Nurses are central to the integration of health and social care
The RCN is ensuring that the nursing voice is heard during the ongoing integration of health and social care in Scotland
Integration has radically changed how health and social care services are planned and delivered in Scotland. Nursing staff in Scotland are in the midst of an ever-shifting landscape requiring new ways of working with many partners who may have different priorities, organisational cultures and ways of doing things. This throws up challenges for ensuring robust clinical and care governance arrangements as well as clear lines of accountability from front-line staff to professional leads.
RCN lobbied during the development of the Public Bodies (Joint Working) (Scotland) Act 2014 for a seat on each of the 31 integration authorities (IAs) to act as a voice for nurse leads, and we were pleased that this was accepted. However, this was a new role and, to support nurse IA-board members in their professional role, we developed a co-produced RCN programme called Creative Influence in an Integrated World, which has been running over the past two years.
This programme was designed to support nursing leads to provide confident nursing leadership, to manage change and conflict and to encourage coalition working and collaboration, to enable them to shape, deliver and monitor safe, high-quality and local integrated services. Programme sessions also offered them a forum to discuss and share their experiences.
This work is continuing at a national level to develop competencies for these roles and in addition the RCN has, for example, developed an integration toolkit for nursing leaders, which is designed to help them make complex decisions about the redesign of integrated community health and social care services.
It is crucial that professional board members are involved in the decision-making process if the original intent of the legislation, to improve quality and outcomes, is to be realised. So far, 24 nurse leaders have attended the programme, and it has been inspirational to see them grow in confidence to be the effective leaders they needed to be.
As the way health and care services are delivered evolves, it is vital that nursing staff are involved in discussions about integration and the voice of nursing is at the heart of decision making.
Ongoing support is needed for nursing leaders and we are working with the Scottish Executive Nurse Directors group and NHS Education for Scotland to develop a competency framework for the role on the basis of the experiences and lessons that participants shared in the RCN programme. The RCN also wants to use participants’ contributions to influence changes to both the government's integrated care and clinical governance framework and formal guidance on the board-level role.
Without nursing, integration simply cannot work effectively for our communities. Ensuring the quality and safety of patient care requires the voice and clinical expertise of our nurse leaders. The RCN will continue to work hard to ensure members feel equipped to get involved and influence discussions and decisions on integrated health and care across Scotland.
About the authors
Ellen Hudson is RCN Scotland associate director of professional practice
Rachel Cackett is RCN Scotland policy adviser