Health and social care integration cannot be complete without the right skills in the right place. Daloni Carlisle talks about bringing people together, as well as building skills and competencies




The rise and rise of the integrated health and social care agenda highlights an important question: what is being done to integrate the workforce and its planning?

This is, perhaps not surprisingly, a question uppermost in the minds of Skills for Health and over the last year the organisation has begun a new programme of work to develop thinking and practice.

Andrew Lovegrove, senior consultant for Skills for Health, believes that little emphasis has been placed on this important topic so far.

‘When you are planning across organisations and sectors with different cultures, there is another layer of complexity’

“It’s the perennial problem,” he says. “There are numerous examples where organisations have got it wrong and ended up without the right sort of workers in the right place. It is something the sector has battled with.”

The cross-party consensus on integrating health and social care coupled with tight public finances make this an ever more pressing issue, he adds.

It is a point highlighted in the planning documents that accompany Simon Stevens’ NHS Five Year Forward View, which lists “plans to invest in and make better use of the current workforce” as one of the key conditions for future transformations.

As the document notes: “The provision of health and care is mainly about people, not buildings or infrastructure.”

‘An organisation spends 60-70 per cent of its revenue on the workforce’

As Mr Lovegrove notes: “An organisation spends 60-70 per cent of its revenue on the workforce. So, as models of care change and services reorganise and integrate, workforce planning and development becomes something we must do.”

Over the last year, Mr Lovegrove and Skills for Health associate Christine Mullen have been working in London to develop some tools that could be used more widely by the NHS and social care sector.

Both have worked on local, regional and national level workforce planning and they agree: integrated workforce planning is tough but worth the effort.

“It’s hard enough to do it with your own organisation,” says Mr Lovegrove. “But when you are planning across several organisations and two sectors with different cultures, there is another layer of complexity.”

The work so far is embedded firmly in Skills for Health’s proven Six Steps Methodology to Integrated Workforce Planning ; there is no need to reinvent the wheel, they say.

Mr Lovegrove explains this overall approach and where it differs from traditional workforce planning.

“I would argue that, historically, the approach to workforce planning has been very input based. How many doctors and nurses do we need? How many physiotherapists?

“Then we look at the number of patients in beds or chairs and ask how are we going to get that patient better or discharged,” he says.

‘An outcomes based approach starts by asking: what does the service user or patient need?’

“What we advocate is an outcomes based approach that starts by asking: what does the service user or patient need and how best can we deliver that?”

This moves away from numbers and whole time equivalents of different professionals and workers and towards a discussion about the competencies and skills needed.

It is a discussion that opens up new possibilities for new types of roles and new ways of working.

In practice

If this is the theory, how do Skills for Health apply it?

“With integrated care, we start with the patient journey or experience. We look at the points in the pathway and what needs to happen in terms of an intervention or experience,” says Mr Lovegrove.

“From that we can look at the skills and competencies that the workforce needs and ask: what do we want the workforce to do? And what are the gaps? Then we can start to look at the options for reconfiguring or reprofiling the workforce.

“It gets away from a uniprofessional approach and moves towards a more multiprofessional approach.”

‘It makes sense to better align health, social and voluntary services and it enables staff to broaden their portfolios’

This, he says, is the key to unlocking productivity gains. One such possibility would be in a situation where a vulnerable patient at home needs visits from a nurse, a physio, social worker and an occupational therapist.

Currently, each is usually done separately. In an integrated interdisciplinary team there could possibly be one professional who could deliver a range of interventions: one visit, not four; better use of the workforce and a better patient experience.

“It does not mean people are more busy but that you are making more productive use of your workforce,” says Ms Mullen.

“It makes sense to better align health, social and voluntary services and it enables staff to broaden their portfolios.”

It is an approach now being tested in Islington and other areas of London (see case study, below) where managers from different organisations have come together to examine population, workforce and other data to develop their priorities and solutions.

Case study: Islington’s model approach

Health and social services in Islington, north London, are already well integrated, with the local Whittington Hospital Trust working closely with Islington social services.

Now partners are involved in a major piece of workforce planning and development with Skills for Health to develop an innovative strategy that will provide a lead for other inner city areas.

In the tradition of all good NHS projects, it already has an acronym attached: IWAMP, which stands for the Integrated Workforce Assessment Modelling Programme.

Kim Sales, the former deputy director for leadership, talent and organisational development at Whittington, led the early work on IWAMP. She is now associate director for workforce, education and development at Birmingham Women’s Foundation Trust.

She says: “If we spend 70 per cent of our cash envelope on people, then we need to have a grip on developing our workforce around the integration agenda. We need a collective leadership approach.”

She was keen from the start to work with Skills for Health, whose consultants not only have wide experience of working with NHS organisations but also have links to Skills for Care and a proven model for workforce planning.

Feet first

The work started with a look at the data to build up a local footprint of public health needs, changing demographics, consumer data, existing service provision and current workforce.

This data was then examined jointly by health and social care service leaders brought together by Skills for Health. They segmented the data to come up with four themes that are priorities for Islington: mental health; children and families; older people; and long term conditions.

Using Skills for Health’s Six Steps Methodology, multisector groups began to identify the skills and the gaps and put together recommendations around care pathways. Skills for Health is developing reports and recommendations in each area.

“We have been co-creating recommendations of what we would need for these different pathways,” says Ms Sales.

It is still a work in progress but, says Ms Sales, it is already proving powerful.

Shared goals

The process of working together to create solutions has brought managers together and helped them to understand each other better. The plans are aligned closely with the priorities of the local clinical commissioning group, health and wellbeing board and providers, building further consensus.

Practically, discussions are starting around how new roles might develop – for example, a new care navigator role.

A simulation training centre is being developed where integrated care staff can train in a mocked up sheltered housing and community clinic setting.

The hard part, she says, was getting people together to do the work.

“It has to be the right people with the right commitment and that requires leadership.”

Ms Sales sees Islington as a trailblazer in this work. Other areas of London are now using the model to explore their own workforce planning and she has been invited to speak at events across the country.

Easy to say, hard to do. Ms Mullen and Mr Lovegrove agree it is challenging.

“People’s natural reaction is to be protective,” says Ms Mullen. “It must be supported and enabled through good leadership and organisational development.”

‘We find people need at least eight weeks notice to free up their time from work to attend events’

It requires commitment and time from busy senior practitioners and managers from health and social services.

“We find people need at least eight weeks notice to free up their time from work to attend events,” says Ms Mullen.

Mutual attraction

Once in the same room, time needs to be allocated to enabling the group to work together and understand each other’s contribution.

“There has to be a synergy developed within the group and, more importantly, the organisations need to have a supportive culture that is ready to accept change and challenge,” says Mr Lovegrove.

‘It’s about organisational development and leadership and thinking beyond hierarchy’

It has to have senior backing if the solutions co-created by these groups are to gain traction.

“It’s about organisational development and leadership and thinking beyond hierarchy,” says Mr Lovegrove.

Ms Mullen adds that there is often an unexpected benefit to such work: the process of bringing people together to talk about workforce planning and development traditionally done separately in itself can help integrate organisations.

“In London we have been bringing together people who often did not know each other and did not necessarily understand each other’s roles or organisations.

“Through working together they are gaining a deeper understanding and by co-creating the future they are taking integration to the next step.”