Integrated health and care in the community and the lived experience of the workforce

The value and understanding of workforce perspectives through lived experience in practice and the inquisitiveness to seek to listen, understand and learn what matters to people with the “voice of the workforce” is a powerful notion and a critical factor to support the scaling up and expansion of the Integrated Care (IC) agenda.

National Context

The landscape of health and social care in the community is changing dramatically with the advent of Integrated Care Systems (ICSs). The NHS Long Term Plan has indicated that by 2021 ICSs will cover the whole country. Primary Care Networks will play a key role in this, envisioning collaboration across organisational boundaries, improving the use of resources, advancing the health and wellbeing of their populations with care closer to or at home and fully integrated community-based health care a priority.

It is universally acknowledged that “there is no healthcare without a workforce” (Britnell). The success of the NHS Long Term Plan in relation to ICSs and the fundamental principles of the NHS People Plan depends on the key contribution of the health and care workforce. It is vital that health and care systems collaborate to lead their local workforce (Department of Health and Social Care White Paper).

Study Key Findings

I undertook a qualitative study which explored and captured workforce perceptions, experiences and insights of the phenomena of Integrated Care (IC) in a community health and care NHS trust in England (Journal of Integrated Care). This study explored whether there were any associated factors that are enablers, barriers, benefits or challenges; and the level of workforce engagement in the process of integrated health and care.

The findings of the study suggest collaborative partnership working, staff engagement, culture, professionalism and organisational structures are the fundamental features of IC with four interdependent emergent themes:

• Theme (1) Insight of IC and collaboration: affording the opportunity for collaboration, shared goals, vision, dovetailing knowledge, skills and expertise. Professional aspirations of person-centred and strength-based care to improve outcomes.
• Theme (2) Awareness of culture and professionalism: embracing interprofessional working whilst appreciating the fear of losing professional identity and values. Working relationships based on trust, respect and understanding of professional roles to improve outcomes.
• Theme (3) Impact of workforce engagement: participants felt strongly about their differing engagement experience in terms of restructuring and redesigning services.
• Theme (4) Impact of organisational structure: information technology (IT) highlighted a barrier to IC as differing IT platforms prevent interoperability with one system to one patient further hindered by differing levels of IT literacy. Shared positivity of IC, embracing new ways of working.

My study highlighted the importance for any IC strategy or policy to incorporate and embed ‘workforce perceptions and experience’ as key enablers for IC to be a fully collaborative approach with improved outcomes.

COVID-19 Pandemic

Following my study in the autumn of 2019 the world changed. Health and social care globally face unprecedented changes and demands. There was uncertainty due to the COVID-19 pandemic which had a profound impact on society at every level and every aspect of our personal and working lives. The pandemic has further exposed England’s health inequalities and the urgent need to expediate population health strategies as a priority for ICSs (King’s Fund).

On reflection, it is evident all four emergent themes from my research study resonate with the need for a  collective response and continued adaptability, not only due to the pandemic but beyond. This highlights valuing the workforce and their influence to afford new opportunities and innovative ways of working.

The rapid changes and the advancement of new technologies and digital space for remote consultations and agile working is a necessity allowing information flow and data sharing to support service delivery and person centred care to meet the individual needs of our local population.

Redeployment of staff  to support areas with the greatest need requires the utmost trust, respect and understanding of differing professional roles, interprofessional working, solidarity and working cultures whilst maintaining individual professional identity and values.   

Anecdotal evidence suggests there have been occasions during the pandemic in the community where professional relationships across health and social care have been tested to the limits. It is incredible the way health and care professionals have engaged and worked together utilising strong, compassionate leadership. Health and care professionals have demonstrated resilience to overcome challenges whilst dovetailing their expertise and skills with drive and tenacity to ensure safe, high quality services are delivered for our local communities.

Equally, there is recognition of how health and social care colleagues are now exhausted and will require support and time to recover with health and wellbeing integral in this process (NHS England).

However, there is also a feeling of hope and positivity with unity, collaborative partnership working and the fostering of relationships and trust. This should be capitalised on and nurtured to “retain and sustain a healthy, caring and compassionate workforce” (King’s Fund). Likewise, recognition and raising the profile of the equal value of all health and care professionals contribution across the system is essential for IC and the potential future sustainability of ICSs.

Scaling Up Integrated Care

As we move forward building our capacity and capability to shape the direction and principles of ICSs across England the phenomenon of collaboration is fundamental and a golden thread in the White Paper with a duty to collaborate and innovate  across health and social care for better outcomes and address inequalities.

For ICSs to be fully integrated and innovation to flourish we need to listen and hear the voice of the workforce, their experiences, perspectives, what matters to people and their contribution across the system acknowledging the absolute distinctiveness this offers as our greatest asset. Having an inclusive culture and collaborative approach ensuring people are engaged, connected and their voices are articulated with pride and positive change evolves is fundamental.

There is a real opportunity to connect, learn together, innovate and be stronger as one team, one system approach to support the IC movement within our safety critical professions delivering optimal quality and safe care to our local populations.

Linda Wain is a Nurse Professional Lead at Central Cheshire Integrated Care Partnership and a Queen’s Nurse.
She holds a Degree of Master of Science in Professional Studies.

Competing interests: none declared.

Link to paper DOI  https://doi.org/10.1108/JICA-10-2020-0061.

@lindawain444

 linda.wain@mcht.nhs.uk 

1. Britnell, M (2019) Solving the Global Workforce Crisis in Healthcare, Oxford University Press, Oxford.