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Supporting integration through new roles and working across boundaries


This report looks at the evidence on new roles and ways of spanning organisational workforce boundaries to deliver integrated health and social care.

Commissioned by NHS Employers and the Local Government Association, it finds increasing focus on roles which facilitate co-ordination and management of care, development of existing roles to increase the skill-mix and enable the provision of more holistic care, and a limited number of truly innovative roles, the most notable being care navigators and community facilitators, enablers or link workers. Given that many of the skills required for integrated care already exist within the workforce, it suggests the central question is how to use those skills more effectively to support boundary-spanning activities.

Key findings

  • Where new roles have emerged, they have mainly done so due to developments in practice or to fill gaps in provision.

  • There is a lack of evidence on the cost-effectiveness of new roles and the extent to which they improve patient outcomes.

  • There are a number of ways in which integrated care is being delivered without the explicit need for new boundary-spanning roles.

  • Engaging staff from the outset and building on the existing skills of the workforce can overcome cultural barriers between professionals and organisations to develop integrated ways of working.

Policy implications

The workforce represents the greatest resource in delivering integrated care. Developing integrated care has to be part of a system-wide process, of which workforce integration is one component. There needs to be greater recognition of the underlying processes involved in building the relationships, systems and governance needed to support boundary-spanning, at a local level and throughout the wider system. In many cases new ways of working and models of care are likely to prove most effective. While new roles may prove valuable as part of a system of care, their need should be demonstrated rather than assumed and defined by the local context in which they are required.