Time for a workforce revolution?

Guest post from Brendan Hill, CEO of Concern Group.

Third sector providers of health and care and their statutory colleagues surely must share similar goals; that is to provide high-quality services, support individuals when they need us most, help them manage their own health, and ensure we coordinate and tailor what we do around the needs and preferences of patients, their families and their carers. Aspiring to these goals at a time when demographics and finances alone provide significant challenge make these increasingly difficult to achieve. 
There are a number of key agendas that affect us all:
  • A common goal of providing more holistic approaches to an individual’s health and wellbeing;
  • Addressing the prevention and public health challenge to reduce the burden on specialist services and complex care;
  • Implementing the ‘Five Year Forward View’ (and within the one and a half year period left since it was published);
  • A shared understanding of the importance of the ‘social determinants of health’;
  • and the integration challenge for health and social care, i.e. integrating around individuals and their communities, rather than organisations.
As already illustrated in some of the NHS Vanguard sites over recent years and currently with the emergence of ‘place based approaches’ to health and care planning; new ways of working across professional and organisational boundaries are beginning to release the potential in local systems to focus on how to better provide and organise care around individual need. The permission to think and act differently, and having the freedom to do things in a way that suits local need, will be key to success. 
This journey that many of us are now on begins with how we start to think System instead of Organisation. Easier of course to say than do. During recent discussions on this agenda in Gateshead, those involved agreed that such change begins with ‘culture’ and ‘behaviours’. Moving from:

Transactional to Collaborative

Reporting to Relational

Commissioner/Provider to System Partners

However, if we are serious about developing this approach across the whole system, we need to start thinking big about workforce. At least 75% of funding is usually spent on staffing services, so the type and number of staff we have, and how we remunerate them, is central.
I believe our biggest challenge (and opportunity) is to redesign our workforce around the needs of the people. A simple idea, and relatively obvious, but if we listen to what we are told, user experience would often indicate that this is not the way our workforces are currently arranged.
There is, of course, excellent care provided to many, and this should naturally be acknowledged. But this good quality care is all too often provided by dedicated staff in spite of the system they work in, as opposed to because of it. I do not want my position to ever come across as ‘professional bashing’, as I am CEO of an organisation that has been predominantly nurse-led, and this is indeed my own professional background too. I believe we need to support and invest in our professions; refreshing their purpose, remit and skill base in order to increase their ability to serve our communities better.
With this in mind, can we now develop a serious conversation with statutory colleagues at the DH, NHSHE, PHE, ADASS, to name a few, on the following issues? With our sector in mind, could we consider:
  • How might we look at the training and development requirements of existing professions, to ensure that they have ‘caught up’ regarding the importance of the social determinants of health, including a greater emphasis on promotion, prevention, and self-management?

  • How can the emerging non-professionally-aligned roles (including ‘navigators’ and ‘peer support’) be expanded and valued particularly with a view to develop improved cross sector workforce planning?

  • How might we challenge the myth that we can tackle the chronic shortages in areas such as general practice, community nursing, psychiatry, etc., by continuing to rob other parts of the system, or chase staff that do not exist? 

  • How might we ultimately look at some professional roles and bandings with a view that the evolving health and care system might, in some instances, require ‘enhanced, but fewer’ of some to help fund the ‘revolution’?

Here at Concern Group we have begun to look at several key posts within our own workforce that we feel could be developed further in our psychological therapy, nursing, and community wellbeing services, with the aim of testing out some of the issues outlined above. In addition we have led on the development of the Newcastle/Gateshead Linkwork Collaborative, bringing together providers of linkwork / navigation / social prescribing services across the area to look at how we can develop a shared language, work as a system rather than as individual providers and establish a common set of measurable outcomes.
We have led on the development and successful submission of a VCSE Health and Wellbeing Fund bid to provide additional capacity to support this programme over the next three years and are working closely with our colleagues at NHS England to shape the emerging guidance and social prescribing tools being developed centrally.
Of course, none of us operate in a vacuum, so we would therefore welcome the opportunity to develop this conversation further with our statutory partners, third sector colleagues, and professional bodies.
Please feel free to contact me.
Brendan Hill
Chief Executive | Concern Group