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Co-production demands radical rethinking of the health and social care workforce

Brendan Martin, 29 April 2015

When we talk about the workforce in health and social care in Britain we usually mean the more than 3 million employed by the NHS and local government and in the private and voluntary sectors.

But since taking part in a workshop on co-production of new models of care organised by Guys and St Thomas’s NHS Foundation Trust (GSTFT) last week I have looked on the health and care workforce in a new way.

My colleague Tamsin Fulton and I took part in the workshop because Public World is working in partnership with the trust’s Adult Community Services to develop new models of care at home.

One of the most exciting aspects of the event was that its composition and design mirrored its co-production theme.

The participants represented not only the Trust’s professional nursing staff, from director to trainee level, but also senior social care leaders from the two London boroughs served by the trust, Lambeth and Southwark, as well as representatives of community organisations, patients’ and users’ groups.

We spent much of the afternoon in groups in which this diverse range of participants discussed -- on equal terms, no ‘them’ and ‘us’ -- the challenge of improving community services.

Even the themes of the group sessions were defined by the participants themselves, and the theme of the group in which I took part was proposed by a community representative of the Citizen Board of Southwark & Lambeth Integrated Care (SLIC).

She gave it the title “Radical rethink of the workforce -- paid and unpaid -- across health and social care’. As well as her and me, the group comprised a practice nurse, a trainee community nurse and a representative of a well-established local community organisation.

Its key conclusion was that we need to understand the workforce broadly, as composed of not only paid health and social care staff, with varying professions and levels of qualification, but also unpaid carers, and -- crucially -- patients themselves.

“It is accepted in principle that good care demands all these people working together effectively and cooperatively, and yet systemic and other obstacles stand in the way,” the group agreed in its conclusions.

It heard from a nurse who, on arrival at a patient’s home to give a flu jab, found and responded to a number of other problems too. This meant staying much longer than anticipated and facing criticism on return to the GP practice for exceeding the pre-planned purpose of the visit.

Yet surely the nurse interpreted the professional duty of care appropriately, by putting actual perceived need above pre-determined time and task? The discussion group certainly thought so but agreed too that systemic change is required to normalise such autonomy.

The group identified a range of barriers to enabling paid and unpaid participants in the care process to work more effectively together. It agreed that staff need more time to train patients and unpaid carers in meeting their own needs safely and effectively, and the professionals themselves need support, time and training to do that.

Clinical qualifications need to be complemented with training in areas such as interpersonal communication, team working and time management to achieve the skills mix required to enable co-production to realise its tremendous potential.

Health and social care of the future will depend on dissolving the provider/recipient divide into cooperative relationships of shared responsibility in which all participants work as a team in accordance with their training and ability.

That means working across organisational and departmental boundaries, of course, but it also means understanding the nature of care relationships in ways that the minutely defined specifications of the contractual model not only fail to capture but actually distort and undermine.

By paying more than lip service to co-production in the design of last week’s workshop I suspect the GSTFT leaders concerned have foreshadowed the future of co-produced health and social care not only in south London but beyond.

It will indeed involve a ‘radical rethink of the workforce -- paid and unpaid -- across health and social care’.

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