Developing The Workforce Required To Deliver Integrated Care Martin Rayson Divisional 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.

21 st 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

2 nd February 2016 Closing the Gap HPMA/PPMA Event Learning from Integrated Care Workforce Initiatives in the West Midlands Julian Mellor Programme Manager - Integrated Care

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 New Care Models - Better Care Fund, System Transformation Plans, Vanguards

Delivering Integrated Care From an approach based on:To an approach based on: PatientsPopulation health management NHS workforceHealth and social care workforce - statutory, private and voluntary sectors ….and wider! OrganisationsPlaces Workforce plans primarily focused on the NHS workforce Integrated system-wide workforce planning

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)

Programme Board – bringing partners together 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 learning Take 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

Learning about Integrated Working

Older Adults Workforce Integration Programme - Pilots Project ThemeLead Organisation Integrated Care ModelPathfinder Healthcare Developments CIC Falls and Fractures - Care HomesUniversity 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 Principles And Frameworks For Integrated Working (Workstream 3) Principles And Frameworks For Integrated Working (Workstream 3) Workforce Competencies And Development Programmes (Workstream 4) Workforce Competencies And Development Programmes (Workstream 4) Support Self Care And Digital Innovations (Workstream 1) Support Self Care And Digital Innovations (Workstream 1) Kaiser Pyramid Model Mindset And Culture Shift INTEGRATED CARE THEME Long Term System Vision And Workforce Profile (Workstream 2) Integrated Care Transformation Theme: Workstreams and Relationship with other Transformation Themes Leadership Theme Mental Health Theme Acute, Urgent & Emergency Care Theme Primary & Community Care Theme

Key Messages 1. Alignment of leadership and OD with workforce development initiatives 2. The definition of the workforce 3. The need for integrated system workforce planning 4. Workforce redesign – roles and competencies 5. Approaches to learning and development

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

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

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

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

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

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

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

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 √

Further Information Julian Mellor – Programme Manager Tel: Mobile: Website: Journal article – Institute of Ageing and Health Skills for Health & Skills for Care blog: how can the health and social care workforce meet the challenge of integrating services? Access from herehere

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?

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