Evidence Says Don’t Get Distracted By Creating New Roles To Deliver Integrated Care

There is limited evidence to support the creation of new roles to deliver integrated care. Indeed the available evidence suggests that working with the existing workforce to create more flexible and multi-skilled teams that can work across boundaries is as, if not more, effective, says a report published today by The King’s Fund.

Supporting integration through new roles and working across boundaries examines the evidence for creating new roles, such as care navigators, as part of an integrated workforce – arguably the most important resource in delivering integrated care. The report found there has been limited assessment of the effectiveness of individual roles as most evaluations focused on the wider process of integration. There is also limited evidence of whether new roles can reduce costs.

Issues were also raised around how new roles often fail to address the cultural gaps between professional and organisational identities – like that between health and social care – which are essential in breaking down barriers to deliver integrated care. This could result in the task of integrating care falling on a small number of lone individuals, at the expense of engaging staff in support of integration more widely.

Instead, our analysis found some common factors that work in developing an integrated workforce.

• Many of the skills required to deliver integrated care exist within the workforce and can be more effectively shared and distributed as part of an overall system of care.
• Engagement with the workforce from the outset on the aims for integration and a focus on the needs of patients and service users can enable staff to take a lead in identifying innovative solutions.
• Wider organisational support and buy-in with appropriate management and accountability for staff is essential to ensuring integrated care solutions provide quality care and are sustainable.
• Acknowledgement of professional boundaries can serve to build trust and respect, which in turn can lead to greater role flexibility.

The report, commissioned by the LGA and NHS Employers, concludes that it is crucial we reflect on what works in creating an integrated workforce. Examples such as multidisciplinary teamwork and integrated care pathways have proved effective and while new roles should not be dismissed, organisations should first address the fundamentals of integration before assuming that a new role is needed.

Helen Gilburt, the report’s lead author and fellow at The King’s Fund said:

‘Too often the assumption might be that to deliver integrated care you need to create a new role. Our analysis found new roles are not always the most effective way of delivering integrated care – and can in fact lead to solutions which are unsustainable. While the aim of creating a more flexible and multi-skilled workforce to provide more holistic care is paramount, rather than create a new role, it is much more compelling to utilise the existing skills of the workforce more effectively and engage staff in identifying and implementing workforce solutions themselves.’

Danny Mortimer, Chief Executive, NHS Employers said:

‘We are committed to working with the LGA and our colleagues in social care to ensure we design services and roles which provide the best care to our communities and citizens.  It is vital that we understand and rapidly apply the lessons identified by this report. We look forward to supporting The King’s Fund and the LGA in the next phase of this work.’

The Local Government Association’s Portfolio Holder for Community Wellbeing, Cllr Izzi Seccombe, said:

‘As health and care integration gathers pace, it is vital that we focus on the most effective ways of working, so that we are best placed to meet the needs of patients and the most vulnerable in society.

‘The LGA has joined forces with NHS Employers to commission this important independent report which will guide planning and decision-making around truly effective workforce integration.

‘We will use the report to work with partners to provide further advice and support as local areas develop their approaches to integration.

‘With resources continuing to be under strain, it is crucial that we make the right decisions for investment in the workforce. The focus on skills, team-building and engagement in this report will help drive that forward.’