Career advice

Helping nurses to integrate health and social care

Resources include a toolkit to support nurse leaders to make decisions about service redesign

Resources include a toolkit to support nurse leaders to make decisions about service redesign


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Nurses who are helping to drive the integration of health and social care in Scotland will benefit from a new competency framework.

Developed jointly by the RCN, the Scottish Executive Nurse Directors (SEND) group and NHS Education for Scotland (NES), the framework has been designed to support senior nurses who sit on integration authority (IA) boards. There is also a toolkit supporting nurse leaders to make complex decisions about the redesign of integrated services.

Learning curve

‘By bringing health and social care together, the idea is to enhance services for patients and families through working collaboratively,’ explains RCN Scotland director Theresa Fyffe.

‘Potentially it can improve outcomes, but it’s tough. You have to step back and look at how you work. It’s a completely new learning curve, and as an organisation we’ve been on the journey too, transforming the way we work.’  

Following legislation which came into force in April 2016, 31 local partnerships have been set up across Scotland. Each brings together NHS and local council care services to manage almost £8 billion health and social care resources overall.

‘The RCN helped to shape the legislation and we’ve been pivotal in supporting its implementation,’ says Ms Fyffe.

Every IA board must include at least one appointed nursing seat but, given they are relatively new roles within an ever-shifting landscape, it can be challenging for those involved, says Ms Fyffe.

‘Many nurses won’t have worked in this way before,’ she says. ‘They may not have local authority experience, for example. In an acute hospital, your line of sight for patient care, accountability and decision-making is very clear. But this is a changing context of care delivery. 

'The lead nurse role is vital in guiding clinical practice, leadership, evidence and learning.’ 

Population health


Theresa Fyffe

Within the competences the RCN has helped to develop, a key area is having an awareness of population health, both in terms of wellbeing and reducing health inequalities. 

‘If your background is working in a hospital, you wouldn’t have done this before,’ says Ms Fyffe. ‘It’s a big change for these leaders, who must understand the different clinical environments staff may be working within. But it really helps inform commissioning and procurement, because you know decisions are based on local determinants.’

Nurse board members need to provide clinical leadership that ensures safe, high quality services. They also need to be adaptable, able to commission and procure, work across different agencies and boundaries, negotiate and manage conflict between different providers, understand financial, legal and governance frameworks, and be able to influence decision-making at local and national level. 

‘They are also a role model,’ says Ms Fyffe. ‘They need to lead, motivate and inspire others to deliver these services within this new way of working.’

Leaps and bounds

For Eddie Docherty, director of NHS Dumfries and Galloway and NHS 24, a crucial element of the competency framework is establishing the level of leadership and political acumen needed by the post-holder, particularly around patient safety and their experience.

‘We’re not saying no one else can do it, but it’s definitely an area nurses excel in,’ he says. ‘We need their voice in what can be a challenging multi-professional and multi-agency environment.’

Nurses on these boards are having a significant impact on areas such as safe staffing and safe and effective care, he believes. 

‘There is evidence showing nurses can be the key stakeholder when it comes to developing and implementing services across primary and community care,’ he says.

‘Their role and function are core to what happens. In my own area, through integration, I’m seeing leaps and bounds moving forwards.’

Widening horizons

Nurse director Maria Docherty was appointed to South Lanarkshire Health and Social Care Partnership three-and-a-half years ago and was among the lead board nurses consulted about the framework. 

‘It’s an important piece of work and very useful for me,’ she says. ‘It’s practical and I’ll be using it with newly appointed staff.’

By taking up her position, she feels she has gained professionally. ‘It’s one of the biggest roles I’ve had,’ says Ms Docherty, whose background is in mental health nursing. ‘I thought the opportunity to improve things with an integrated approach would be exciting and I wanted to see if it could make a difference.

‘Without doubt, it’s been an enormous learning experience, particularly of local government and elected members. I’ve worked in the community for years, but this has widened and broadened the horizons.’

For Ms Docherty, it’s important that her post is on an equal par with senior managers, the chief social worker and medical director. ‘Here it’s by design, not default,’ she says.

‘We wanted to ensure that same level of seniority and authority - and Lanarkshire has done a good job. Without this strong voice, nursing will be lost.’

Find out more

A copy of the framework and the toolkit are available from the RCN website 


Lynne Pearce is a health journalist

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