principles underpin successful integration. The first is the centrality of the patient - placing the patient’s individual circumstances and requirements at the centre of care provision. Second is the adoption of a population-centred approach. Different localities need to consider their health needs of their own unique population, and the institutions available to provide the care required. The third emphasising the wellness agenda: focusing on how people can sustain and improve their physical and mental health, rather than on the treatment of sickness.
Engage your workforce
The health sector is often characterised as being ‘risk averse’ and ‘change resistant’. One of the most compelling findings of our research is the need to shift the mindsets of those working in the sector, in order to effect change. The sector may well already have the skills it needs to provide excellent integrated are, but individuals may have to work in substantially different ways to employ them effectively.
There are several ways to help change mindsets, including: building relationships beyond traditional boundaries, such as encouraging people to experience work in other institutions; adopting ‘growth’ mindsets, such as helping individuals step out of their comfort zones and engage with the idea of new ways of working; developing knowledge and understanding of other roles and organisations; and achieving parity of esteem between health and social care, as well as ‘registered’ and ‘non –registered’ roles.
Stimulate demand for high quality support roles
Our research indicates that the sector’s productivity may have been inhibited by its failure to recognise the contribution of the support workforce, and to develop and utilise high quality support roles. Rather than attempting one off, large-scale changes, organisations must take regular opportunities to think about functions and skills mixes across both front-line and support staff, and look at what they can do to help the whole workforce.
Integration will require organisations to go deeper into skills mixes than they might have done in the past. They must identify the services they need to deliver, both now and in the future, and then explore how they can use the skills of their whole workforce to deliver these outcomes.
Train and develop
Successful integration will not happen overnight: development must be ongoing in order to introduce such a fundamental shift smoothly. Areas that will need to be regularly considered and reviewed include: the development of management and leadership; the refocusing of health professionals and general practitioners; the continual development of generic skills; and strategic and technical skills, to exploit technological innovation.
Plan and plan again
The most effective workforce plans are ones that are open to ongoing review and redevelopment. System-wide planning is needed for health and social care providers to come together. It will require structured debate with a wide range of stakeholders, including the professionals working within the sector currently and those that live and work in the community being served. Their views will need to be sought regularly and their feedback absorbed into future plans.
Planning must also be undertaken across geographies, organisations, teams and on an individual level. For instance, individual organisations can develop their own organisational plans while referring to overarching regional or national strategies. Individual or team level planning can then refer back to organisational-level plans. There are a range of useful methods that can assist those wishing to develop their workforce plans. The Six Steps methodology is a useful means by which communities can structure their discussions about the workforce development. Scenario application sessions can also help structure conversations about the possible future shape for health and social care systems.
Taking the long view
One of the most common frustrations of the workforce planning cycle is that it does not always fit in with government initiatives and demands. As a result, some are deterred from taking the long view, but when it comes to integration this is precisely what is needed. Looking to and planning for the future, and being willing to revise plans flexibly as required, empowers those working in the sectors: helping make sure they are prepared for the challenges ahead and ready to do the best job that they can. This will no doubt impact upon those the sector cares for; giving them the confidence that the care they need will be there for them, whenever they should need it.
Introducing an effective, patient-centred, integrated workforce will have an enormous impact on the future of all of our health. Successful integration is a marathon and not a sprint, and the workforce truly is the most important resource the sector has to take it across the finish line.
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