Integrated Care Systems in Workforce Development England - consultation response

In May 2019 we responded to the NHS Confederation consultation "Defining the Role of Integrated Care Systems in Workforce Development". We welcome the role of Integrated Care Systems but raise concerns on the devolution of workforce planning and the finance-driven approach.

This is a response to the NHS Confederation consultation on Defining the Role of Integrated Care Systems in Workforce Development.

Our response

  • The proposed role and responsibilities of local systems for workforce development would create a further barrier between workforce planning and the Department of Health reducing their accountability to provide a Health Service. As a result, central government will be less accountable when things go wrong and there is a risk of local systems being blamed.
  • We are concerned that paediatrics will be overlooked because local priorities tend to focus on social care and adult services. Local systems will be overwhelmed by social care issues leaving no scope to focus on child health.
  • Devolving workforce planning to Local Workforce Action Board (LWAB) level will create more bureaucracy as work is unnecessarily repeated at a local level, and there is unhelpful competition. The model proposed in the paper encourages ‘reinvention of the wheel’ in each locality that would be wasteful and inefficient in our overall specialty and many subspecialties.
  • Not all Integrated Care Systems (ICS) have the right training environment: they are not all co-terminous with educational establishments. That is, universities/colleges may not exist for some ICS or have capacity for type of training/education needed for the local health workforce. There may also be regional boundary differences: there are 16/17 deaneries in UK and it is not clear how they map on to ICS for training.
  • Implementing these plans will make it harder to monitor and impose national standards for staffing without regulation, such as the British Association of Perinatal Medicine’s standards (PDF); the RCPCH’s Facing the Future standards and the Royal College of Nursing’s standards. Since there is an international market for highly qualified healthcare professionals ensuring local conditions and support for professional practice is essential for retention of the best staff.

Our recommendations

  • We do welcome the proposed moving away from individual providers determining local workforce demand; this has been unsuccessful as it is always finance rather than needs driven. Innovative approaches and local solutions should be encouraged so long as they are embedded within national frameworks and core curricula.
  • ICS should not just commit to working together across boundaries, but also identify where there is common need in collaboration and work together to address those needs. There is need for clarity about what is local what is regional.
  • ICS needs to collaborate with national workforce planning experts to assess system-wide demand. We are concerned not all ICS will assess in same way because of different priorities, therefore we would question whether they can adequately assess demand in their relatively small footprint.