Hello PPMA members and friends

Our blog post this week is from Julian Mellor, Programme Manager – Integrated Care at Birmingham Community Healthcare NHS Foundation Trust/Health Education England, and Prof Guy Daly, Executive Dean of Faculty of Health and Life Sciences at Coventry University. Julian and Guy summarise the findings of a multi-year study into workforce issues exploring themes and best practice in integrated working, research that initially involved health and social care providers across Birmingham, Solihull and the Black Country.

Integrated care itself means different things to different people. The following definition developed by Think Local Act Personal/National Voices 2013 sums up how integrated care is person-centred coordinated 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.”

This person-centred approach aims to ensure that people receive dignified and compassionate care, while financial constraints continue to demand a more collaborative approach in terms of reducing emergency hospital admissions, reducing length of stay and facilitating the effective discharge of patients.

An important initial consideration in setting up this research was to ensure that the programme boards had a mix of representatives to include those who were leading service transformation, as well as workforce development and education leads from provider NHS Trusts and local authorities. Membership was strengthened to formalise the link with system-wide service transformation led through the Better Care Fund and Sustainability and Transformation Plans. The Executive Steering Group for the Integrated Care programme has senior level leadership from an NHS Trust chief executive and ADASS workforce lead.

Studies of nearly 400 national and international examples of service integration revealed that very few of these had initially given consideration to the specific workforce issues that needed to be addressed. From those that did recognise workforce factors, however, it was possible to identify some good examples of training programmes and competency frameworks that would support the work of multi- agency, multidisciplinary teams. Of particular importance, however, was the recognition of the role of care co-ordinators and care navigators in supporting people, especially in their own homes, and providing a conduit to other services in both the statutory and Private, Independent and Voluntary (PIV) Sector.

Learning from the best practice review was also useful in identifying both the barriers and the enablers to effective integrated working. The finding and recommendations from the best practice review were mapped across to six pilot projects, each of which provided a unique vehicle for testing out different aspects of integrated working in different settings, including communities, care homes and primary care.

All pilots demonstrated commitment to the integrated care agenda and the ability to work across multiple partners in different sectors. They provided access to expert clinical as well as patient/service user perspectives; many had their own established patient/user representative groups, thereby helping   the programme to stay grounded in practice and patient experience.

All six pilot projects had commenced by April 2014 and were substantially completed by July 2015. The best practice that has been developed will be scaled up and spread as part of the Integrated Care Programme, which is developing tools and resources, e.g. training programmes, workforce profiling methodology, for use with a wide range of new models of care across the West Midlands. This includes the development of a framework of shared core principles and functions for those working in integrated care teams.

A new workstream has been established to ensure that the workforce has the skills and knowledge to support self-care and raise awareness of the potential of digital technology in relation to both healthcare and reducing social isolation. The future emphasis must be on supporting the adoption and adaptation of workforce best practice.  This will include an emphasis on developing organisational culture and system leaders.  In addition, further work is needed on developing inter-professional and interdisciplinary working which may necessitate professional body regulators such as the HCPC and NMC becoming more flexible in how health and social care professionals are educated.

On top of that, the future integrated workforce must be one that is sensitive to the needs of local populations and communities. This will recognise, for example, the different challenges in achieving integrated working in rural and urban environments as well as the complexities of multiple partners, commissioners and service providers, working across the boundaries of health and social care.

We’d love to hear from you with your experiences of integrated working, so why not drop us a comment – just click on the comments link above and type away.

Julian Mellor & Guy Davies