The NHS Five Year Forward Plan released in 2014 provided the catalyst for major changes to health and social services.The changing scene follows a number of drivers in particular the increasing shift of services from the acute sector to community, the demographic changes to the populations’ age profile and the increasing number of high demanding health conditions such as long term conditions.The Five year Forward Plan new footprint is a mandate to radically change the way services are developed and delivered.The changes require organisations to work across health and social care, to work with other non-traditional providers such as the voluntary and independent sectors and to determine a model of care that better meets the needs of their local population.

The focus of the new models is to work across the whole ‘community’ to provide integrated care, as partners in care and to develop a service model that improves services that will reduces duplication, prevent patients ‘falling down gaps in service’s” and is designed with the patient/client in the centre.This will require the workforce to change the ways in which they work, what they do and who they work with. The aim is to create a more flexible and efficient workforce .As a consequence of these changes organisations are increasingly seeking to develop new ways of working that will support them in taking forward integrated care in their local area. Skills for Health (SfH) consultancy team have worked with the stakeholders across London to develop a workforce assessment model that would enable them to progress towards integrated working.

The whole programme was designed to encourage people to be comfortable thinking about the future of health and social care in their local area.The programme aimed to challenge participants in relation to ‘doing things that they have always done’ and to consider what was done right and what could be done better.It was the start of changing ‘mind-sets’ and to begin thinking about doing things differently.

The programme was designed in partnership with the Skills for Health team and local leads.Each locality was asked to identify either one or more themed care pathway/s as the focus for the programme.The objectives were to identify and determine the workforce and the learning needs required to support organisations to progress towards delivering and developing integrated care and services across their local communities.

The chosen themed areas reflected local commissioning priorities particularly services increasing indemand and/or services that have significant economic and social impact on the local health and social care services.The evidence provided in the programmes on the population and health indices and trends supported and validated the chosen themes.

Throughout the programme the Skills for Health 6 steps Integrated Workforce Planning Model was used and a further development opportunities for stakeholders, on using the model has been delivered with the aim of ensuring there is sustainability for this important agenda moving forward.

The programme highlighted some key points, of particular note were:

New Ways of Working for current staff – all sites emphasised the need to enhance the roles of current staff in particular:

Health and social care support worker (HSCSW) roles– there was recognition that these roles need to be enhanced to improve quality and efficiency.There was also, in some areas, lack of clarity about ‘what these roles should be doing’ despite the introduction of the care certificate across health and social care. Work was undertaken to agree what the core functions of these important roles should be.

Navigator role – In principle the roles aim to provide support to people using services in terms of access and choice with close links to GP practices and community teams.Navigation as a function was also recognised as being an important function that all staff in health and social care need

The programme of work whilst at times challenges ultimately demonstrated the need for better integration and for the need for the workforce to change and respond to new models of care. It also demonstrated the commitment and energy within our health and social care organisations and that we have good people able to take on these challenges.

Andrew Lovegrove

September 2015

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James Stephens

Interesting article on the issues (and possible responses) to the need to work in a more integrated way across traditional organisational/care boundaries. It would be interesting to see whether in this example (or others) the issues of potential greater fragmentation as a result of recent structural and policy changes were raised. As we know, not all changes in the healthcare sector support this push to greater integration of services - ways around this are paramount to move forward on this agenda in a sustainable way.

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