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We're at the advent of a new opportunity for the nursing community, following the implementation of new integrated care systems in England this summer. Nursing staff have always supported members of the public wherever they reside through the deployment of their professional knowledge, skills and competencies – despite the constraints that agency boundaries might impose on their practice.

The pandemic has demonstrated just how important it is to remove the structural boundaries that exist between social, home and NHS health care, and to provide free access to the skills that our nursing workforce can, and should, deliver.

The gestation of a new approach to integrated health and social care system design and skills deployment emphasises the importance of adopting plurality in how we operate. It presents an opportunity to bring together disparate parts of our health and social care system to provide the public with much-needed co-ordinated and comprehensive access to skilled nursing support and delivery within the primary, secondary, social and independent care sectors.

Achieving this will require the adoption and implementation of a renewed focus on skills development. And this must be supplemented by enhanced knowledge, education and training, in order to support both the current workforce, as well as a new emerging and transformative workforce in a facility-independent model. Skills, competencies and knowledge are transferable wherever members of the public reside and require support. Nursing staff demonstrate this to the full, operating widely in all contexts. And though many nurses possess specialist skills, these are often very generalisable: Ultimately, no nurse works in isolation, hence the interprofessional and multi-agency nature of our profession.

So it’s important that we focus on delivering nursing skills, knowledge and competencies that reach all parts of our community, including those living in care or nursing homes and those supported by home care services – all of whom have a significant requirement for our services. Questions remain around how the excellence and skills of the nursing workforce can be deployed across and between existent sector boundaries. The nursing workforce is resilient, confident, capable and knowledgeable, but not yet capacious enough to rise to the demands that the new integrated care systems will require of us.

This current capacity challenge will undoubtedly result in a new set of needs that we must be prepared for. New ways of working and engaging with our local communities and society at large must be sought, as well as the discovery of new ways of participating and sharing our skills with others.

I propose a relational partnership model of engagement with members of the public and with our primary care and social service colleagues. This would need to be accompanied by a strategic change in organisational culture and leadership. It would involve a significant realignment in how members of the public, system leaders, front line employees and public health and social care systems transition into new relationships and responsibilities. At its best, it would mean a triad of shared responsibility – the health and social care services, adherence to local community norms and individual internalised accountability, underpinned by shared governance and external scrutiny.

The creator of the NHS, Aneurin Bevan, predicted that the Health Service “must always be changing, growing and evolving”, so that “it must always appear to be inadequate”. So here’s the challenge: To continue to succeed in the future, our health and social care system must always look forward and seek to build trust, confidence, competence, capability and effective collaboration. Only by doing so can we ensure that members of the public (wherever their care is provided) experience shared and purposeful engagement with the health and social care system that permits their access to skilled nursing practitioners.

 

Professor David Sines CBE FRCN (1989)