For Integrated Care Systems to succeed they need freedom and resources to address the NHS workforce crisis

Niall Dickson

Local NHS leaders welcome NHS Improvement’s intention to hand over more power to integrated care systems to tackle the NHS’ workforce crisis but say any new powers must come with the funding and genuine autonomy to make this work.

That is the message from the NHS Confederation in a consultation for workforce development that follows a recent high-level roundtable and other discussions the Confederation has had with front-line and national leaders.

Welcoming the intention of NHS England and NHS Improvement to move in this direction following a recent letter to provider chief executives, the NHS Confederation report calls for integrated care systems to be the default level for workforce planning and development in future.

It recommends the devolution of a range of workforce decision-making powers and finance to better equip system leaders in the areas of strategy and planning, supply and retention, and system deployment.

NHS leaders at the NHS Confederation roundtable expressed clear support for the passing of powers, responsibility, funding and governance down from the national level to integrated care systems, but also for an increased understanding from individual institutions of the need for further system collaboration locally.

They say integrated care systems should have control over the design and development of the local system architecture; pilot and prioritise local approaches to supply and retention, such as ‘Grow your own’; and deploy new measures to better understand and utilise their existing health and care workforce.

The consultation also focuses on the role of the NHS in the wider local labour market. As the largest employer in any local area, the NHS and local authorities should exercise significant power and influence on local skills development and employment. However, there remains the question of how best to use it.

Niall Dickson, chief executive of the NHS Confederation, which represents organisations across the healthcare sector, said:

“Everyone accepts workforce is our number one concern. If the NHS is to tackle this we have to hand more control of workforce training, funding and planning to local leaders working with staff and their representatives. Local systems should be the default level at which critical decisions are made in this area.

“For too long we have tried to run everything from the centre. That is why it is encouraging to hear national leaders talk about devolving control of workforce to the emerging integrated care systems.

“For this to work, local leaders in both health and social care will need the freedom to develop local solutions, introduce new roles and ways of working, and embed local accountability mechanisms as their services are transformed. It will be a significant challenge but we do not have any other option but to make this work.”

Julian Hartley, National Executive Lead, NHS Workforce Implementation Plan said:

“It is vital that local leaders have the freedom to plan their workforce based on the need of their patients.

“The Workforce Implementation Plan will outline support for ICS’s so they can secure the skills required locally, and ensure patients receive the right care from the right professional.”

Dr Amanda Doyle, a GP, Chief Officer at Blackpool and Fylde and Wyre CCG and Chief Officer, Lancashire and South Cumbria ICS, said:

“The current system isn’t working. Whether based in Lancashire or Dorset, we heard similar concerns from those at the roundtable about how we address our local challenges. There was a clear will for greater local accountability in relation to workforce and we want to play a part in understanding how this process can be shaped. Leaders are ready to step up but we also need the resources to match any new responsibilities.

“What was particularly pleasing was the amount of good practice already happening at the local level. We need to support, share and scale up some of these ideas as part of realising this manifesto.”

A second roundtable in April will explore the necessary relationships with training providers and other local partners that integrated care systems should be prioritising to support this new local autonomy.

The NHS Confederation is consulting as part of its wider plans to support local system leadership. It will be critical that local leaders and systems are able to shape this wider discussion and the proposals are designed to be a first step towards this. Questions in the consultation include:

  • Do you agree with the proposed role and responsibilities of local systems for workforce development as set out in the consultation?
  • What further activities or responsibilities, if any, would you recommend an ICS has future control over, specifically in relation to workforce?
  • Is it fair to place an expectation on ICS leaders to sign up to the commitments listed under any new future operating model?
  • What support would ICSs and STPs value the most, whether referenced in this document or not?
  • What is happening locally that should be highlighted as part of a wider good practice toolbox to other areas across England?

The deadline for comments, including responses to the consultation questions, is 30 April 2019.

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