Integrating health and care in the 21st century workforce

Abstract

Purpose The NHS needs to adapt as never before to maintain and plan for an integrated and sustainable multi-professional workforce, spanning all health and care sectors. This cannot happen without system leaders embracing workforce transformation at scale and enabling system-wide collaboration and support for multi-professional learning and role development. “By learning together, we learn how to work together”. The paper aims to discuss these issues. Design/methodology/approach The case studies included in this paper provide evidence of the ability of NHS systems to adopt integrated workforce models at scale. The case studies were chosen to demonstrate how system-wide change is possible, but still requires a partnership approach to innovation, strategic workforce planning and commissioner support for new models of care. Findings With partnership working between arm’s length bodies, commissioners, educators and workforce planners, the NHS is more than capable of generating a transformed workforce; a workforce able to continue providing safe, effective and joined-up person-centred care. Research limitations/implications The focus of this paper is integrated workforce development undertaken by Health Education England from 2017 to the date of drafting. The case studies within this paper relate to England only and are a cross-section chosen by the authors as a representative of Health Education England activity. Practical implications The NHS needs to find ways to use the wider health and care workforce to manage an ever-increasing and diverse patient population. Silo working, traditional models of workforce planning and commissioning no longer provide an appropriate response to increasing patient need and complexity. Social implications The evolution of the NHS into a joined-up, integrated health and social care workforce is essential to meet the aspirations of national policy and local workforce need – to centre care holistically on the needs of patients and populations and blur the boundaries between primary and secondary care; health and social care; physical and mental health. Originality/value This paper contains Health Education England project work and outcomes which are original and as yet unpublished.

An International Competency Framework for High-Quality Workforce Development in Integrated Care (IC): A Modified Delphi Study Among Global Participants

“…Our framework describes in detail the competencies and methods to achieve this including training health and social care professionals together to work in interdisciplinary teams; teaching and role modelling communication, collaboration and shared decision-making skills; care coordination; and training in providing a comprehensive assessment of patient and family needs [31,32,33]. These principles do not appear to be fully integrated into the current training and curricula for our health and social care workforce where workplaces and training organisations have limited understanding of integrated care and where health care professionals are still trained in silos [6,17,34,35]. Other key features of the curricula include a focus on digital health, and regular interprofessional learning among stakeholders in both health and social care settings, including teamwork and shared decision-making within these settings provided by supervised mentorship and shadowing opportunities.…”

Ethical challenges and principles in integrated care

“…It is easy to sign up in principle to admirable statements of standards since these are clearly hard to disagree with; but they do not guarantee success in practice. As with the associated concept of ‘person-centred care’, integration is aspirationally important for the NHS 55 (and, presumably, healthcare systems in other countries which face similar challenges to the UK). But there is more to be done to help realize the indisputable vision.…”

Workforce Development in Integrated Care: A Scoping Review

“…RELEVANT STUDIES Scale up existing competencies among all practitioners to deliver more integrated care [15,30,13,36] Incorporate integrated care concepts organically, so that they are fundamental to delivering care Create a working environment that values wellness and creates a climate of respect and work-life balance [14,36] Engage faculty teaching staff who convey joy in their work and provide trainees with education around work-life balance, self-reflection and self-improvement [14] Embed structures to support collaboration and interprofessional learning among colleagues and professions across services, strengthening multisector relationships; multi-organisation training [33,47,48,11,36] Incorporate simulation-based scenarios using actors from the local community with lived experiences [49] Incorporate education and support for caregivers, including prevention of health problems and improving quality of life. For example, implement a weekly meeting for caregivers to discuss topics related to the experiences of the patients' healthcare and their self-care needs [37] Allow more time for networking, interprofessional education and opportunities for individual service presentations and diverse attendance, including the social care and voluntary sectors [47,50,36] Case studies, exercises and simulations are encouraged to allow students to interact with the content in as realistic a venue as possible [42] Focus on soft skills, such as communication, teamwork and relationship building [5,34,13,41] Focus on skills to build durable relationships with patients, other professionals and caregivers [5,34] Focus on self-management promotion and skills, including the use of motivational interviewing techniques [34] Skills to navigate the health and social care systems and work on individualised care plans and assessments [30,34,47,13] Ongoing mentorship [38,…”

“…Thus, workforce planning should include traditional health professions like nurses and physicians and workers employed in health and social care [9,11,41]. Similarly, Aiello and Mellor [48] recommend collective action that connects local innovation and best practice within consistent national frameworks to meet the aspirations of multi-professional health and care workforce across local systems. Such action requires a joined-up, transformational approach at strategic and operational levels from workforce planners and commissioners to enable integrated health care at scale [48,36].…”

“…The rigid separation of disciplines at the educational level results in a process that can lead to discontent, animosity, fragmented learning, fragmented practice and, subsequently, fragmented care [24] 18 Although health and social care staff may value joint working to improve quality of care, interprofessional collaboration did not occur routinely due to organisational limitations [26] 19 Employees and organisations had limited understanding of integrated care practices [48] Table 5 Barriers/Challenges.…”