NHS Reset: Integration and whole-system thinking – it’s all about our people | Alison Lathwell

Alison Lathwell

NHS Reset is a new NHS Confederation campaign to contribute to the public debate on what the health and care system should look like in the aftermath of the COVID-19 pandemic.

In this blog, part of a series of comment pieces from NHS Confederation members and partners, Alison Lathwell considers how COVID-19 has propelled joint working across the NHS, social care and wider public sector and what needs to happen to make it stick.

Workforce integration 

Integrated health and care service delivery happens when staff are enabled to do the right thing. 

I work as the strategic workforce transformation lead within the Bedfordshire, Luton and Milton Keynes (BLMK) Integrated Care System (ICS). The COVID-19 response, as in many areas, has really propelled forward joint working across the NHS, social care and wider public sector teams, in a way we couldn’t have imagined. 

For example, we have seen rapid decision making and (safe) bypassing of the rule book, which has resulted in more effective up-skilling, such as for ward-based staff developing critical care skills or mental health nurses delivering end-of-life care. There are no ‘blame’ conversations, and we have been unhindered by financial and bureaucratic processes, and instead have been supported by enhanced relationships and authentic leadership across organisations, teams and sectors. This has led to swift joint problem solving. 

Our primary care networks have rapidly deployed and teamed differently to create red and green hubs, while digital platforms have revolutionised online consultations for GPs, hospital consultants, midwives, nurse specialists, social workers and others. 

Our primary care and community teams have provided training, support and mutual aid to care homes. Our community teams have made a huge difference by assuming responsibility for the discharge pathway, effectively coordinating out-of-hospital care. This has all been supported by volunteers working alongside councils, pharmacies and our mental health teams. 

Working in partnership 

We have seen that you can achieve real integration and a whole-system approach to service delivery when staff across health, social care and our broader caring communities, such as volunteers, personal assistants and carers, are able to work differently together around the needs of local residents. 

So, it’s clear that workforce transformation approaches that support integration must focus on all elements of this caring community. 

However, national policy does not consistently support whole-system approaches. As Donna Hall emphasised in her recent blog, there are failures in parity of value between the NHS and social care. They are intrinsically linked and yet are often not viewed as such when developing policy and allocating funding. She highlighted inequality in pay and employment conditions for social care staff. These are not the only divides. 

The increase in continued professional development funds for nurses and allied health professionals from Health Education England is welcomed, but only applies to those staff working within the NHS. As we start to consider once more the commitments of the Interim People Plan for addressing workforce shortages and options for international recruitment, we are failing to mitigate the impact of the proposed new immigration system on social care. 

It is the responsibility of ICSs to deliver service integration for local people despite conflicting national policy and without regulatory power. In my ICS, we work to re-balance focus for health and social care staff. We have developed a home-based care staff group and explored local workforce trends for staff working in social care. We have also launched a directory of education and training offer for staff in this sector, and included opportunities for volunteers and careers. We have partnered with Frimley ICS to develop a local systems leadership programme, Leading Beyond Boundaries, where our super connected leaders from across health, social care, fire and police services learn and develop together. 

We are also developing a pilot for health and social care rotational apprenticeships for support workers and exploring the potential for closer working with our local enterprise partnership. We have recently partnered with councils to promote skills and employment pathways within health and social care for residents facing redundancy as a result of COVID-19 pressures. 

I am sure that there will be many similar examples across the country where ICSs and STPs are striving to work outside of constraints of national policy to support health and social care workforce transformation, embedded alongside wider community assets for volunteers, charities and public sector services. 

Systems policy for workforce

But is it enough, I ask? As we look more widely for effective models of integrated health and social care teams, we see approaches inspired by the Dutch ‘Buurtzorg’ healthcare approach which move away from ‘command and control’ to enablement structures and hierarchies. And despite being in an emergency response command and control environment, staff reflect on connections, trust and relationships as being the enablers for effective joint working. The Montefiore Health System New York, the Canterbury Model, New Zealand and the Wigan Deal identify civic partnerships, across all public sector leaders, as a defining feature for enabling teams to work differently together. 

Relationships therefore, are at the heart of integration and whole-system thinking and its staff that create those relationships. If I had a wish list it would be to call for a joint health and social care people’s plan with jointly held responsibilities between the NHS and local government for delivery, pooled funding opportunities for education and training and movement towards greater parity in pay and conditions. This would support the development of better relationships and truly integrated care delivery.  

Alison Lathwell is BLMK ICS strategic workforce transformation lead. Follow her and the ICS on Twitter @AlisonLathwell2 @BLMKPartnership


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