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.

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Comments

Pearl baker

Position
Independent Mental Health Advocate and Adviser/Carer,
Organisation
Independent
Comment date
05 July 2016
I have said this many times before unless you take on board 'experts by experience' comments nothing will or can improve.

I have identified a 'gap' in the system, and a meeting is taking place with the CQC who have acknowledged my 'findings'.

Those patients subject to Section 117 of the 1983 MHA are most at 'risk', discharge from Hospital is the starting point, GPs in my area of West Berkshire are being instructed to discharge from future 'Care Plans' yet many remain on Section 117, they are no longer supported by CMHT.

A recent Public meeting with the CCGs confirmed the above, this goes against the the contents of the Care Act 2014 Statutory Guidance. CQC words not mine.

The above patients including those subject to a COP Order are denied Personal Budgets, Patient centred choice of Health and Social Care Provider.

West Berkshire Council removed ALL the Bus Passes from the Mentally Ill, however i have been successful in the re-statement of one, so will be pursing this based on 'Discrimination.

phil strong

Position
Designer /managing director,
Organisation
Ergo Ike Ltd
Comment date
04 July 2016
Much needed report and conversation, however a glaring absence of end user (patients/voluntary care providers/private providers)consultation and involvement inthis integrated approach going forward. This unfortunately once again indicates a narrow thinking (same as, same as)reactive approach
thathas resulted in constant multiple innitiative failers over the last 40 years trying to prop up a failing system with the same thinking,mentallity and indoctrinated staff that gives rathan meets the end user needs.

Stella Tsartsara

Position
Consultant Integrated Care,
Organisation
South East Europe Healthcare
Comment date
30 June 2016
I agree with Dean Holiday's comment above but with a condition
First let me say how thrilled I am reading you!
Isn't there anything you haven't yet found out about Integrated Care and you have not done an excellent job on it? Every publication from you is a precious sine qua non tool.
I really rarely have encountered such a useful and inspiring organization as King's Fund is in Integrated Care! Happy that you are there doing what you are doing.

Now as for the comment above which touches the core question how to expand the use of such professions which are the A and Z to any real model of Integrated Care and not just system's reorganization and specially to low middle income regions.

About the evidence, if it works: we do not have time to think if it works at scaled level. In general in healthcare reform that social care is so much needed and budgetary cuts are going to still be, dramatic.
If it has worked in 3-4 different pilot cases, bring the results and lets start multiplication
There are Forums that do this, we have created one ourselves to cover the need at European level with many UK partners we value uniquely in Social and Community Care in it. Please send us your work and join in. https://www.facebook.com/SocialCareForumEU/

On another level the issue Dean is raising on culture change is the No1 priority for any integrated care model with social care, development.
The key is there to propose win - win interconnected nodes in service planning and forecasting and delivery proving at co-production level the usefulness of the new workforce needed.
This is how we convinced investors, co-developers, political leaders and the existing workforce to buy in. It is indeed the most difficult part but if you create the win - win scheme for all involved they will support and ask for these new roles, specially if they save money, time and other valuable resources.

Dean Holliday

Position
Integrated care,
Organisation
KHP
Comment date
30 June 2016
Proactive and holistic care that is cross proessional (General) will better meet people's needs, reduce transition issues and "bouncing around the system" and does reduce costs. However it is a difficult objective to achieve and will take 5-10 years of committed graft and support to deliver. We have to go right back to an educational, degree and training level with all professions groups and ensure they see the value of these integrated roles. That they see the importance of the roles in the system, rather than something that "isn't specialist". We have to create a system where specialists and generalists are needed and valued. Where social is on the same level as health and clinical. Just creating new roles and filling gaps as part of integrated care change programmes doesn't tackle the cultural change. Having tried at an operational and programme level, and knowing that behaviour is key, I know first hand how challenging this is but how vital.

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