In July 2021, Care City published A Healthy Living – Four Stories from the Future of Care, written by their Chief Executive, John Craig. The report presents insights from their work, reflecting on the growing gap between the job care staff are asked to do and the one they really do. If we close that gap, we can help patients and service users stay well, we can help staff progress in their career and help the whole system to thrive. It is a call to action, to change care to make it better for both care staff and those they care for.
On 27 July, we held a webinar with John to explore the themes in his publication and to add perspectives from a panel of those supporting and leading the transformation of care. As is often the case in these Doing Things Differently sessions, we had a discussion rich with ideas and insights, so if you missed it, the recording is available to view below. I’ve picked out a few themes which particularly stood out to me.
Investing in and developing the workforce is key
As John Craig said in his introduction, when we talk about care, we tend to talk about the money problem, which he feels has ossified the debate. Just as importantly, we need to focus on care staff who want to learn, progress and have a career. The increasing stress and complexity of work means that the struggle to retain care staff is far greater than the challenge of hiring them. A large part of this problem is the limited career pathways for people working in care. Training and development opportunities need to be provided that will not only attract more people to roles but encourage them to stay in the sector.
…the struggle to retain care staff is far greater than the challenge of hiring them
Building on this, Sir David Behan, Chair of Health Education England and former Chief Executive of the CQC stated that how we develop a training curriculum is going to be the key influence on future quality of care. We need to develop the notion of a career in care and that ICSs will be a vehicle for this, being in a position to ask themselves “what is the workforce we need to meet the needs of the population we serve?”
Reflecting on how COVID has changed this narrative, Katherine Ward, Managing Director of Healthy.io, talked about how the disruption in sectors such as hospitality and retail has provided an opportunity for young people who perhaps didn’t see the world of care as a career option. Katherine gave an example of the patient onboarding team for an at-home urine testing app being largely comprised of people who had been displaced from these sectors during COVID. Through this work they have become engaged and committed to this world. However, this surfeit of people is temporary – the norm is a huge shortage of people, so how can we make this offer better? Our panel felt that innovation can play a big role in this.
Innovation and technology as an enabler
This is an ideal time to rebuild the care system to be healthier for staff and healthier for patients. Cheap, portable health tech devices are widely available that are simple to learn, both for care staff and their clients and families. At the same time, COVID has allowed for remote collaboration, supervision and learning on a level not seen before. This allows us to think about how the technology can enable people to develop the way care is delivered, allowing care workers to focus on the interactions rather than processes.
Rachel Bell, Senior Product Manager at Satalia, spoke about how technology can be harnessed to free time for developing the workforce. Time that care workers spend on scheduling and other similar tasks, means they have no capacity for training or upskilling. As Rachel said, “It was phenomenal – it was instantaneous in almost every conversation we had: the desire to broaden out that particular role to learn and grow” Care is still perceived as a low-skill occupation, so we need to change the narrative around this and support the development of career pathways and training opportunities, alongside developing systems to free up time so it’s not spent on tasks such as scheduling.
Care is still perceived as a low-skill occupation, so we need to change the narrative around this and support the development of career pathways and training opportunities
Katherine gave an example that through technology you can enable and upskill people to manage complex health processes. She talked about Healthy.io’s wound care app, which allows care workers to accurately measure and evaluate a pressure sore, with remote support from clinical staff. This means someone who wouldn’t normally be able to carry out this task now has the skills to assess wounds accurately and confidently.
The panel recognised that the digital innovations we need in care are the ones that will make care staff more valuable in their jobs. As John Craig said, it’s not the idea that digital innovation is a substitute, it’s that with more powerful infrastructure and tools, those care staff can become more valuable to everyone – to the system and those they care for and that’s really exciting.
Collaborate to integrate
John Bryant -Head of Integration and Development at Torbay & South Devon NHS Foundation Trust, where they have run an integrated health and care service for 15 years, talked to us about the importance of collaboration.
His experience is that you don’t need structural change to integrate. Integration carries baggage in terms of reorganising and restructuring things, as opposed to collaboration, which is how people usually work differently together. Look at how you can collaborate first before looking at how (and if) things need to structurally change. This gives all sorts of opportunities and helps to remove the anxiety around the changes. John also recommended providing shadowing to allow people to walk a mile in another’s shoes. This helps build understanding and empathy, which are essential for successful collaborative working.
John felt that the future is about system integration (or rather collaboration) and that collaboration is across all parts of the sector: all the way to self-care, family carers, professional services, and our voluntary and community sector colleagues. It’s how we collaborate across all of those aspects in a way that is meaningful and that would then truly be system integration.
David agreed that collaboration as opposed to competition is becoming the organising principle of health and care, which is a significant shift and he wanted to stress the importance of leadership in integration. Behaviours from leaders will need to shift accordingly, from a set of behaviours which are focused on competing with your near neighbours to those of collaboration.
…collaboration as opposed to competition is becoming the organising principle of health and care
A call to action
To close the webinar, I reflected back on the Care City document, A Healthy Living, being a call to action and I asked the panel what they thought was the most important next step:
John Bryant: “do something, make it happen, share it”
David: “we have great examples, so we need to tell people what makes a difference. Show and tell will help get over some of the reservations in the sector”
Kath: “take the risk”
Rachel: “collaborate, share and learn, focusing on the value for the people you are trying to help and those around them”
John Craig: “there are clinical leaders in the health system with lots of money in their pocket who want to do ambitious things using remote monitoring and remote assistance to help people to stay well – let’s get them together with care leaders to think about what integrated care could mean for those ambitions”
As Network Development Lead for UCLPartners, Sophie brings people working in the region together to connect, share learning, and support each other in their improvement work. Sophie designs and delivers activities to support network development in programmes across the organisation, and leads on work to develop and sustain networks and communities of practice.