Making Integrated Care Systems Effective: The Workforce Agenda
By Integrated Care Journal-
When Integrated Care Systems (ICSs) were originally conceived by NHS England, the proposition was seen as a meeting of equals between the NHS and local government. Last month, PPP convened a meeting of the key stakeholders in the NHS, social care, local government, and ICSs to consider the extent to which the legislative framework set out by the government is fit to realise this ambition.
The group discussed several cross-cutting themes that must be addressed if health and care delivery is to be effectively integrated in local communities. Reforming the workforce agenda was first on the list.
ICS Board Representation
ICSs represent a great opportunity for a more joined up workforce agenda. There is a real appetite for closer working relationships between health and social care. However, incentives for integration need to be embedded across the system so that the right motivations are in place for key players. As Jenny Paton, Policy Director at Skills for Care explained, “Culturally, the adult social care workforce is well-prepared to deliver integrated care and support because the model of adult social care is already designed around the individual and holistic assessment of their needs. However, the incentives -structural and otherwise - are not currently in place for them to take an active role in integration”.
The inclusion of representatives from all the relevant groups on ICS people boards should create exactly this, by creating ‘skin in the game’ for both the health and care agenda to have a direct influence on what will be prioritised in their own geography. Social care representation on ICS boards is a great step forward, but it is important that we ensure representation is proportionate to the scale of the workforce. The multiplicity of services provided through the health and social care systems need to be reflected in the governance structures of ICSs so that leaders understand the care pathways individuals take through these systems. “Otherwise,” Jenny warned, “ICSs may fail to understand the appropriate levers to support integrated workforce planning”.
Recruitment and Retention
The turnover rate in social care was 34 per cent in 2019. ICSs should promote incentives for each sector to support the other on workforce recruitment and retention issues. A major concern is competition of workforce. Jenny argued that while “there are opportunities for bridging career pathways between social care workers and health, ICSs need to make sure that the journey is not just one-way. This means aligning career frameworks, terms and conditions where possible”. For a two-way exchange between these sectors to become a reality, we will need to address disparities in pay, working conditions and quality of experience.
Dame Suzi Leather, Independent Chair of Devon ICS, remarked “We have to do something a bit more deliberate about professional status” if we are going to improve recruitment and retention in the social care sector.
There have been calls to improve professional status via a national Social Care People Plan that would sit alongside the current NHS People Plan. However, “The NHS People Plan already exists. What we need is something like that with a real focus on integration. If we were to create a separate social care people plan, there is a danger that we just have parallel streams of work”, argued Patricia Hewitt, Independent Chair of Norfolk and Waveney ICS. “We need to use the new bill and the statutory framework to try and bring these workforce plans together, rather than pulling it apart. ”
As much as we lack integration at the top level, there is evidence of very good collaborative working on the ground. As Naomi Eisenstadt, Chair of Northamptonshire ICS, commented: “If you go near the frontline, if people like each other and get on, they just work together. It’s very dependent on relationships and it’s very dependent on parity of esteem. At the baseline, people want to do good things and they don’t want to disappoint”. Under the current system, people ‘do good by stealth’ – they work together, but they don’t tell anyone because they are afraid that they will get into trouble – she explained. The challenge is how to make this more systematic. “The vast majority of people want to do good things. It should be part of the purpose of policy to make it easy for people to do the right thing”, commented Rt Hon Stephen Dorrell.
At present, health and care providers have been very good at delivering services, making workforce improvements and undergoing digital transformation in siloes. ICSs represent an opportunity deliver these changes in a “properly aligned way”. In terms of digital leadership, it is important that ICSs boards properly understand the digital agenda and what is required to achieve its aims.
Data is going to drive the health and care sector over the next decade, but we need more data analytics informaticians on the ground to drive this agenda. According to Patrick Mitchell, Director of Innovation and Transformation at Health Education England, “This can only be done from an ICS level, not an individual provider level”. ICSs boards will have the ability to devise a single digital agenda for their geography, meaning they will be able to plan out and ensure the digital literacy of their workforce.
In terms of workforce transformation, Patrick argued that we need to look at this from a skills and capabilities point of view, “We can’t rely on the education sector to produce X number of doctors and Y number of nurses. Each ICS needs to decide what are the skills and capabilities, without looking at professions, it requires. Then, based on what the production line can produce, based on what its own local population has in terms of people to do those roles, the ICS can decide how best to design the workforce it requires for the future”.