Hello PPMA members and friends
Izzi Seccombe is chair of the LGA’s community and wellbeing board and leader of Warwickshire CC and she believes that Health and social care is more important now than it’s ever been. In our blog post this week she talks about the challenges and opportunities the integration of these two key services will bring and the role of HR in this.
Health and social care is in a period of uncertainty. It is now more important than ever for local government to work with our communities and our counterparts in the NHS to secure a future for health and social care. But in the midst of flux and change, one thing that is certain is that joining up services is essential to achieving better health and wellbeing outcomes.
One of the key aims in health and care integration is to use resources more efficiently. However there is little straightforward evidence that integration produces immediately obvious efficiency savings. In fact the process can be long and complex and can even cost money at first. The emphasis has to be around investing to save, which means a longer-term effort to reduce demand on acute services through better home-based services in the community. It also means that we need to focus on the workforce. Make no mistake, although technology and personal responsibility can do a lot, health and care are uniquely labour intensive industries and the workforce is the key to change.
There are many challenges to deal with and partners in every area will find their own solutions, but one of the main lessons so far is that there is a risk of obsessing about structures. Organisational design is important but any organisation, however well designed, will fail if its people are not involved properly in change just as surely as if it is poorly led and governed.
There is much to suggest that efforts to integrate services need to be focused on developing well functioning multi-disciplinary teams drawing in people from all partner organisations. Alongside this there is plenty of general learning about good HR practice that suggests that improving the quality of team working is very important in driving staff engagement and thus increasing productivity and efficiency. So overall we should have the potential for a virtuous circle of improvement but only if we get our approach to the workforce right.
The Local Government Association (LGA) and NHS Employers recently commissioned a major report from The King’s Fund which took a detailed look at the lessons about integrated working. The report looked in particular at the pre-occupation with the idea that integration requires the development of a range of entirely new jobs with new and perhaps unfamiliar skill sets. Importantly, the report noted that there is little real evidence that new job design is always worth the effort. Instead, integration partners should come to realise that all the skills and experience they need are already available in their existing workforces and that effort is needed to build people into teams where skills are recognised, celebrated and used properly. This doesn’t mean getting people to do different things but instead getting them to do things differently.
The best way to achieve this is simply to bring people together in teams as soon as possible in the timeline of integration so they can develop mutual trust and understanding. Building from the strength of good joint team working, it is then easier for partner organisations to develop closer approaches on policy and process issues. For instance, joint approaches to workforce planning are important and there are many tools and techniques available to help with this, but we need to acknowledge that there are very different planning traditions in the NHS and local government for example, and it will take time to develop truly joint approaches.
In the meantime it’s important to put efforts into other processes such as joint recruitment exercises and the alignment of a wide variety of HR policies such as disciplinary procedures, most probably on a gradual basis. This evolutionary approach, based around good quality team working and the development of consensus means that there is a good context to deal positively with the two big elephants in the room. One is the set of what are often called ‘hard’ issues around contracts, pay and pensions while the other is the so-called ‘soft’ issue of cultural differences between organisations.
The terms hard and soft are perhaps unfortunate because developing a shared culture is a very demanding process, but once it is in place it can make it easier to deal with contracts and pay. The LGA is working in partnership with other national organisations to do what we can to facilitate integration and change. One major aim is to ensure that good quality learning and information is made available more easily to local partners. This is in fact a big task given the great diversity of projects currently underway throughout the country.
Efforts are also being put into understanding the potential for imaginative approaches to pay and rewards which will make it easier for talented people to move around a much more flexible health and care system. I’ve only been able to touch briefly on some of the key issues and developments here, but we are really encouraged to see that the workforce is now seen as the key to integration and that partners at every level are focused on their people. This gives HR specialists a major role to play.
Izzi seccombe , chair of the LGA’s community and wellbeing board and leader of Warwickshire CC