The Skills for Health working paper, Integration and the development of the workforce (Skills for Health, 2017) set out a drive for greater integration between health and social care, reframing the debates around how services might be delivered and the skills, knowledge and understanding that clinicians may require.
The key principles of integrated care aim to ensure that care is catered to, and led by, patients and their communities, with a focus on maintaining a healthy lifestyle to prevent illness. This will involve collaboration between organisations, from volunteer groups to hospital trusts, and will also endeavour to use new technologies in a way that improves efficiency without isolating patients.
Integration and midwifery
Many of the principles of integrated health and social care will already be present in the midwifery model. Women are placed at the centre of care, and a holistic philosophy ensures that physical, psychological and social factors are recognised as essential components of health for the mother and her baby.
Midwives will also be familiar with working across health, voluntary and social care boundaries, by coordinating the handover of care from maternity to health visiting services, or by helping women to access antenatal classes, parental education, breastfeeding advice and postnatal social support. In addition, midwives are already experienced in working with social services, and primary and secondary health care in cases where women have, or developed, complex needs.
Given how the midwife model of care operates now, the integration of health and social care is unlikely to change midwives' roles in future. Skills for Health have identified several important attributes required for integrated care to flourish, including management and leadership, finessing wider roles, developing generic skills and technological innovation.
Examining these skills in detail, however, shows how midwives are leading the way to greater integration.
Management and leadership
Ensuring that clinicians have the skills to shape the communities they serve will continue to be a priority, as change focuses on the needs of the local population, to help communities themselves transform health and social care.
Increasingly, midwives will be seen as the professionals who understand what women want from local services and who are most in touch with their communities. They must therefore be equipped with the skills to identify emerging trends in health and social care needs and understand how to use this to shape and influence their local services.
In addition, reorganisation and the creation of new roles could mean that midwives find themselves managing multi-professional teams, for which they must have the skills and knowledge to lead.
Finessing wider roles
As coordinators of maternity care, midwives could increasingly be required to assist women, especially the vulnerable, in navigating joined-up systems of health, social care, education and housing in order to find the providers that best fits their needs—which may require skills such as advocacy, brokerage and information organisation.
The importance of highly skilled and competent support workers who are able to work across professional groups is increasing as greater integration occurs. Within the midwifery context, support workers with maternity, general nursing, mental health and social work skills could emerge to support women with more complex health and social care needs.
Developing generic skills
High quality maternity care depends on both generic and professional midwifery skills. Generic skills, such as teamwork, communication and problem solving, are often dismissed, but working across teams and organisational boundaries relies on good communication, diplomacy and negotiation, as well as other generic skills. As health and social care integration expands, these skills will continue to increase in prominence.
Technological innovation
Technology drives change across health and social care. In an increasingly connected society, with a technologically savvy population, the challenge for the sector is not only to keep up, but also to enable the free exchange of data within the system. All employees, including midwives and the wider maternity team, will have to develop the IT skills necessary to use new and emerging technologies appropriately and to interpret results in order to make safe professional judgements and decisions.
Conclusion
Placing women at the centre of antenatal and postnatal care and ensuring their access to the broader health and social care system to receive appropriate support is crucial to improving outcomes. Midwives can therefore pave the way for other services when it comes to delivering greater integration between health and social care.