Getting into shape: delivering a workforce for integrated care

Document type
Laycock, Kate; Borrows, Maisie; Dobson, Ben
Date of publication
14 September 2017
Health Services, Employment, Social Policy, Social Work, Social Care and Social Services
Social welfare
Material type

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As the Government and the NHS leadership have repeatedly said, the priority for the NHS is to increase its speed of innovation. To do this, the NHS is seeking to devolve decision-making and to deregulate. For the workforce, however, policy remains highly centralised and tightly regulated. This paper shows how to bring the same reform ideas to the workforce as the NHS is applying to other areas.

A number of practical and cultural barriers need to be overcome if this imbalance is to be redressed. The funding model of the NHS continues to drive activity, and resources, towards the acute sector. Medical training is based on specialisation and gives little recognition to inter-specialty transferable skills. Interviewees for this paper concluded that this approach creates a workforce of ‘super-specialists’ based predominately in the acute sector rather than an integrated team built around patient needs. The vast majority of clinical training placements are weighted towards the acute sector. Interviewees also reported a ‘snobbish’ attitude that places primary care at a lower status than secondary care.

This paper follows a previous Reform report, 'Work in Progress', which showed how better use of technology and a better culture of employment can increase efficiency in the whole public-sector workforce. The paper focuses on the structural barriers to delivering integrated care.

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