NHS ConfedExpo 2023 Conference Keynotes

Workshop session: Care to collaborate? The challenges and opportunities of collaborative working


NHS Professionals hosted a well-attended interactive workshop session focused on collaboration at the ConfedExpo in June 2023.

The session saw groups of delegates explore the new collaboration agenda in more detail and share their experiences of collaborative working in health and care across both secondary and primary sectors. We asked each group to identify the ‘challenges and opportunities’ for one of five key issues related to collaboration: technology and process; pay and reward; local factors; system influence; and skill gaps. One group also focused on more general issues that could affect collaboration.

Here we summarise some of the points agreed by each group for their chosen issue. Facilitated by senior staff at NHS Professionals, the session was led by Kate Harper, NHS Professionals’ Director Research, Insight and Thought Leadership and Jon Waters, Business Development and Client Solutions Director.

Please note the session was held before the publication of the Government’s new Workforce Plan.


Issue one: technology and process

Narrative: ‘Lack of technology and/or process integration between the different parts of a system to enable effective flexible workforce passporting/shift visibility


  • Purchasing rationale and selection resides with IT. More consultation on data, user experience and friendliness needed
  • Lack of flow between primary and secondary care
  • Lack of process automation
  • Technical issues leading to data loss
  • Data quality issues
  • Training not prioritised


  • One unified ecosystem aligned to strategies and workforce planning
  • System-level conversations and collaboration to enable things like passporting
  • Pre-planned collaboration on tech, rather than short-notice change
  • AI needs to be part of the conversation
  • Start with remote working in mind
  • Ready the culture for change


Issue two: pay and reward

Narrative: ‘Lack of pay and reward alignment between the different parts of the system to encourage/incentivise the flexible workforce to consider alternative locations/opportunities


  • Increased pressure and workload
  • Leadership behaviours and trust
  • Culture of ‘we’ve always done this’
  • Rota system barriers
  • Perceived difference between public vs private pay levels affecting morale


  • Skills-based rostering using one roster to see upskilling and career development opportunities more easily
  • Utilise time better for thinking and learning to develop projects that save time in the system
  • Collaborate more to reduce duplication of effort and develop time-saving projects
  • Align tangible reward packages, for example annual leave, pension, sickness and development
  • Streamline recruitment processes


Issue three: local factors

Narrative: ‘Local organisations being fearful of losing access to their current pool of flexible workers if they participate in a collaborative workforce arrangement


  • Conflicting priorities and shortages of time: start smaller projects and collaborate at different levels of an ICS to gain momentum
  • Varying processes between systems
  • Availability of funding, especially when organisations are trying to transition services
  • Culture, competition and complacency


  • Use ‘hyper local’ approaches – down to street level in some cases – to uncover different community experiences (such as rural/urban) and work with other local agencies
  • Adopt a community-focused ‘trial and error, let’s give it a go’ mindset to develop new ways of working at local and day-to-day level and build up case studies to use as evidence to release funding. New ways of working can lead to more roles being created – for example, in Doncaster, paramedics were rostered across the area and worked flexibly which meant more people were trained. People can also be taught regular phlebotomy skills to free up District Nurses from blood sample collections within people’s homes
  • Request budget from colleagues and other departments and release some of your own when pooled budgets are hard to administrate
  • Engage with what is really local and involve lots of departments – adopt a ‘silo smashing’ mindset
  • Cross-skill across communities


Issue four: system influence

Narrative: ‘The lack of a clear collaborative strategy/collaborative culture at system level setting out the care and cost benefits of flexible worker collaboration across the system



  • National workforce strategy yet to be published*
  • Workforce challenge – people working across differing systems are already in a role so it is hard to ‘do more for less’
  • ‘Domineering’ leadership and perceived lack of openness to solutions sharing
  • Cultural fears about feeling secure to making changes and always sticking to the known ways of doing things
  • Lack of urgency and common purpose post-pandemic
  • Stakeholders identifying and committing to priorities and being held to account for benefits realisation
  • Problematic funding due to deadline changes and competing priorities
  • Complexity of systems
  • Change fatigue

*mid-June 2023


  • Align vision and agree outcomes. Value and quality also needed
  • One national digital system needed to reduce competition - integrate systems to talk to each other and reduce duplicated data
  • If feasible, one solution (or at least frameworks) so system partners can share best practice
  • More flexibility for staff to choose where, when and how they can work flexibly
  • Budgets clearly delegated to priorities and measurements aligned to these
  • Reduce inefficiencies to lower costs and improve working relationships and patient care
  • Improve communication and transparency between providers and become more aware of each other’s activities
  • Develop technology functionality to be less ‘clunky’
  • Community empowerment to bring community closer to system and vice versa – for example, virtual wards, telehealth and community collaboration with local government, ICS and voluntary sector


Issue five: skill gaps

Narrative: ‘The lack of appropriate system-based learning and development to help encourage flexible workers to upskill/cross-skill to work outside of their current roles/locations/parts of the system’



  • Lack of clarity and certainty on objectives
  • Lack of time to prioritise
  • Psychological safety – lack of trust in leadership
  • Training too academic
  • Skill gaps driven by pay disparities, competition for skills and the need for flexibility
  • Funding not available for pay
  • Leadership issues including inconsistent rates, lack of market control and reactive behaviour
  • Cultural variances between organisations


  • Start small and celebrate success
  • Capture success and share the story of how things happened
  • Focus training more on pragmatic outcomes
  • Build more regular communities and share innovation
  • ‘Future-proof’ frameworks, competencies, skills and learning pathways
  • Achieve a good balance between variance and competition
  • Be creative and create trailblazers
  • Develop roles and reward development
  • Understand any resistance to investment
  • Build relationships for Learning and Development


General issues


  • Separate care and finances across mental health and acute
  • Different governance processes across Trusts – for example, for uniforms
  • Lack of speed on process around non-standardised compliance affecting retention
  • Non-standard benefits for staff


  • Shared workforce platform for discharges that allows resources to be targeted
  • Use a single system and data point to identify problems
  • Standardisation would mean a reduction in competition for staff and they could collaborate more easily on data
  • Shared controls would help to prevent ‘firefighting’