The Ward Round: ‘One workforce’ – the tough ICS to-do list

The deadline for all integrated care systems to become statutory bodies is edging closer and the NHS is picking up the pace in order to meet it; recruitment was launched this week for the 42 ICS chief executives and further guidance was published on the workforce objectives that systems are expected to focus on.

Although getting everything done on time is going to be challenging – as discussed in detail in this recent HSJ Health Check episode – it is an opportunity for systems to recruit their leaders and boards from scratch and mould the organisation to fit their population’s needs.

In the new NHS England workforce guidance, which supplements the ICS design framework published earlier in the summer, it sets out that NHS leaders will be expected to work with ICS partners to deliver “10 outcome-based people functions from April 2022”.

The ICS’ ‘People-function’ – a robotic-sounding phrase referring to the workforce-related activities it must deliver – outlined in this document are ambitious; from leaders ensuring their organisations “leverage their role as anchor institutions” to creating a “vibrant local labour market’ and ‘one workforce’ across the ICS. For systems without a history of working together, the latter could be particularly tricky.

The 10 workforce ambitions are linked to the People Plan and the People Promise, with the very first ‘outcome-based function’ calling on systems to ensure its people are supported in their physical and mental health wellbeing, enabling them to provide “high quality, compassionate care to patients”.

Despite this encouragement, could the speed at which this work must be done threaten the ability of systems to put workforce at the heart of what they do?

One of the most interesting aspects of the guidance is the requirement for systems to “utilise the ICS’s intelligence function” to understand how the workforce and skill mix are likely to change in response to future population health needs.

Alongside this, systems must also provide data to regional and national workforce teams to support workforce planning and agree a system-wide approach to analysing this data.

The links between this and the work already being done by trusts to report workforce gaps is not yet clear and questions also remain as to how this data will be published. It is surely time for the secrecy around NHS workforce planning to end.

Practise what it preaches

It is of course important for systems to create healthy cultures in which to work; and whether they have done this successfully will become more apparent after their first NHS staff survey results are published.

On the subject of this, staff survey results specifically from the staff experience and engagement sub-directorate within NHSE’s People Directorate suggest more needs to be done to lead by example and improve working practices and culture at the centre.

According to the results, seen by HSJ, and collected in October 2020, 65 per cent of staff within the sub-directorate reported they have come to work despite not feeling well enough to perform their duties and over half have reported suffering from work stress. Overall, the directorate scored 6 out of 10 for health and wellbeing. 

Although this is just a temperature check from a small group of around 50 people, it does give quite an interesting snapshot of a group set up to transform working conditions for NHS staff across the whole of England.

Michael West, professor of work and organisational psychology at Lancaster University and senior visiting fellow at the King’s Fund, told The Ward Round, NHSE/I should “ideally be a model for what it is advocating for trusts across the country.

“More fundamentally, if NHS England and NHS Improvement does not have a healthy and inclusive culture, it is less able to fulfil its purpose of supporting trusts,” Professor West said.

“I think what needs to be done is for NHSE/I to make use of the culture transformation programme it advocates for trusts and implement this comprehensively and in a sustained way [itself],” he said.

NHS England makes it clear a lot is expected of ICSs when it comes to fostering a healthy culture and strong leadership - but it must also ensure all parts of the national team are putting this into practice too.