Overview of the current call for integrated health and social care services in England, the rationale behind the push for integration, the facilitators and barriers to this way of working, and the related workforce and funding issues.
The following key messages can be drawn from
the story so far.
Skilled nurse leadership is fundamental to the integrated care setting, through management roles, providing input into decision-making processes (for example, organisational structure, staffing and commissioning) as well as clinical leadership and care delivery.
Nursing expertise must be recognised and utilised at all levels of the commissioning process. The ability of nursing staff to view whole care pathways and to take holistic perspectives that go beyond day-to-day clinical issues affords them a vital role in supporting commissioners in their decision making.
Effective multidisciplinary and multi-sector workforce planning coupled with sufficient funds to train the workforce for new ways of working, will be fundamental to achieving the goal of creating effective, safe and high-quality integrated services.
Any philosophical and ideological differences between the professions brought together within MDTs need to be addressed in order for the team to be able to work in a truly integrated way.
There needs to be greater clarity about how the £3.8 billion given to the Better Care Fund is actually being spent and more information on the resulting outcomes, both positive and negative.
There must be consistent political focus and strong leadership provided at local, regional and national levels, to ensure appropriate mechanisms including funding, are created that will enable the delivery of effective, safe and quality integrated care, for everyone who needs it (RCN, 2013).
In addition to these system issues, the RCN sees
the following issues as crucial in the further
development and promulgation of integrated