We prefaced our recent report, Reshaping the workforce to deliver the care patients need, with this statement from the NHS Five Year Forward View: “We can design innovative new care models, but they simply won’t become a reality unless we have a workforce with the right numbers, skills, values and behaviours to deliver it”.
Our report focused primarily on the opportunities that new and extended roles give you to address current deficits in workforce numbers and skills. Chairing a session at NHS England's Health and Care Innovation Expo – where three Vanguards described how they were supporting and enabling their workforce to deliver new models of care – brought home to me how important values and behaviours are to bringing about change. Having staff in the right numbers and with the right skills is not enough unless the right values and behaviours are embedded too.
The trust test
A key driver of behaviour is trust. Time and again, the evidence shows how building trust between staff trumps structures when it comes to delivering integrated care. The team from My Life A Full Life (Isle of Wight) Vanguard got us all thinking by asking us to give scores out of ten, on trust, to the people we most and least trust at work. If the difference between the two scores was more than five, our workplace might benefit from some trust building. The Isle of Wight has been building trust across their community with their training programme based on the ‘Speed of Trust’ methodology.
The training brings people from across roles and sectors together. It builds their people skills and trust in each other. The Isle of Wight team feel the programme is not only enhancing the confidence of those that attend but changing the culture across their system – by giving them a common language. For example, one unforeseen consequence has been that district nurses and firemen undertaking fire safety visits have started referring vulnerable people to each other. It left me more than convinced that investment in building trust across the system is not a 'nice-to-do', but an essential.
Better team working
High-performing teams have high levels of trust. All three Vanguards emphasised the importance of team working and 'teams without walls', particularly in caring for the top five per cent of patients that have multiple and complex needs. This facilitates holistic care and avoids unnecessary duplication. Both Dudley Multispeciality Community Provider and Northumberland Accountable Care Organisation described how the introduction of different and new roles to their teams had changed their culture and dynamics.
Impact for patients
In Dudley they have introduced a link worker, who visits patients at home and signposts them to services that address their social as well as care needs. One of the link workers told us that they saw themselves as “another eye in the room”, able to spot and help remedy problems that would otherwise go unnoticed. The example they gave was of helping someone get a hearing aid – transforming their quality of life. Dudley said that the clinical commissioning group now sees itself as commissioning for "a life, not a condition”.
In Northumberland, they have developed multidisciplinary population-based teams focused on providing holistic care to patients in the community. Pharmacists have been introduced to these teams – offering additional skills and competences. They have driven a change in culture, including better team working and the team operating with greater autonomy. As well as contributing to the multidisciplinary team, the pharmacists are providing input to residential and nursing homes, a community visiting service and general practice. They have significantly reduced the GP workload. Northumberland estimate that up to 40 per cent of GP visits could be undertaken by other professionals.
One of the audience members at Expo posed a challenge to the Vanguards: how did they know what skills were needed in their multidisciplinary teams? The response was that until you have teams working collaboratively, making the most of the existing team members, you may misjudge the gap.
If possible, you need to make things simple for patients; not more complex. The type of person is just as important as their skills. Which takes us back to where we began. Staff numbers and skills without values and behaviours won’t work.
Imison C (2016) ‘Trust in transformational change’. Nuffield Trust comment, 12 September 2016. https://www.nuffieldtrust.org.uk/news-item/trust-in-transformational-change