Why is technology underrepresented in the training of health, housing and care professionals?


Andy Hart, Head of Delivery and Technical Support at Tunstall Healthcare, discusses why educating health, housing and social care professionals is vital to meet the needs of our growing and ageing population.

People today are living much longer. It’s recently been reported that the UK’s population hit a record with over-65s overtaking under-15s, and by 2030 it is estimated that 1 in 6 people globally will be aged 60 years or over.

But living longer does not necessarily mean living more healthily. Long-term health conditions are more prevalent in older people, with approximately 15 million people in the UK requiring health and social care services for chronic illnesses.

Andy Hart, Head of Delivery and Technical Support at Tunstall Healthcare, discusses why educating health, housing and social care professionals in the benefits and appropriate use of technology is crucial if we are to improve service provision, and why technology continues to be underrepresented in training.

Why technology is underrepresented

The urgent need to invest in preventative services and early interventions to reduce pressures on our services is being increasingly recognised. In fact, almost two thirds (63 per cent) of directors of adult social care recently indicated that their local authorities were taking positive investment strategies in digital and technology.

However, large-scale change involving health and care technology is complex and presents many challenges for the stakeholders involved. Key barriers to successful digital evolution include the budget constraints and the cost of implementing new systems, organisational attitudes towards risk, and the relationships that exist between health, housing and social care services.

Most of these barriers can be mitigated through greater training and the education of professionals. Greater education will help to build partnerships, maximise the use of data, drive cultural change and bring staff on the digital journey, whilst supporting them in their roles.

Investing in education

People are the greatest asset of any organisation and, like any other asset, they need investment and maintenance. The next generation of health, housing and care leaders require support if they are to continue to develop themselves, and therefore their teams and services.

The education of professionals within these sectors is crucial in enabling a cultural shift so that staff understand the value and use of technology, and how it can support them in effective caregiving, as well as improving the quality of life of the people being cared for.

With the right education staff should reap a number of benefits, including becoming more aware of the features of telecare devices, developing confidence in assessing and referring end users to the right solutions, and understanding the positive impact of telecare on working practices.

As the Occupational Therapy programme lead at the University of Lincoln, Carol Duff is significantly involved in the education of Occupational Therapists. She commented: “It’s very important that we give our students the opportunity to gain practical confidence in the use of digital solutions in a safe setting that are essential to support their practice in health and social care.

“Technological solutions may mean our patients are able to remain safely at home for longer and avoid or delay moving into hospital or into care. It is essential that our occupational therapists of the future can confidently and creatively explore digital solutions that may also reduce pressure on the system and release time to care.”

A digital future

With the impending changes to our telecoms network, digital is fast becoming the industry standard to ensure the safety of health and social care services, staff and end users.

New kinds of leadership will be needed to deliver change and evolve governance, while at the same time improving the working lives and motivation of employees. Cementing a cultural shift towards technology driven, outcomes-led approaches is required to achieve this, and in turn, this needs early engagement from professionals and an understanding that technology is designed to provide support, rather than to replace.

By harnessing the benefits of training and education, we can raise awareness of the value and potential of technology across the healthcare landscape, and provide enhanced support to users, carers, professionals and providers.

For more information on educating the future generation of health, housing and social care professionals, please visit www.tunstall.co.uk/training-services.

The Health and Social Care Committee’s report on the care workforce; what is missing?

social care workforce

On 25th July, the Health and Social Care Committee (HSCC) published their report, Workforce: recruitment, training and retention in health and social care.

The report calls for the government to provide its workforce plan for the NHS and social care (promised in spring 2022 but still not yet published), and provides several practical recommendations for the plan. Refreshingly, large sections of the report focus specifically on the social care workforce; a workforce often ignored in conversations around health and care.

The report appropriately recognises the gravity of the situation facing the social care sector, stating that, in comparison to the NHS, “the situation is regrettably worse in social care”, referencing incredibly high staff vacancy and turnover rates and poor working conditions.

Key recommendations in the HSSC report regarding the social care workforce include:

  • Higher baseline pay for care workers, reflecting the true value to society of the services they provide
  • Sustainable strategies in terms of pay progression, professional development, and career pathways
  • Contract choices offered to care workers on zero-hours contracts
  • A call for the government to produce an externally validated care certificate, provided at no cost to care providers, and is transferable between care providers and the NHS

While the report makes some promising recommendations, it falls short in several areas. On 26th July, Public Policy Projects (PPP) launched its report, The Social Care Workforce: averting a crisis.

This report was based on two roundtables with PPP’s Social Care Policy Network, held in May 2022, made up of key stakeholders in the adult social care sector and a lived experience panel (comprising five individuals with first-hand experience of the social care system). While many of the conclusions and recommendations of the HSCC’s report have parallels in PPP’s report, PPP highlights further areas that the workforce plan should address.

A fairer deal for the social care workforce

The reports from HSCC and PPP are broadly aligned regarding their sentiments and recommendations around pay for care workers. It is evident that care workers must be paid more, and equivalent to, their NHS counterparts.

Both reports therefore include recommendations advocating increases to the baseline pay for care workers, to reflect the true value that care workers bring to society and reduce the number of care workers leaving for better paid jobs in retail, hospitality, or elsewhere. Both reports also agree that there must be pay progression in the care sector in line with that of the NHS Agenda for Change pay scale, providing opportunities for care workers to be paid fairly and to advance their careers.

The two reports agree that terms and conditions, as well as pay, must be improved for social care workers. They acknowledge that zero-hours contracts can provide instability for many adult social care workers, and that care workers do not tend to enjoy the same pension options, sick pay or overtime renumeration as equivalent NHS workers, nor do they receive the public admiration or ‘sweeteners’ (including NHS staff discounts offered by many businesses).

It is no secret that the social care sector is severely underfunded. In order to appropriately pay care workers, both reports agree that local authorities must be appropriately funded to provide the fair cost of care to providers, to ensure that self-funders are not subsidising the cost of workers’ wages. This will require substantial investment from government.

However, PPP’s report provides several additional recommendations for the elevation of the social care workforce. Crucially, PPP’s report focuses on the need for an elevation in the status of care work, to raise the profile of those working in care. The report notes the boost in public sentiment towards nursing that followed Florence Nightingale’s work during the Crimean war, and stresses the need for a similar shift to take place for care work. Not only would this ‘Nightingale shift’ boost staff morale, PPP’s report argues that it would help to address recruitment and retention issues, provided it is accompanied by improvements to pay and conditions.

To kickstart this ‘Nightingale shift’, PPP’s report recommends that the government should provide investment for positive advertising campaigns for social care careers, with clear messaging of the immense value of a career in care and its potential to transform lives. In conjunction with this, it recommends that care providers should be working with careers advisors in schools to promote care work to young people as an attractive and fulfilling career.

Another recommendation in PPP’s report, which was not addressed by the HSCC report, is the potential creation of cross-sector roles between health and care, as well as placements and secondments of NHS staff into social care. This would help raise the status of social care by actualising a parity of esteem between the NHS and social care workforces. It would also serve to increase the awareness and visibility of the social care system within the NHS, and aide in the integration of the workforces.

More training is not a panacea

Training was highlighted as a key area in the HSCC report. However, PPP’s Social Care Policy Network argues in the report that extra workforce training should not be conflated with the wider issues around attracting and retaining staff. PPP’s Lived Experience Panel were at pains to express that constant training and annual training renewal is often a poor use of time and resources and cannot be a substitute for meaningful sector reform.

Where PPP’s report addresses training is in their recommendation around the proposed Social Care Leaders Scheme, dubbed the ‘Teach First’ of social care. The care sector is in need of strong leadership, as registered managers are not always sufficiently prepared or trained for a job that carries substantial responsibility.

The Social Care Leaders Scheme, proposed by a steering group of leaders from the social care sector convened by the CareTech foundation, aims to attract high calibre talent to the sector by training bright university graduates for leadership roles in social care, emulating the successful Teach First model. The report calls for the government to reconsider its position on the partial funding of the scheme, which promises to elevate the sector, provide attractive careers, and improve leadership structures.

The HSCC report also focuses on mandatory Care Certificates, which should be offered, at no cost, to care providers, and are transferrable between care providers and the NHS. This is undoubtedly a sensible recommendation, and PPP’s report further recommends the establishment of a Royal College of Care Professionals. The institution of a Royal College would serve the dual purpose of professionalising the workforce and secure an elevation in its status, as well as providing a central body which can represent, support, and oversee the development of, the care workforce.

Finally, the report by the HSCC makes no mention of a vital section of the care workforce: volunteers. PPP finds that volunteers can greatly alleviate the burden on social care professionals and improve the experience of recipients of care. It is essential that volunteers are included in the workforce equation.

PPP recommends that the volunteer sector should be integrated into the workforce strategy and planning for social care, given the substantial value it provides. Further, it warns that the government must act soon to seize upon the enthusiasm for volunteering that built up during the COVID-19 pandemic.

For a truly comprehensive workforce plan which will truly elevate social care and reduce the immense pressure on the sector, these recommendations must, too, be incorporated. For more information on the report, please contact PPP’s Social Care Policy Analyst, Mary Brown, at mary.brown@publicpolicyprojects.com

Featured, News, Workforce

Could a review of cancer and diagnostics staffing and career pathways reverse waiting times?

waiting times

NHS waiting times for cancer treatment and diagnosis in England are now the longest on record, with the Health and Social Care Committee publishing a report urging the government to take action or risk jeopardising patient care.

At the core of the issue is staffing.

The national shortage of nurses, including cancer nurses, is well known – a problem seemingly exacerbated by the pandemic, with a reported 170,000 NHS staff voluntarily leaving the service in the last two years.

Despite being brought into sharp focus most recently, there has, for some time, been mounting concern among healthcare leaders regarding staffing in cancer care, which is why a group of ten NHS trusts and cancer alliances across South East England have been collaborating on scalable strategies and solutions to overcome their workforce challenges.

In partnership with Skills for Health and Health Education England South East, these local NHS Trusts and Cancer Alliances are blazing a trail when it comes to opening up career pathways, finding new and smarter ways of working and streamlining patient journeys, with the aim of transforming cancer care and diagnostic services.

East Sussex Healthcare (ESHT) is one of the NHS Trusts in question and has been a pioneer in the creation of a range of new roles to support Consultants, Doctors, Nurses and Allied Health Professionals (AHPs) caring for patients on the cancer and diagnostics pathway.

Building upon their award-winning rollout of band 3 Doctors’ Assistants across the Trust, which cut the administrative burden of doctors in half, EHST have also developed other new roles to support cancer and diagnostic services.

In partnership with Skills for Health and Health Education England South East, these local NHS Trusts and Cancer Alliances are blazing a trail when it comes to opening up career pathways, finding new and smarter ways of working and streamlining patient journeys, with the aim of transforming cancer care and diagnostic services.

East Sussex Healthcare (ESHT) is one of the NHS Trusts in question and has been a pioneer in the creation of a range of new roles to support Consultants, Doctors, Nurses and Allied Health Professionals (AHPs) caring for patients on the cancer and diagnostics pathway.

Building upon their award-winning rollout of band 3 Doctors’ Assistants across the Trust, which cut the administrative burden of doctors in half, EHST have also developed other new roles to support cancer and diagnostic services.

A new approach to recruitment

Having experienced difficulties recruiting Endoscopy Nurses for its two endoscopy sites in Eastbourne and Hastings, ESHT took the decision to develop the band 3 Endoscopy Assistant role to work alongside an Endoscopist and ease the pressure on its Endoscopy Nurses.

The impact of this new role has enabled EHST to support cancer wait times, says Service Lead for Endoscopy Sue Winser.

“ESHT handles 21,800 cancer referrals, 283,000 X-rays and scans and 7 million pathology tests every year, including 14,500 endoscopy procedures, so the pressure is on.

“Easing the burden on existing staff is crucial in a tight labour market, where specialist skills are in short supply. Our pilot has reduced the need for two nurses being involved in any one procedure – this has massively freed up nursing time, enabling our team to see more patients.” she continued.

Also embracing new roles and routes into cancer care and diagnostics support is University Hospital Southampton NHS Foundation Trust (UHS).

With UHS’s pathology departments handling over 6 million clinical laboratory requests a year, it is hoped that by offering enhanced career progression the Trust will reap its rewards in terms of staff recruitment and retention in harder to recruit services.

Among the various different apprenticeship standards adopted by UHS, the new level 6 Healthcare Science Practitioner apprenticeship provides a platform to achieving the BSc in Biomedical Science and undertaking the role of band 5 Biomedical Scientist.

An evolving workforce

The threat of a mass shortage of cancer nurses including Cancer Nurse Specialists has similarly prompted a rethink of career progression routes by Thames Valley Cancer Alliance (TVCA).

Bringing together cancer leaders, commissioners, service providers and third sector organisations, TVCA takes a whole population approach to improving cancer services across the three Integrated Care Systems of Buckinghamshire, Oxfordshire and West Berkshire (BOB ICS), Bath & North East Somerset, Swindon and Wiltshire (BSW) and Frimley Health and Care ICS.

Key to the approach of TVCA has been to raise the visibility and awareness of careers in cancer. This includes the roles of band 5 nurses as well as of Cancer Nurse Specialist and the Nurse Consultant.

“Faced with an ageing workforce, we took the decision to create a visible cancer nursing (and Allied Health Professional) career progression route from pre-registration nurse through to registered, enhanced, advanced, consultant and strategic leadership to encourage specialisation in this vital field of healthcare.” said Lyndel Moore, Lead Cancer Nurse.

“We want to align to the national Aspirant Cancer Career and Education Development Programme (ACCEND) and in the interim we are supporting the development and training of the different roles for Allied Health Professionals and Cancer Nurse Specialists.’’

Bringing down waiting times

The Royal Berkshire Breast Cancer Service in Reading, which is part of TVCA, has seen patient numbers increase over the last five years. 555 patients were diagnosed with new primary breast cancer in 2021, and a further 211 patients with metastatic breast cancer are in the overall workload, meaning that a total of 1339 breast cancer patients are being monitored by the Centre’s follow-up pathway.

To meet this demand, the Centre conducted a review of the breast cancer pathway and the cancer nursing and other staffing requirements needed to support it.

The Nurse Consultant role was identified as being key in the pathway, and this advanced role, which is embedded in practice, enables care of the patient at an independent autonomous level.

With advanced clinical decision–making and a non-medical prescribing role, running independent chemotherapy and follow-up clinics, giving patients results and discussing treatment options, the Nurse Consultant plays an essential role against the backdrop of a national shortage of Oncologist Consultants.

Better use of resources coupled with clearer career progression routes has provided a platform for Great Western Hospitals NHS Foundation Trust (also part of TVCA) to expand patient support by setting up a new ‘Personalised Care Service’ with the help of Macmillan Cancer Support.

The Service, launched in 2021, is designed to look holistically at the needs of cancer patients, enabling them to self-manage their illness better. The Service received 60 referrals in its first three months alone and is, according to Cancer Nurse Specialist Michelle Taylor of the Macmillan Personalised Care Team, proving highly beneficial in streamlining patient pathways.

“Some newly diagnosed cancer patients can feel overwhelmed and anxious about their diagnosis and pathway. The Cancer Nurse Specialist teams are now able to refer to the Personalised Care Service so we can all work together to help their needs and offer tailored support for improved health and wellbeing requirements.”

Staffing capacity to undertake diagnostic imaging (such as x-rays and scans) too is essential for patients on the cancer pathway and to meet demand for routine imaging.

With the challenges of an ageing workforce, Trusts in the Surrey and Sussex Cancer Alliance (SSCA) struggled to recruit both diagnostic and therapeutic radiographers, before deciding to take a fresh approach to workforce planning.

Rethinking career progression

It was recognised that existing roles had a lack of career progression opportunities. This prompted the Sussex Imaging Transformation Workforce Group – representing services across the region – to facilitate a patient pathway-mapping workshop, which identified a shortfall in the workforce required to undertake routine, elective computerised tomography (CT) examinations.

As a result of this exercise, a competence map was developed with the aim of increasing the skill mix and consistency of roles to meet service needs. Furthermore, it identified the need for a career framework across the CT pathway and to support new roles across the diagnostic workforce, such as the Radiography Department Assistant as an entry point.

Dawn Probert is a Senior Consultant at Skills for Health and has been leading on the project along with Health Education England South East. She comments:

“Workforce planning is crucial to identifying and alleviating blockages in the system that delay diagnosis and treatment of cancer patients.

“Now more than ever, detailed skills analysis and robust workforce planning is required if cancer and diagnostic services as a whole are to meet patient demand in the medium to long-term.

“What this regional project has demonstrated is that there are many positive and transformational approaches and roles which have been developed and utilised to finding solutions to the recruitment, retention and training of the workforce to improve cancer patient journeys and diagnostic services.

“Designed to be scalable, they offer NHS trusts and cancer alliances nationwide innovative tools and strategies to get to grips with recruiting, retaining and developing staff and to meet the increasing demand for cancer and diagnostic services and improve patient care into the future.”

Skills for Health, in partnership with Health Education England South East, has developed 10 cancer and diagnostics workforce case studies and an accompanying Resource Guide to showcase the work of NHS trusts and cancer alliances across South East England. To find out more about the innovative tools and strategies they developed to help with recruiting, retaining and developing staff and to meet the increasing demand for cancer and diagnostic services visit: https://www.skillsforhealth.org.uk/info-hub/cancer-and-diagnostics-careers/

News, Primary Care, Workforce

LDC Confederation: taking an active role in combatting discrimination


Martin Skipper, Head of Policy for the LDC Confederation, discusses how the organisation is taking an active approach to addressing racism, working as part of the London Workforce Race Equality Strategy (WRES), to ensure that the dental profession benefits from the programme of work.

The aim of the London Workforce Race Equality Strategy work is to address the inequality experienced by a large proportion of the NHS workforce. The experience of professionals from black and minority ethnic backgrounds continues to lag behind that of white colleagues.

To address this imbalance, the objective is for the NHS in London to be a more inclusive place to work. The workforce strategy aims to create a step change by increasing the diversity of the workforce and promoting equality, diversity and inclusion strategies. This includes improving the leadership culture and growing and training the workforce. In a recent survey undertaken by the London WRES for Equality and Discrimination in Primary Care, around half of respondents said they had faced some sort of discrimination or harrasment at work, with 39 per cent saying that they had received this from patients. The remaining 29 per cent had been on the receiving end of discrimination or harrasment from colleagues. Of these cases only one third were reported.

Colleagues from Asian or African backgrounds were most likely to be on the receiving end of discrimination, and also less likely to know where to turn for help. Additionally, while ethnicity was the main factor reported to underlie discrimination and harrasment by a considerable margin, gender was the second most common factor. Unfortunately, responses from dental practice were very low, so few conclusions about issues specific to dentistry can be drawn.

Registration data from the General Dental Council, however, shows that many of the issues reported above can be expected to be true in dental practice. Over 50 per cent of dentists on the register are women, leaping to almost 93 per cent of dental care professionals (DCPs). At least 31 per cent of the dental workforce identify as Asian, Black, Chinese, mixed or other non-white ethnicity, with a further 17 per cent unknown. Around nine per cent of DCPs by contrast, identify as non-white, with a further 14 per cent whose ethnicity is not known.

There will be sizeable groups within both parts of the dental profession with at least one characteristic strongly associated with discrimination and harrasment. With 60 per cent of DCPs and 52 per cent of dentists being aged under 40, expectations of professionals will vary considerably from this younger cohort of professionals to their more established colleagues.

The LDC Confederation is supporting dental teams in several ways to make sure that their workplace is inviting and supportive to everyone. One these is working with the National Guardian’s Office to ensure that all practices in member LDCs have access to a clear pathway to a dental guardian. This impartial champion provides support and guidance to those in the dental team who are unsure of where to turn when they have a concern.

As many dental practices continue to be independent providers with relatively small teams, the LDC Confederation act as an impartial body able to support practices and practitioners alike. By providing this opportunity for confidential and impartial support we hope that a more open and accepting culture will be developed in dental practice.

We will continue to work with the London WRES to embed their plans for increased awareness among teams of the issues and behaviours, as well as providing a trusted environment for all members of the dental team to seek support. We will also maintain a campaign of zero tolerance towards harrasment and discrimination from patients. Individual LDCs will be working with their local training hubs to embed training opportunities at the local level and with EDI leads in the Integrated Care Systems to align practice processes and outcomes with those of system wide strategic objectives. Through these combined efforts, the LDC Confederation will continue to take an active approach to promoting equality, diversity and inclusivity in the dentistry profession.

Royal College of Physicians issues stark warning over social care crisis

social care

The Royal College of Physicians is warning that the combination of an ageing population and a lack of NHS workforce planning means the country is risking an unavoidable crisis in social care for older people.

The Royal College of Physicians (RCP) has issued a stark warning that NHS workforce shortages are driving the social care crisis in England and that the NHS is “woefully unprepared to cope with an ageing population.”

New analysis from the RCP shows that there is the equivalent of just one full time geriatrician per 8,031 people over the age of 65 in England. The findings use data from the RCP’s own census of physicians and the Office for National Statistics’ (ONS) population data and demonstrate the extent to which England’s care crisis is only set to grow.

The ONS estimates there will be more than 17 million people aged 65 and above in the UK by 2040, meaning 24 per cent of the population would require geriatric care. Additionally, many of the doctors currently providing geriatric care will, themselves, soon be requiring the same care, and 48 per cent of consultant geriatrics are set to retire within the next 10 years.

Considering these trends, the RCP, along with more than 100 medical organisations, is supporting an amendment to the Health and Social Care Bill requiring the government to publish “regular, independent assessments of the numbers of staff the NHS and social care system need now and in future.” No such data is currently publicly available. The amendment, currently being debated in the House of Lords, was tabled by Baroness Cumberlege and is supported by former NHS England Chief Executive Simon Stevens (now Lord Stevens of Birmingham), is set to be debated in the House of Lords

Responding to the RCP’s warning, Danny Mortimer, Chief Executive of NHS Employers and Deputy Chief Executive of the NHS Confederation, said: “As exhausted NHS staff strive to tackle the enormous treatment backlogs that have resulted from the pandemic, we must not forget about the pressures that our health and social care services face as they work to meet the growing needs of our ageing population.

“To be able to plan effectively for a future workforce, healthcare leaders need clarity in the shape of a clear long-term workforce plan. Sajid Javid’s recent commissioning of a workforce strategy is a very welcome step, but… we would urge the government to accept amendments requiring the health secretary to publish regular, independent assessments of the numbers of staff the NHS and social care system need now and in future.”

The President of the RCP, Andrew Goddard, said: ““I have dedicated my career to working in the NHS – a service that I am fiercely proud of – and yet it scares me to wonder what might happen should I need care as I get older. There simply aren’t enough doctors to go round, not least within geriatrics.

“The workforce crisis we’re facing is largely down to an astonishing lack of planning. All successful organisations rely on long-term workforce planning to meet demand and it’s absurd that we don’t do this for the NHS and social care system. The government needs to accept the amendment put forward by Baroness Cumberlege and make workforce planning a priority.”

Dr Jennifer Burns, President of the British Geriatrics Society, said: “These figures show very clearly the current nationwide shortage of geriatricians – a situation that will only get worse with the predictable rise in the numbers of older people across the UK needing healthcare.

“It is absolutely vital that these fundamental issues around the recruitment, retention, development and support of the workforce are addressed, and that there is a properly-resourced strategy for future needs. The British Geriatrics Society stands with the RCP in strongly supporting the amendment to the Health and Care Bill.”

News, Population Health, Workforce

New IPPR report argues health is ‘holding back UK economy’


The UK will suffer an £8 billion hit to economic activity this year due to lack of government action to improve the nation’s health, according to a report launching the new cross-party IPPR Health and Prosperity Commission.

The IPPR report published today marks the launch of a new Commission on Health and Prosperity. The report warns that health inequalities and ineffective policies are shortening life expectancy in the UK, coupled with more years spent in poor health.

New analysis by IPPR and health analytics company Lane, Clark & Peacock, reveals that the workforce is also being affected as people face barriers to staying in work.

The IPPR is calling for a ‘new post-pandemic approach’ to the nation’s health to ensure that people can live long healthy lives as well as to strengthen the UK’s suffering economy.

There are now more than a million workers missing from the workforce compared to pre-pandemic levels. About 400,000 of these individuals are no longer working due to health factors, including long Covid, disruption to healthcare and declining mental health. The researchers warn that without intervention, this will drag down economic activity this year by approximately £8 billion.

The report states that the relationship between health and the economy is a decisive factor in the UK’s low productivity, low growth and significant regional inequalities.

According to the report, local level analysis reveals that someone living in North East Lincolnshire can expect to fall into bad health eight years than the UK average, while the output of their work is also valued at £8 less than the average. The report argues that this is a vicious cycle and that factors like lack of job opportunities can harm people’s health.

To explore how good health can be the foundation for a fair and prosperous economy, IPPR is launching a new cross-party Health and Prosperity Commission. The cross-party commission will be chaired by Lord Ara Darzi and former Chief Medical Officer Dame Sally Davies.

The report argues that the UK’s poor health outcomes and stagnant economy are a result of poor policy choices. According to IPPR, policy makers must now ‘set about putting the building blocks of good health in place’, including ‘good work, quality housing, local public health services’ and a ‘well-funded and staffed NHS. ‘

Dame Sally Davies, former Chief Medical Officer and co-chair of the Commission on Health and Prosperity, said: “A fairer country is a healthier one, and a healthier country is a more prosperous one. While the restrictions have eased, the scars of the pandemic still remain deep on the nation’s health and our economy.

“Not only are we facing a severe cost of living crisis, driven in part by pandemic induced inflation, we’re also experiencing a workforce shortage driven by poor health that’s holding back the economy. It has never been more important to put good health at the heart of our society and economy – and our commission will bring forward a plan to do just that.”

Matthew Taylor, NHS Confederation chief executive and commission member said: “The pandemic has shown how deep health inequalities shape and cut across the lives and livelihoods of people across the country.

“Yet this is not new, disparities in health have not suddenly appeared, they have been part of the make-up of our society for decades. As millions of people now face the reality of a cost-of-living crisis there is an urgent need for a much bolder and more strident approach to tackling inequalities to create improved population health and stronger economic wellbeing.

“We are delighted to be part of the Commission on Health and Prosperity and look forward to reflecting member insight. ”

News, Social Care, Workforce

Care employers come together for Ukraine

Care employers

With the conflict in Ukraine raging, care employers are working together to provide opportunities for those displaced to work and find a home in the UK.

Care employers have been working together to understand how they can provide a meaningful employment opportunity for those displaced from Ukraine and other parts of the world and finding a home within the UK.

The National Care Forum (NCF), the leading association of not-for-profit care and support providers, in association with the Care Provider Alliance, have brought together a wide range of partners committed to offering support. This includes expertise from across national and local government, housing, recruitment specialists, legal and immigration experts and regulators.

Employers and partners are working closely with recruitment experts to enable displaced people from Ukraine and other parts of the globe to identify roles within the care sector, direct individuals to localised support and ensure that employers work together to provide the best opportunity for those who wish to work.

While this work progresses, the broader support for people displaced from Ukraine through the Homes for Ukrainians scheme is being clarified. Alongside this, local government has an important role in regards to how local support will work, and specific roles and responsibilities are still emerging. It is imperative that the desire to work is aligned with the need for displaced people to be connected into wider community and pastoral support.

Vic Rayner OBE, CEO of the NCF said: “Like many people affected by the plight of the people of Ukraine, care employers are pulling together to take action to help. The ideas are progressing at pace, and there is a strong desire to do something meaningful to help the people of Ukraine, and others from around the globe who arrive into the UK.

“We are pulling together opportunities for care and support employers to share details of available job vacancies, which we hope will be tied into the broader communications for displaced people. There are many other ways for people to offer support, including support to Ukrainians needing care and support, assistance with vetting and matching, and those who have a housing solution.

“However, there remain significant unanswered questions around regulatory requirements, right to work entitlement, safeguarding, etc. We need the government to work at pace alongside adult social care employers to resolve this. Furthermore, we are working with other partners, to understand how most effectively the sector can be engaged to provide a solution at this moment of crisis.”

More support needed for “fatigued” social care workforce

Social care

On the 16th March 2022, Public Policy Projects (PPP) hosted an evidence session entitled The Social Care Workforce: Averting a Crisis as part of its report series The Future of Social Care. PPP’s Social Care Network examines the most urgent issues facing social care and presents tangible solutions to address workforce challenges in the sector.

The crisis facing the social care sector is fundamentally a workforce one. The sector itself is a large employer in the UK, employing about 1.54 million people, equivalent to five per cent of the workforce. As one participant noted, “the sector itself is a huge contributor to the economy and to society”. Given that staff pay is the single biggest expenditure faced by care homes, workforce management should be front and centre whenever system finances are being considered.

Even before the pandemic, there were about 112,000 social care vacancies in England, with jobs paying only £8.50 an hour. Following the pandemic, the vacancy figures are assumed to be worse. Key issues driving individuals away from working in the social care sector include low pay, stressful working conditions and a low sense of worth.

A participant of the evidence session emphasised that the working conditions of the social care sector have led to 74 per cent of care professionals reporting that they regularly experience stress at work, an average number of sick days 25 per cent above the national average, and a staff turnover rate significantly higher than the national average.

As phrased by one participant, social care is suffering from a “fatigued workforce” not only due to the pressures of the pandemic, but issues which have existed within the sector for much longer. The problems within the social care workforce are chronic , and are considered by many to constitute a crisis. As one participant said, “clearly a workforce strategy is one of the absolute essentials that we need to have to make a success of the sector over the next decade or so”.

“The social care sector should work alongside recruitment organisations to recruit young, bright people into social care, and help them consider where a career may lead.”

One problem identified was narrow recruitment to the sector. It was stressed that within social care, “we should cast our nets wider in a recruitment approach… and recruit not only people with previous experience”. The social care sector should work alongside recruitment organisations to recruit young, bright people into social care, and help them consider where a career may lead.

It was also suggested that more effort must be made to recruit hard-to-reach and underemployed groups, including people living with disabilities, and immigrant workers. “What frustrates me is that there are individuals in these groups who can be wonderful, caring staff [but]are missed, because hiring managers are too narrow in their focus”, said one participant.

Staff retention rates in social care are low. Network members noted that social care workers often leave the sector for other, similarly paid jobs, such as retail roles, while few choose to leave and work for the NHS. One network member identified that “between care assistants in the NHS and the social care sector, there is around a 23 per cent deficit in social care. The terms and conditions are vastly better in the NHS. Pensions, sick pay, overtime and unsocial hours all contribute to that deficit.”

Essentially, social care workers are underpaid and undervalued. For both better recruitment and retention, social care workers must be appropriately paid and treated as though they are valued. Some network members identified low pay as the key driver for individuals choosing to leave the social care workforce, and yet, it was emphasised that social care is a both a skilled and psychologically demanding profession, and should be commensurately well-paid.

However, funding in the system is limited, and paying the workforce is the sector’s single biggest expense. One participant said “there is not a settlement from government or local government that actually meets the cost of care to enable us to pay a proper wage for the level of skill, ability, responsibility, dedication that [care workers] have”. Furthermore, a high proportion of social care workers are on zero-hours contracts; in London, this figure stands at 41 per cent of social care workers. Therefore, many social care workers have to deal with pay inconsistency and insecurity, on top of being low-paid.

“Network members were in agreement that social care is, and should be publicly regarded as, a skilled profession.”

While pay is regularly described as the most pressing issue in the workforce, one participant argued that in their experience of conducting exit interviews with workers, it is not low pay, but rather a low sense of worth which leads people to leave the profession. While higher pay is one way in which care workers can be practically appreciated, it was agreed that more must be done to value care work both by improving the public image of care workers and ensuring that internal structures provide support and give value to workers.

Network members were in agreement that social care is, and should be publicly regarded as, a skilled profession. “It is not the kind of job that everyone can do,” said one participant. “It is a skilled job, which requires the creation of quality human relationships and working with people who have complex care needs… it is a real skill and should be regarded as the same as working in health.”

Social work is challenging and worthy of respect, all participants agreed. One commented that “no two days in social care will be the same; you have to be agile and move with that, so it does take very special people to take those roles”. The public status of social care work must be elevated to reflect this, and the workforce to feel appropriately valued if these retention issues are to be effectively addressed.

Securing an integrated future

For a supported workforce, good leadership is essential. One participant noted that in the social care system “there is a varied approach to leadership”, and good leadership is not always evident in the system. Given the demanding nature of social care work, it is essential that carers feel well supported in their roles. One participant added that “workers do not stay because of a good job, they stay because of a good manager”, and therefore, proper leadership training must be a central goal of the workforce plan.

A practical solution suggested by one of the network members to combat low recruitment, retention and the poor image of the profession was a ‘social-care-first’ scheme, mirroring the successful teach-first scheme. Many other sectors have emulated the ‘teach-first’ template with great success. The aim of the scheme is to engage with young people to consider social care work as a career by espousing the value of a career in care. Such a scheme would emphasise how care work has the potential to transform the lives of dependent individuals, and the importance and value in building personal relationships with system users, improving the image of the profession. As part of the scheme, there should also be structured leadership, coaching and mentoring training, for the purpose of also transforming the quality of social care. This may serve to solve some of the leadership issues in the sector, as young and bright individuals will be well trained to manage and lead social care in the future.

Now that the NHS and social care are moving towards integration, participants noted that for a true and fair integration of the systems, employees should be paid and treated equally. One participant called for a joint recruitment scheme for the NHS and social care, with equal pay offered. It was also emphasised that NHS workers receive many ‘perks’, particularly since the start of the pandemic, which social care workers do not (including food and drinks discounts from certain companies).

Other suggestions to aid the integration of the NHS and social care workforce included social care placements and secondments for NHS staff, in which they are exposed to social care, and the richness and value of social care work. The status of care work must be elevated for proper integration of the two systems can occur, in order that social work and NHS work can be equally respected.

A large part of the discussion focused on the role of volunteers within the social care sector, and the value they bring to both paid carers and system users. Volunteers are an invaluable part of the social care workforce given that they reduce pressure on care workers, improve patient experiences, facilitate higher quality of care to drive better health outcomes, and strengthen community connections. One participant said that in the context of social care, “volunteering is a public health tool. There is a body of medical research which talks about the huge benefits for mental health and physical wellbeing for patients”. Volunteers also serve to raise the visibility of the social care sector.

Since the start of the Covid-19 pandemic, the UK has seen an unprecedented rise in the numbers of people volunteering in their local communities. During the pandemic, the UK had 12.4 million people volunteering in their local communities. 4.6 million of these were first-time volunteers. Currently, the UK has a window of opportunity to make the most of the interest in volunteering to reduce the immense pressure on care workers.

As part of the workforce strategy, there needs to be investment to drive the volunteer sector, for the wellbeing of the social care system and its users. However, time is undoubtedly of the essence; as one participant emphasised, “there is an urgency to the conversation we are having. As Covid dissipates, what we don’t want is for people to go back into the corners of their community and not come out again to contribute.”

Digital Health Academy to provide free digital skills training

Digital Health Academy

The Digital Health Academy opens today and aims to provide free digital skills training to all NHS staff by 2031.

From today, the Digital Health Academy, a free, digital training tool for NHS frontline staff, is in operation. Aimed at providing digital skills training to all NHS staff by 2031, the modules are now freely available on the Health Education England NHS Learning Hub. As highlighted by Health and Social Care Secretary, Sajid Javid, in a recent speech, it’s crucial that the NHS improves digital provision across all health and care services and the Digital Health Academy aims to address this by building on the digital skills of all NHS staff.

A survey from the Organisation for the Review of Care and Health Apps (ORCHA), reveals that although 65 per cent of the public are open to trying digital health technologies, only a fraction of tools are recommended by health or care professionals.

In total, amongst those using digital health, only a small proportion of recommendations came from healthcare professionals, with 17 per cent of recommendations coming from GPs, eight per cent from hospital doctors, and two per cent from nurses.

The need to support a digitally ready workforce has been highlighted by the NHSX Readiness Plan and the CPD-accredited Digital Health Academy responds to the critical requirement to invest in developing front-line skills for digital health through professional development.

Currently, there is still no mandatory digital health training for health and care professionals, and the courses that frontline workers can attend are often scarcely available. In response to this need, ORCHA, with the support of universities and healthcare professionals, and with financial support from Boehringer Ingelheim, developed the Digital Health Academy, the foundation level modules of which will be freely available at orcha-academy.com and on the Health Education England NHS Learning Hub.

The academy’s online training modules are designed specifically for frontline health and care professionals who want to use and recommend digital health tools but have been struggling to access the knowledge to do so safely.

ORCHA has created the infrastructure of the online training portal and designed courses, drawing on experience gained reviewing more than 17,000 health apps and operating health app libraries in 70 per cent of NHS regions.

The Digital Health Academy’s aims include:

  • Free access for all NHS and social care staff
  • Availability on Health Education England NHS Learning Hub
  • Enabling staff to gain Continuing Professional Development (CPD) points in a vital new area of professional development

The CPD-accredited Digital Health Academy programme includes:

  • Short, bite-sized learning modules to suit busy schedules, which can be accessed at any time
  • Two foundation modules which explain the function of health apps, the current digital health landscape, the barriers to using and adopting digital health and the importance of prescribing good quality digital health products
  • Coming soon, a series of specialist modules including topics such as digital health for mental health, diabetes, physiotherapy, long Covid and winter pressures

Commenting on the academy’s resources, Dr Neil Ralph, Head of Health Education England Technology Enhanced Learning (who has previously written about the need to prepare the NHS for digitally-driven healthcare), said: “COVID-19 accelerated the rapid adoption of digital health across health and care services and the need to embed digital health in the long term. We are delighted that ORCHA has contributed its Digital Health Academy foundation content to the Learning Hub and look forward to hosting new content in the future, further supporting health and care professionals in their roles.”

Learning about the value the Academy offers frontline staff, Boehringer Ingelheim committed to sponsor the foundation modules. This has enabled it to be opened up at no cost to health and care professionals. Commenting on this, Uday Bose, Managing Director at Boehringer Ingelheim UK & Ireland, said: “There’s widespread recognition of the need for digital health training for frontline workers, with organisations from the King’s Fund to the Royal College of General Practitioners calling for it. With six million people now waiting for elective care, and with first-class digital tools available which could support healthcare workers with many of the high volume and low complexity cases, the need to improve digital skills and digital confidence in the NHS has become critical. We felt the academy was a perfect way to address this very real need amongst frontline staff.”

Ahead of the launch, the academy has been introduced to professionals using the ORCHA digital health libraries to a positive reception:

Dr Michelle Webster, Chief Clinical Information Officer & Consultant Clinical Psychologist at Coventry and Warwickshire NHS Partnership Trust, said: “The ORCHA Digital Health Academy has helped to demystify digital health, strengthen our clinicians’ digital skills and boost their confidence in using healthcare apps. The bite-sized modules are easy to follow, interesting and relevant and designed to flexibly fit around their busy jobs. I would highly recommend.”

Najia Qureshi, Director of Education and Professional Practice, British Dietetic Association, said: “This is a really welcome resource for our members, who work across the NHS supporting patients with a wide range of health conditions. Innovation in healthcare is introducing new ways of working and is transforming patient care. This programme will help dietitians and other health and care professionals to develop the professional skills needed to confidently use and recommend the right digital health products – helping patients to benefit from digital healthcare.”

Reviewing a foundation module course, Dr Joel Brown said: “It takes quite a paradigm shift to move physicians away from seeing prescribing as an exclusively pharmaceutical enterprise. As medicine is increasingly digitised, clinicians need to take seriously the opportunity to prescribe digital health. The course by ORCHA, as part of their Digital Health Academy, makes this point brilliantly.”

Taking practical steps to address a growing crisis in domiciliary care

domiciliary care

John Bryant, Head of Strategy and Development for Torbay Council, outlines a series of practical steps to enhance the role of the care worker and address the growing crisis in domiciliary care.

The solution to the domiciliary care crisis is to enable the sector to do more, not to simply ask more of it. The distinction is important, as the development of integrated care provides opportunities to enhance system efficiency like never before. And yet, the scope of what could be asked of, and performed by, trained, supported, committed community-based practitioners is yet to be fully explored or achieved.

All the while, the expectations of those receiving care, and certainly those considering a future career in health and care, are greater than they have ever been.

To meet these ever-rising expectations, system leaders are likely to find fertile ground in looking to better embrace the assets that already exist within the system. This includes domiciliary care workers, whose skillset could be expanded and developed, a move that could encourage others into the system. This can happen by re-positioning the expectation, skills and rewards to produce and provide, for example, enhanced wellbeing services (EWS) provided by enhanced wellbeing practitioners (EWP), of which domiciliary care is a major component among a portfolio of beneficial interventions and service provision.

The 6Cs of care are prevalent within our frontline domiciliary partner staff; the opportunity is there to optimise their engagement and knowledge of patients and clients to:

  • Support retention and recruitment
  • Respond to the discharge and reablement challenges
  • Drive early intervention and prevention
  • Offer a developed interface with general practice
  • Engage with population health management

The support of these four key drivers for public service change: politics, policy, measurement and money, are positioning us as never before to achieve success. The government’s social care reform white paper, People at the Heart of Care, connects to the £5.4 billion pledged for adult social care reform between 2022 to 2025. It is notable that healthcare is a major beneficiary of this funding in early years, however within the policy of integrated care the opportunity exists to bring about radical, beneficial system reform from the outset.

“Together, these measures aim to put people at the heart of social care and move us towards our 10-year reform vision.”

(Department of Health and Social Care, 2022).

These themes were also present in the subsequent integration white paper, Joining up Care for People, Places and Populations. The measures set out in the paper provide clear areas of opportunity, focus and policy support.

A growing crisis

These government white papers are in no small part a response to a care crisis the likes of which we have never seen. One key element of that is domiciliary care, the unseen service that is delivered behind the front doors of our communities to keep people safe, comfortable, medicated and cared-for. For over a decade the policy has been to bring care closer to home, and the People at the Heart of Care paper reinforces that. The Covid-19 pandemic has compounded the need to ensure people are cared for and supported in this way, minimising their movement between different health settings to reduce infection risk.

“The endeavours of care providers to recruit at this level should be celebrated alonside any other part of the system that has been able to do the same”

Present estimates indicate that there is a care shortage/vacancy rate of 17 per cent which equates to at least 100,000 jobs based on Skills for Care data in England. Given the challenges in recruitment felt by providers, there can often be a projection that care providers are not ’good‘ at recruitment. However, in looking behind the headlines we find that in one area, Torbay, care providers have increased their capacity through recruitment by 39 per cent in the 18 months leading to September 2021. The problem is that the demand for their services has totally outstripped this staffing influx, increasing by 47 per cent in the same time period. This trend is consistent across the country’s health and care ecosystem.

The endeavours of care providers to recruit at this level should be celebrated alongside any other part of the system that has been able to do the same. If organisations who have been able to recruit as well as Torbay have done are finding it difficult, is it probable that any other part of the system will do better?

The Health Foundation recently published research suggesting that over a million more health and care staff will be needed in the next decade to meet growing demand for care. What is clear is that these shortages were well established trends before the Covid-19 pandemic. If the challenge of capacity is to be permanently addressed, then retention followed by recruitment is essential – as any marketing of roles from ‘the system’ will be trumped by the messages communicated by those working in or leaving the services.

Recognising a new future, communicating that and providing examples of what could be achieved will produce opportunities for beneficial results.

Practical steps

In this respect, returning to the domiciliary care issue, what might emerge if we were to turn the issue on its head?

To address the crisis currently seen in domiciliary care, I propose a series of practical steps to enhance the role of the care worker and to use the ICS framework to transform system level efficiency:

  • Addressing the domiciliary care shortage: expand the potential of the service and provide those delivering it with more responsibility and control by becoming EWPs
  • Supporting the community nursing challenge: offer them the opportunity to have a wider team of EWPs at their disposal; enable them to work to the top of their licence
  • To address GP availability: create neighbourhood teams of EWPs that are able to be with patients, directly support with digital literacy and connectivity, and be a physical presence to further enhance the experience of the remote general practice
  • To reduce A&E admissions and improve the discharge process: use EWS to support the safe discharge of increasingly complex patients to optimise recuperation in at-home settings, have the digital skills and tools to monitor and report e.g. RESTORE2 for early intervention and re-admission avoidance, and be able to support reablement; the stepping stone to independence
  • Develop greener care:reducing mileage by minimising cross-overs between staff and building a wider multi-disciplinary team

The practical possibilities for this are supported by the further development of the Allied Health Professionals strategy. The publication of the Allied Health Professions’ Support Worker Competency, Education and Career Development Framework received support from Trades Unions, Professional Bodies and Trade Union partners. Whether it is development within roles or providing new career paths, new forms of offer and opportunities are going to be central in encouraging a post-Brexit, domestic workforce into the social care and health sector; along with producing the impact value of those roles and associated care interventions which enable commensurate levels of pay and reward.

Underpinning all endeavours and quality care and support are the 6Cs of Care. These emerged as part of ‘Compassion in Practice’ and were rolled out by NHS England to all staff in 2014 with subsequent promotion to the wider care sector by the national body Skills for Care.

“But what cannot happen is that domiciliary care continues to be overprescribed without receiving more support or being allowed to expand its offering”

The characteristics of commitment, care, compassion, competence, communication and courage are prevalent throughout our community care partners and their staff. With that commonality between the professions what might we do to deliver even more fulfilling roles: more people doing fulfilling roles, more fulfilment within the roles, more roles in addition to the present ones that are also fulfilling?

6 Cs of CareThe alchemy that will bring this about is within the gift of every system in England and available to all domestic nations. It is the meaningful flourishing and delivery of an integrated care system (ICS). The ‘holy grail’ of ICS development is to provide timely, personalised care that maximises the independence of the individual receiving care which, naturally, points to a home-based solution. But what cannot happen is that domiciliary care continues to be overprescribed without receiving more support or being allowed to expand its offering.

This article seeks only to look at one small area of that; however, it is a vital area, being felt by the 957,000 people in the UK that receive domiciliary care and their families, along with the 822,000 staff looking after them (as recorded by RCN surveys). This, quite rightly, is now receiving both political support and national media attention.

The pandemic should be recognised as a catalyst for accelerated change, avoiding any sense of ‘once we’re through this we can get down to business as usual’. What has been done, and is being done in response to the pandemic, has demonstrated the creativity and pace of change possible as system partners have collaborated. Fostering and building on that is in itself both an opportunity and a challenge.

Across the sector there are understandable concerns of implementing radical service reform on an already exhausted and beleaguered workforce. But there are examples we can look to where workforce wellbeing is protected while simultaneously enhancing capacity and quality of care that motivates staff.

Domiciliary care

Some facts from one system

To service 800 clients in a 75-mile geographical perimeter, home care staff drive almost one million miles per annum. In work supported by the Health Foundation, it was found that at a (sub)urban travel speed averaging 20 mph, over 43,500 hours were being spent in vehicles; a substantial proportion of that could be put to new ways of working.

Work has shown that by reorganising the rounds, 5,220 hours of care could be released from the existing workforce. This would provide opportunities not only for more care to be delivered but importantly, and in respect of future retention and recruitment across the system, time for wellbeing, supervision, learning and development, accreditation of skills and assurance in their application. And with no extra hours of care being purchased.

In terms of application and the development of broader multi-disciplinary teams within ICSs, it was established that of the community nursing patients nearly 20 per cent were also social care clients. People were being visited by multiple staff in one day, requiring travel from multiple staff.

There are of course many activities and health interventions which can only be done by those with nursing and clinical qualifications. However, in approaching this issue with a mindset of curiosity, courage and compassion there are many interventions that could be performed in different ways.

For instance, one of the many activities that domiciliary care staff undertake is washing and creaming clients’ legs when there are wounds to be attended to. Nursing staff will then arrive to apply a bandage. While certain grades of wound clearly need nursing attention there are many at lower levels of severity that are capable of being attended to by a well-trained EWP – and of being checked on regularly, though less frequently, by the stretched community nursing complement.

Benefits of EWS for participants and for system development

Enhanced wellbeing practitioners:

  • Feel respected and able to develop their domiciliary care roles, feel even more a part of the system and that their contribution is valued. This could lead to enhanced profile and esteem. The additional activity means more time with the client and the opportunity to further enhance the relationship that exists
  • Opportunities will be presented to work in strengths-based ways and with programmes such as Making Every Contact Count, leading to enhanced wellbeing of the clients and a development of their connectivity and circle of support
  • This leads to improved job/role satisfaction – improved retention leading to increased recruitment. Developed circle of support for clients, enabling them to step up towards independence and reduce their reliance on statutory interventions. Release of capacity for those with assessed needs to have their needs met and begin their journey towards well-being

Community nurses

  • Feel an increased level of support with a bigger, more integrated, team available to them. They are then able to work with the more complex cases and make the very best use of their skills and knowledge while enabling and supporting other integrated team members to develop
  • Through enabling better management of case-loads, job satisfaction is increased and stress is reduced. As the RCN has established, with 75 per cent of community nurses reporting that they had left necessary activities undone, the professional dissonance of the role is alleviated, supporting staff wellbeing and retention
  • With the nursing and Allied Health Professional colleagues active in this way, early intervention and reductions in exacerbations of conditions lead to reduced admissions. With greater capacity, along with the skills to manage more complex discharges, hospital flow is improved

domiciliary care

Benefits of EWS for health providers

Admissions through A&E:

  • Are reduced by earlier interventions and the ability to deploy the highly skilled staff in the community to support patients and reduce the deterioration in their condition
  • Improved flow through A&E with reduced admissions, enhancing the wellbeing of staff as well as the patients, and contributing to the enhanced application of funding to meet elective care

Discharges and re-admission rates:

  • Are further improved with the skills and capacity made available to support increasing numbers of and increasingly complex patients. With the integrated approach to working and early intervention opportunities, people are supported to remain at home, with their condition even better managed and do not require a re-admission to hospital
  • Skills and capacity across the community integrated team are available to support timely, safe discharge from hospital and discharge to assess and ensure people remain at home
  • The patient/client gets less ill and recovers more quickly being supported by a team that has the resources, capacity and skills to meet their needs. This increases the ability for them to remain well or recover quickly in their home setting, which include care homes and supported living
  • Increased numbers of people cared for closer to home with reduced exacerbations in conditions. Complex clinical requirements being met in community settings with both care-giver and the patient having a well developed strengths-based relationship throughout the care and support period, enabling a step up to independence

domiciliary care

It is understandable that there will be anxieties associated with the shift in activities. In order to ascertain who delivers what and where to achieve the five aims of population health management (as illustrated below), the mantra to hold onto is right person, right care, right place, right time. Risk-managed prototyping using good design methodologies is key and implicit within the title on the tin of sustainability and transformation partnerships (the predecessor to ICSs).

There are many practical examples already available and still plenty of headroom for further development, which will accelerate the transformation in health and care models which are both sought for and needed.

Covid has shown us how much can be done in a short space of time; even with all the pressures in the system, GPs, acute trusts, AHSN and domiciliary care providers worked together to train 148 staff in the RESTORE2 methodology in just three months, with some going further to be trainers themselves.

Practical steps to developing and implementing enhanced wellbeing services

  • Train domiciliary care and care home staff to use the protocols and develop relationships with primary care practices
  • Ensure that training is accessible and that the nursing staff are corporately supported in the delegation of tasks
  • Look to see if care packages are allocated by geographically focussed provider or on first-come-first-served basis, and what the mileage component to the care rounds is for providers
  • Review the wounds being attended to in community settings and what best practice can offer in tackling the £5 billion cost of wound management
  • Consult on ways in which the Allied Health Professions’ Support Worker Competency, Education, and Career Development Framework can be optimised
  • Get the best facilitators and design thinkers, often found outside the system, to help ask the questions, listen and gather the answers and develop action-orientated plans with system partners – which includes the care unit, the patient/client and those caring for them

Whichever of the four policy drivers (politics, policy, money or measurements) one wishes to consider, they are captured within the Five Aims of Population Health Management; moving to EWS and development of the practitioners supports their delivery. Beyond this the one element that is maybe more implicit within the ‘petals’ below is capacity. EWS supports this explicitly.

domiciliary care ews

Achieving more with less

In summary, below is the 30-second elevator review of how we can achieve more with less on the topic of domiciliary care.


  • Time to care, more time to be more caring
  • Development and enrichment of roles
  • Person-centred care
  • Satisfaction with the role
  • Retention
  • Recruitment
  • Prevention and early intervention


  • Dissonance in the role and 6Cs
  • Siloed working
  • Variation in care team and discontinuity of care
  • Dissatisfaction with roles and system design
  • Turnover and leaving before retirement, or at the earliest opportunity
  • Vacancy and cost to trying to encourage people into services
  • Illness and cost

Addressing the care crisis

With the job-seeking public indicating that insufficient numbers of them wish to work in domiciliary care, now would be the time, supported by the policy of integrated care, to develop a new offer that enables truly integrated roles. This should seek to provide enhanced wellbeing services through an increasingly broad, multi-disciplinary, person-centred team.

To address this multifaceted care crisis, we should do more than seeking to invite people into traditional domiciliary care. The system might benefit from offering people a new role(s) that encompasses the domiciliary care that they are proud to already be doing, but also one that offers development, inclusion, satisfaction, esteem and commensurate compensation. This could become increasingly available if and when ICSs fulfil the potential that exists; one that reflects those stated aims within the recent white paper(s) and meets the five tenets of Population Health Management.

This should also note the observations of the CQC and their likely support to engage in discovery sessions for regulation alignment towards new ways of working. In doing so this should create a virtuous cycle towards a sustainable system, both financially and with capacity, through the delivery of integrated care.

John Bryant is Head of Strategy and Development for Torbay Council and an ICJ contributor. To contact John, become an ICJ contributor or to obtain a full reference list for this article, please write to news@integratedcarejournal.co.uk, and one of our Editors will assist.