The development of new care models requires changes to the make-up of the care workforce – changes that are not always easy to deliver. Recently, representatives from the vanguards came together to reflect on their experiences so far in developing and redesigning their workforce to support the new models of care. The conversation – while realistic about the scale of the challenge – was optimistic about what could be achieved and the progress made so far. Across the country, vanguards are finding new ways to engage with and develop their staff to support improvement.
Despite financial and service pressures, new models of care are beginning to demonstrate benefits for patients and staff. We heard about paramedics screening 999 calls and then visiting people at home – helping 80 per cent of them to stay at home and avoid a visit to A&E. We also heard about a scheme where GPs access specialist advice through a weekly, consultant-led "online” clinic, preventing half of their patients with kidney disease from having to travel to hospital.
I took away five lessons from the conversations across the day.
Systems move at the speed of trust
Fundamental to the new models of integrated care is a shift of focus – both for leaders and staff – from their organisation to the population they serve. This requires trusting relationships across organisational boundaries. It also requires system leadership skills. At one level, this includes the capacity to build a shared vision across a system; at another, inviting someone out for a cup of coffee. As one participant said, areas may need to "go slow to go fast". There will need to be an investment of time up front to develop the vision, ‘without walls’ culture and trust that will ultimately secure lasting change and improvement.
Your current workforce is your most valuable resource – nurture them
The existing NHS workforce is ripe with untapped potential to innovate and deliver more patient-focused care. For example, Allied Health Professionals (AHPs) are a frequently neglected staff group that is already equipped to work across traditional boundaries. A recommendation of one of the working groups on the day was to “smoke out” the AHP workforce everywhere and fully utilise their skills. There is also a need to be compassionate about the impact of change on staff, particularly clinical staff, who may equate change with a loss of personal autonomy and control.
Help your workforce to be self-improving
Supporting staff to improve and develop not only leads to better care for patients but boosts staff morale, retention and engagement. This will require strong leadership with a board and executive team committed to long-term improvement and able to give staff air cover to get on with it. It also means boards will have to develop a culture that encourages innovation and collaborative behaviour. As Richard Bohmer laid out so well in his recent New England Journal of Medicine article, improvement is a multi-stranded process that requires an integrated organisational approach and mindset.
New roles can be valuable but should be used sparingly
New roles can seem an enticing solution to delivering new ways of working. Indeed, a strong message from the day was that new roles, such as the care coordinator or navigator, can be valuable. But leaders should focus on a few and do them well. A competence-based approach to role design, building on current roles, also supports greater workforce flexibility.
Secure your future workforce
Local service strategies will struggle to get off the ground without a coherent workforce plan, yet workforce planning skills are in short supply. However, there are some resources available to help organisations model future service and workforce scenarios, as well as the support offered by the Local Workforce Advisory. Health Education England is also currently developing the STAR tool that aims to address all possible elements of a local workforce strategy.
Sweat the small stuff
Last but not least, many participants described how relatively small changes can make a big difference. The one that stuck in my mind was the purchase of a spiderphone, a simple improvement that enabled the multidisciplinary team to dial in to meetings and case conferences, saving travel time and increasing participation. As Richard Bohmer told us, when undertaking organisational transformation: “The short-term investments that are required can be surprisingly small… The most substantial hurdle, it seems, is the change in mindset.”
Imison C (2017) 'Learning from doing: workforce lessons from Vanguards'. Nuffield Trust comment, 31 March 2017. https://www.nuffieldtrust.org.uk/news-item/learning-from-doing-workforce-lessons-from-vanguards