Developing The Workforce Required To Deliver Integrated Care

Martin RaysonDivisional Director – HR & OD

London Borough of Barking & Dagenham

Principles of Workforce Integration

• Focus on better outcomes for people with care and support needs

• Workforce integration involves the whole system• Overcome resistance to change – acknowledge how it

affects people’s roles• Address workforce issues from the beginning - manage

engagement• Process matters – gives messages, demonstrates the

workforce is valued• New relationships, networks and ways of working

Lessons From Scotland

• Sound governance arrangements need to be quickly established• Previous audit reports on community planning partnerships have

highlighted the importance of – shared leadership, which takes account of different

organisational cultures– a clear vision of what the partnership wants to achieve, with

a focus on outcomes for service users– a shared understanding of roles and responsibilities, with a

focus on decision-making– an effective system for scrutinising performance and holding

partners to account.

Lessons From Scotland (cont.)

• There is a pressing need for workforce planning to show how an integrated workforce will be developed

• Health and social care services are personal services; it is important that staff have the skills and resources they need to carry out their roles, including providing emotional and physical support and clinical care.

• Developing a suitably skilled workforce is crucial to the success of integrated health and social care services.

21st Century Public Servant is …

• Rethinking public services for an age of “perma-austerity”• Working co-productively with citizens• Recruited for generic skills as well as technical expertise• Expecting a “zig-zag” career• Combining public service ethos with commerciality• Working within fluid organisations, with silos• Displaying dispersed rather than heroic leadership• Rooted in locality• Learning from others and expects to continually improve and

adapt

New Public Service Age

New Relationships With Citizens

Distributed & Collaborative Leadership

New Roles/New Skills

2nd February 2016

Closing the Gap HPMA/PPMA Event

Learning from Integrated Care Workforce Initiatives

in the West Midlands

Julian MellorProgramme Manager - Integrated Care

www.hee.nhs.uk

Context• Increasing numbers of older

adults/increased longevity• Increasing numbers with

complex co-morbidities / LTCs

• Need to reduce emergency admissions, length of stay and facilitate effective discharge from hospital

• Improving the experience of people who use services

• Develop a fit for purpose workforce delivering appropriate care in the right setting

• NHS Five Year Forward View • Care Act 2014• Framework 15 – HEE Strategic

Framework 2014 - 2029• New Care Models - Better Care Fund,

System Transformation Plans, Vanguards

www.hee.nhs.uk

Delivering Integrated Care

From an approach based on: To an approach based on:

Patients Population health management

NHS workforce Health and social care workforce - statutory, private and voluntary sectors ….and wider!

Organisations Places

Workforce plans primarily focused on the NHS workforce

Integrated system-wide workforce planning

www.hee.nhs.uk

Integrated Care - Definitions

Integrated care is person centred co-ordinated care: “I can plan my care with people who work together to understand me and my carer(s), allow me control and bring together services to achieve the outcomes important to me.” (TLAP/National Voices, 2013)

“Care which is intended to improve the quality of care for individual patients, service users and carers by ensuring that services are well co-ordinated around their needs”. (Kings Fund)

www.hee.nhs.uk

Programme Board –

bringing partners together

Acute Trusts

Patient & Practitioner reference groups

Community Health Trust

Local Authorities

(Social Care)

Mental Health Trust

Better Care Boards

CCGs

Crucial role of care co-ordinator

Consider the wider workforce, including: independent sector

providers, social care, informal carers

ICT is an enabler but don’t over rely on it - process and interpersonal communication are more important

BEST PRACTICE

RESEARCH Multi-disciplinary teams should be built around models of continuous learningTake care with

recruitment to new roles – use value based approaches and ensure buy-in from the team

Knowledge of local population and services is very important

Service redesign and workforce development need to go hand in hand

Co-location helpful - more important for team members to align their goals and work together

Patient engagement is important to sustain integrated services, that are responsive

www.hee.nhs.uk

Learning about Integrated Working

www.hee.nhs.uk

Older Adults Workforce Integration Programme - Pilots

Project Theme Lead Organisation

Integrated Care Model Pathfinder Healthcare Developments CIC

Falls and Fractures - Care Homes University Hospitals Birmingham NHSFT

Falls Prevention – Health and Social Care

Walsall Council

Complete Care Programme (community)

Birmingham Community Healthcare NHS Trust

Integrated Care and Support (GPs) Solihull CCG

Competency Based Education and Training Programme – Care Homes

Shropshire CCG

Acute Care

Diagnostics

Self Care

Specialist Treatment

Primary Care

More Investment In Workforce Here

Prin

ciple

s And

Fra

mew

orks

For

Inte

grat

ed W

orki

ng

(Wor

kstr

eam

3)

Workforce Com

petencies And Development Program

mes

(Workstream

4)

Support Self Care And Digital Innovations (Workstream 1)

Kais

er P

yram

id M

odel

Mindset And Culture ShiftINTEGRATED

CARE THEME

Long Term System Vision And Workforce Profile

(Workstream 2)

Integrated Care Transformation Theme: Workstreams and Relationship with other

Transformation Themes

Lead

ersh

ip T

hem

e

Mental Health Theme

Acute, Urgent &

Emergency Care Theme

Primary & Community Care Theme

www.hee.nhs.uk

Key Messages

1. Alignment of leadership and OD with workforce development initiatives2. The definition of the workforce3. The need for integrated system workforce planning4. Workforce redesign – roles and competencies5. Approaches to learning and development

www.hee.nhs.uk

1. Leadership & OD

• Workforce development in isolation?• The importance of OD and systems leadership in

promoting integrated working• Sustaining integrated working• Experience of pilot projects• The “Leading Integrated Workforce Solutions”

Programme

www.hee.nhs.uk

2. Defining the Workforce

Everyone, including paid and unpaid/informal carers, working in health and social care settings, including people’s own homes.

Workforce integration v integrated working • Relationships• Understanding each others perspectives• Good communications• Trust

www.hee.nhs.uk

3. Integrated System Workforce Planning• Across health and social care economies• To reflect new models of care• HEE North Central and East London• Aligned with local commissioning priorities and plans• The offer: helping commissioners to identify and address

workforce implications• HEE North West – Devolution, Workforce Planning and

development of tools

www.hee.nhs.uk

Integrated System Workforce Planning Challenges

• Definitions: the system, the workforce, the plan?• Timescales• System leadership• Intelligence gathering – demographics/long term conditions,

trends and projections,• Workforce intelligence: health, social care, PIV

www.hee.nhs.uk

4. Workforce Redesign Options

New (alternative) worker

New work

Old worker

Old work

increasing the numbers of nurses, doctors, and other health professionals

expanding the job descriptions of existing workers, such as community matrons, to include work previously not done by anyone

handing off existing tasks to other workers, such as nurse practitioners and general practitioners with specialist interests

creating new jobs for work previously not done by anyone, such as genetic counselors, and lay providers to support self-care

Redistribution Creation

Capacity expansion Retraining

Source: Bohmer, Imison. Health Affairs 2013

www.hee.nhs.uk

Skills, Competencies, Roles

• Common principles, values, behaviours based on outcomes for patients/service users

• Competencies, skills and knowledge for the wider team

• Care Co-ordination and Navigation • Supporting workforce transition, eg acute to

community settings• Apprenticeships

www.hee.nhs.uk

5. Learning and Development

• Emphasis on learning together, training, networking, job rotation

• Expand Multi Professional Learning opportunities• Common foundation and part of CPD• Role of HEIs and other training providers

www.hee.nhs.uk

Conclusion

• HR Practitioners • HR Business Partners• Learning and

Development Specialists

• Terms and Conditions?• New Organisational Structures?• Changing the way we work √• Change management/OD √• Systems Leadership √• Integrated workforce planning √• Creating shared opportunities for

learning √

www.hee.nhs.uk

Further InformationJulian Mellor – Programme Manager

E-mail: julian.mellor@bhamcommunity.nhs.ukTel: 0121 466 7474Mobile: 07720 343443Website: www.hee.nhs.uk

Journal article – Institute of Ageing and Health www.iah-wmids.org.uk

Skills for Health & Skills for Care blog: how can the health and social care workforce meet the challenge of integrating services? Access from here

Scenario Planning

Case Study – Muriel

• As HR and OD practitioners, when we see a case study like Muriel's, what problem are we trying to solve?

• What questions should we ask to answer this

question?

• What are your main learning points today?

• What action will you take to use this learning in your professional practice?

• What additional learning and development do you plan to undertake to further develop in this area?

For more information on our HR Competency Framework, please take one of our packs or visit our website

http://www.hpma.org.uk/branches/london/ hrod-competency-framework

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