Integrated workforce thinking across systems: practical solutions to support integrated care systems (ICSs)

About this guide

This guide provides tips and insight to help system leaders consider what is needed to plan for and achieve a successfully integrated workforce.

It is aimed at ICS workforce leads, chief people officers, directors of adult social services (DASS), chief executives, human resource (HR) directors, elected members including adult social care (ASC) portfolio holders and chairs of health and wellbeing boards, and those who are responsible for integrated workforce thinking across health and social care.

It has been produced in partnership with NHS Employers, Skills for Care (SFC), and the Partners in Care and Health, a partnership of the Local Government Association (LGA) and Association of Directors of Adult Social Services (ADASS). 

We recognise that every ICS will be at a different place in their journey to developing a fully integrated workforce plan. This guide has been written to support you in whatever stage you have reached.

Foreword

The introduction of 42 ICSs across England represented a change in how we bring together organisations to plan and deliver health and social care services in their localities. Those ICSs are now operational, and you will be trying to make sense of a huge amount of information about health and social care services in your areas. High quality health and social care services are dependent upon a highly skilled and valued workforce. We recognise the vital impact that our workforce has on people’s lives and the contribution that each makes to an effective health and social care system. So, we felt it was important that we produced a guide that would help you plan what sort of workforce you will need.

Every day, leaders of social care and health services role model and foster positive culture within and across organisations. Through working together – thinking together - leaders across systems will be able to create a shared culture that builds on our strengths, with a focus on people at the heart of care.

But integrated working isn’t just an important step towards sharing expertise, maximising our resources and avoiding duplication of effort, though this will help to create a sense of common purpose and connection between our staff. When people and communities experience a coherent and consistent system, they’ll be able to make decisions about their care that are truly at the core of what’s important for them and their quality of life.

Data from Skills for Care’s adult social care workforce data set and health statistics support the need for improving how systems work together. With vacancies currently running at 152,000 for social care and 125,000 in health creating an integrated workforce plan that tackles key issues like recruitment and retention, digitalisation, workforce redesign and staff development will mean better outcomes for people. For example, by ensuring they will only have to tell their story once.

This guide doesn’t have all the answers, but has been designed to support all 42 ICSs to develop effective integrated workforce plans that will meet the needs of those they serve, wherever they might live and whatever services they will need to live the lives they want.

All the partners who created this guide have generously shared experiences and offered case studies to help workforce leads and others really think about key issues they need to consider when planning an integrated workforce. We will also shortly be publishing a case study based on learning from those with lived experience, as it is vital that the voices of those drawing on care and support are represented.

We’re grateful to colleagues from NHS Employers, Skills for Care and the Care and Health Improvement Programme, which is a collaboration of the Local Government Association (LGA) and Association of Directors of Adult Social Services (ADASS), who have come together to create this guide. In many ways our work mirrors the effective partnership working the ICSs will develop over the coming months.

Danny Mortimer, Chief Executive, NHS Employers
Oonagh Smyth, Chief Executive, Skills for Care
Councillor David Fothergill, Chair of the LGA Community Wellbeing Board
Sarah McClinton, President, ADASS

What is integrated workforce thinking?

Integrated workforce thinking is when leaders across systems work together to consider population health, health and care needs and their system strategy, so they can plan a workforce that delivers population health and person-centred care within their communities.

However, integrated workforce thinking is more than just about bringing together what different organisations are already doing; it recognises the complexity of the health and social care system, the challenges, and the need to build on strengths so that new and creative solutions can be formulated through joint working.  

The current capacity pressures in the system mean that new ways of working will be paramount to delivering health and social care across our communities. Building relationships across partners within systems, where there is a shared understanding of each organisation’s strengths, is key to successful future delivery.  

Successful workforce integration provides a positive experience for people who draw on care and support. This is achieved when health, social care, voluntary sector, unpaid carers and local partners work across systems, to assure that people in their communities are always at the centre of their care in the context of their whole lives.  

This joined-up way of working is achieved through leaders building strong relationships across systems to create a culture and workforce that champions integration and the opportunities that it provides for both the people who draw on care and health and staff.

Any service redesign that informs a reorganisation or reskilling of workforces across systems should be informed by population health and person-centred care. It can be supported by taking into consideration the social and environmental factors that influence our health, such as education and income, and the strengths talents and assets within individuals and in communities.

Personalised care means that people have the resources and information to look after their own health as well as having control over the way that their care is planned and delivered when needed. Preventative support to maintain the wellbeing and independence of individuals in the community must also play a part in decisions made about use of resources. These person-centred principles will help people live the lives they choose based on what matters to them.

For example, a person living with dementia, learning disability or autism should be encouraged to make decisions about their own care, based on what matters to them. Care plans should be created with the individual and a health or care professional so that they can decide how they want to receive their care, should they need to access emergency treatment. Through doing this, staff have an instant understanding of what care that person needs as well as learning about their life and what matters to them in their care. The person receiving care has confidence that they are going to get access to the best care for them as an individual. 

Changing the way that systems work and think to become more integrated can be a challenge at first. However, by understanding what each sector can bring can significantly improve outcomes for people in our communities and the experience and opportunities for the workforce.  

The health and social care challenges that impact workforce thinking

To support workforce thinking, an integrated workforce plan must be aware of and address the key issues currently facing health and social care, including recruitment and retention, workforce redesign and staff development as well as anticipate the future demand based on any future service or workforce redesign.

The health and social care sector in England is facing significant pressure, driven strongly but not exclusively by the capacity challenges affecting social care. Data from Skills for Care’s adult social care workforce data set and health statistics support the need for improving how systems work together. Like the NHS, adult social care faces significant vacancies and is struggling to recruit and retain the staff desperately needed to keep people well at home, and to support them to leave hospital safely to live in the community, in their own homes, with support from families.

With vacancies currently running at 165,000 for social care and 105,000 for health, creating an integrated workforce plan that tackles these issues will mean better outcomes for people. For example, by ensuring they will only have to tell their story once.

The July 2022 assessment of adult social care by ADASS reveals significantly more people seeking support and rising cases of breakdown of unpaid carer arrangements than in 2021. Simultaneously, almost seven in ten directors say that care providers in their area have closed or handed back contracts to local councils. Many more cannot deliver the increased care and support needed due to staffing shortfalls. 

These findings illustrate the extent of the interdependency between health and social care, with squeezed capacity in primary and community care being an important factor impacting demand for social care services. ADASS has also noted the greater acuity of care needs, which impacts on ASC providers as a result of delays in accessing NHS treatment and reductions in community health services. 

The challenges facing the sector are not new, with health and social care struggling to recruit and retain staff for a number of years. However, this has been more acutely felt in the wake of events such as COVID-19 and Brexit, with employers increasingly having to rely on expensive agency staff. Issues are likely to be compounded by spiralling inflation and ever-intense labour market pressures nationally.  

While this guide is designed to encourage integrated workforce thinking and support workforce planning across systems, workforce planning also needs to be coordinated nationally across health and social care to ensure we have a sustainable workforce for the future. As our population grows and ages, many of the challenges faced by health and social care will require more innovative models of care and a more integrated and strategic approach to the workforce required to meet that demand. A decision to address recruitment and retention issues in one sector may have implications in the other, or fail to take advantage of opportunities arising from joint working. Most recruitment takes place from the same pool of ASC staff and so the pay differentials between health and social care staff results in a one-way flow of staff joining health organisations due to better pay and conditions. It is important to highlight that the average care worker pay is £1 per hour less than healthcare assistants in the NHS that are new to their roles.

Challenges are not only around pay and conditions but include career progression, training and qualifications. Employers and training providers are working to identify the training needs of the workforce going forward and the skills that both health and social care will fulfil in the new ICS architecture.     

There are opportunities to undertake more work with universities and colleges to improve the narrative around jobs in health and social care and for all parts of the domestic workforce to see health and social care as a valuable career opportunity. 

Similarly, digital information and assistive technology needs to be explored further to identify opportunities to digitalise activities across health and social care. This will provide more time for meaningful interaction with people who draw on care and support, such as shared digital care records so an individual only has to tell their story once.

Checklist of readiness

This checklist suggests things to consider in your integrated thinking to ensure you are ready to embark on your workforce planning journey. While systems and organisations will be at different stages in the development of a workforce plan, the checklist will help to ensure partners are aligned and have a clear shared purpose, vision and agreement on the outcomes they wish to achieve together.

Top tips for integrated workforce thinking

We have pulled together a series of top tips from a range of people across health and social care with some experience of integrating their workforce thinking.

Governance

It is important that the people responsible for integration set out governance arrangements to ensure collaborative working across the system.

Top tips

Agree and model the behaviours of integrated thinking and working.

Set and agree a transparent framework and system governance that incorporates risk share and clear ownership.

Think about how to incorporate checks and challenges to ensure agility in the process.

Do not overcomplicate decision-making. Agree how you will prioritise as a team by concentrating on something that is important to everybody, for example, getting people home.

Consider pooling funding to bring in external expertise, to maximise resources to achieve the desired outcomes.

Consider identifying a cross-sector project team to lead development of the thinking and planning. 

Consider how digital solutions such as virtual wards and digital care plans can support the development and implementation of the workforce plan.

Changing cultures

Culture is an integral part of establishing an integrated working environment. Historically, organisations within systems have been working in silo, so it is important that culture change is addressed from the offset when beginning to integrate workforce thinking. 

Top tips

Focus on culture change in systems by listening and engaging with leaders from each organisation to agree how integration can be achieved at a system level.

Understand systems’ ICS strategy and population health data to understand how this can impact ways of working.

Take time to build relationships to understand who is who, what each other’s contributions are and how organisations can work together best to deliver better quality care and support population health. 

To help build relationships, encourage proactive contact between colleagues across the system who have similar roles, rather than waiting for formal meetings to begin.

Systems need to invest time in creating a culture to support integration across services. To help systems, we have identified ‘six ways to create a culture for integration’: 

1. Be prepared to experiment and learn together by having a test-and-learn mindset.  

2. Have a clear shared vision of the aims that your system wants to achieve. 

3. System leaders need to set the tone by fostering a shared sense of belonging and holding systems to account. 

4. Get to know each other and understand each other's worlds. You will need to understand each other’s knowledge and perspectives to be successful. 

5. Use data on population health to facilitate conversation and prompt discussion.  

6.Bring people together from different parts of the system to share challenges and strengths. 

For further information, please read our Six ways to create a culture for integration resource. 

Communication

Communication is key to developing a shared understanding of what an integrated working looks like. We are all new to this way of working so it is important that learning is shared continuously.

Top tips 

Communicate across the system at every stage of the process, internally and externally.   

Celebrate success and share learning from what has worked locally, within the system and nationally.

Data

Data is crucial to integrating workforce thinking, to provide a shared understanding of the challenges across systems.

Top tips

Ensure a clear understanding of the current and future health, care and support needs of your local population through Projecting Older People Population Information (POPPI) or Projecting Adult Needs and Service Information (PANSI).

Identify where the local workforce demographics can be obtained and analysed along with any other complementary data sources, such as the Office of National Statistics, ESR system, NHS Digital, Workforce Disability Equality Standard (WDES), Workforce Race Equality Standard (WRES), NHS Staff Survey and the Adult Social Care Workforce Data Set (ASC-WDS)

Consider having a data lead to collect information and share across all partners within the system.

Demonstrate how data analysis has informed any decisions, and particularly potential biases of the data sets, to ensure any data gaps. For example, make sure geographical or ethnic indicators are noted and considered during decision-making.

Data and integration

Every day, information and data are used to inform decision-making across health and adult social care in England. Workforce leads, local authorities, and ICSs use data to gain insight on the local labour market; future demand for care and support services in their areas; and trends and patterns in workforce issues such as turnover and pay rates. ICSs need to know their market and the workforce that supports it to help shape it. At a strategic level, data is essential to gain a shared understanding of challenges and opportunities.

True integration and genuine person-centred care and support is underpinned by collecting and sharing this data effectively. A health and social care system where someone can tell their story once to access high-quality care and support is reliant on data being accessible, accurate, reliable, and readily available between sectors and organisations.

Integrated workforce planning presents both the opportunity of thinking across the whole system, as well as the challenge of bringing incomplete and distinct data systems together across ICSs. If comprehensive, accessible and robust data flows support informed decisions, then standardisation is needed in the collection, full sector(s) coverage and interoperability of data architecture. This will give decision-makers a more complete picture of local needs and therefore more certainty on potential outcomes when planning for population health or workforce requirements.

Data collection and reporting for ASC providers is currently not as accessible as it is for health, and at present, there is no central data set combining health and social care workforce information. However, the adult social care workforce data set collects information from around 20,000 social care providers, offering an overview of the adult social care workforce in England. NHS workforce data is held in the ESR system, Office of National Statistics, POPPI or PANSI, ESR system, NHS Digital, WDES, WRES, and the NHS Staff Survey (see resources section below).

Facilitated discussions about data, evidence and insight help to forge connections and trust between partners as well as generating a shared narrative.

Good practice and learning from ICSs

A variety of ICSs across the country have shared their good practice examples of integrating their workforce thinking. While there is not a one-size-fits all solution for ICSs, these examples aim to give an idea of what can be achieved.  

Further resources