In this context, it’s easy to fall into a trap of looking for quick fixes. The health care workforce is a classic example of this. Our recent report on supporting integration by working across boundaries found limited evidence for creating new roles to support the transformation called for in the NHS five year forward view. The report suggested that we should first consider ways of better using the skills that already exist in the workforce. It sets out practical considerations and advice that areas thinking about the workforce implications of integrated care will want to consider. It also explores where there is potential for new workforce roles and different ways of working across organisations.
We followed up the report with a roundtable event, which made it abundantly clear that there is almost certainly no such thing as an easy solution for workforce development. Participants discussed how:
- managing the practical and administrative requirements of roles that cross organisations – particularly information sharing, and employment terms and conditions – takes significant time
- it seems almost impossible to avoid re-inventing wheels, not least because differences in local information governance and information systems make it harder for each area to simply import solutions to local problems from elsewhere
- new roles, or new ways of working in a role, often create a requirement for new ways of working across the entire multidisciplinary team – which can be hugely positive, but also demanding for staff and for change leaders
- sustaining and embedding new roles or new ways of working require continued efforts and, in practice, are likely to need ongoing evolution and development.
And yet... the roundtable was unquestionably a positive, optimistic discussion. Considering real-life examples from Greenwich and Cheshire showed what can be achieved, and that it is possible to adapt or create staff roles so that care is truly organised around individual patients rather than professional territories. In each case, these areas have created just one new role, but beyond that their emphasis was on bringing together existing roles to work more closely and flexibly. Neither area would claim that it is easy, or that they have completed working through all the challenges.
Both case studies illustrate how our report’s conclusions play out in practice, including the implications for leadership at team, service and area levels, and the need for greater flexibility across traditional professional boundaries, whether that is in hands-on delivery of care or related issues such as staff management, training and engagement.
Vanguards sites and STP footprints are bringing in more flexibility in how services work together across local care systems. More flexibility and innovation in staff roles can only help, but are not easy. NHS Employers and the Local Government Association, which commissioned our report and co-hosted the roundtable, clearly view this as an important area and are continuing to engage with providers to explore what support they need.