Dr Minesh Patel
NAPC Senior Leadership Team
Across the NHS and wider health and care system, the shift toward Integrated Neighbourhood Teams (INTs) and system-wide population health approaches is one of the most significant reforms of the past decade. But while policy, structures and governance frameworks often dominate discussions, there is a far more fundamental determinant of success: the experience, engagement and activation of the workforce.
Put simply, integrated care cannot succeed without activated staff working in real teams.
Yet the latest NHS Staff Survey should give system leaders pause. Several indicators that directly affect the ability of staff to deliver safe, compassionate and effective care are moving in the wrong direction.
Concerning Signals from the NHS Staff Survey
Recent findings paint a worrying picture:
- Morale and engagement are declining. Scores for feeling valued and motivated have hit five-year lows, and only 52% of staff report looking forward to going to work.
- Staffing pressures remain severe. Just 32.8% of staff feel there are enough people in their organisation to do their job properly.
- Confidence in care quality is falling. Only 62.8% of staff would recommend the NHS for care, the lowest recorded level.
- Support for staff wellbeing is weakening. Positive perceptions of employer action on wellbeing have dropped to 54.8%.
- Encouragingly, experiences of bullying and harassment from colleagues and managers have improved, suggesting that targeted cultural interventions can work.
These trends matter not only for workforce wellbeing but also for patient safety, care quality and system sustainability.
The Evidence: Staff Experience Drives Patient Outcomes
A consistent body of evidence shows that staff experience and patient outcomes are closely linked. Organisations with higher staff engagement typically demonstrate:
- Better patient safety outcomes
- Higher patient satisfaction
- Lower mortality rates
- Greater innovation and service improvement
In integrated care systems attempting to move toward population health management and proactive neighbourhood care, these links become even more critical. Teams must collaborate across professional, organisational and sector boundaries – often in environments of high complexity and uncertainty.
That is why the concept of “real teams,” articulated by Professor Michael West, is so important.
What Do We Mean by “Real Teams”?
Michael West defines real teams as groups that:
- Have clear, shared objectives
- Possess interdependent roles
- Hold collective accountability for outcomes
- Have time and space for reflection and learning
Many structures in healthcare are called teams, but in practice they function more like co-located individuals working in parallel.
Integrated neighbourhood care requires something different: genuinely collaborative, psychologically safe teams capable of learning, adapting and improving together.
Without these characteristics, integration risks becoming merely structural reorganisation rather than meaningful change in how care is delivered.
Staff Activation: The Missing Ingredient
Alongside real teams sits the concept of staff activation- the extent to which clinicians and staff feel empowered, supported and motivated to improve care.
Activated staff typically demonstrate:
- Greater ownership of outcomes
- Stronger commitment to improvement
- Higher levels of innovation and problem-solving
- Greater resilience in challenging environments
In neighbourhood models, where care must be personalised, preventative and community-focused, staff activation becomes a central capability for the system.
Five Actions Leaders Can Take Now
Improving staff experience and building real teams is not an abstract ambition. There are practical steps organisational and system leaders can take today.
1. Make Staff Experience and Activation scores a Core System Metric
Staff experience should be treated with the same seriousness as finance, activity and waiting times.
Integrated Care Systems (ICSs) should:
- Track staff engagement and wellbeing metrics at system level
- Include staff experience indicators in performance dashboards
- Ensure board and partnership discussions explicitly address workforce experience
When staff experience becomes a strategic priority, leadership behaviours and organisational investment begin to change.
2. Build and Protect “Real Teams” in Neighbourhood Care
Integrated neighbourhood teams must be designed intentionally around stable multidisciplinary teams, not loose networks.
This means:
- Clear shared purpose around population health outcomes
- Protected time for team reflection and improvement
- Joint decision-making across health, social care and community partners
- Stable team membership where possible
Evidence from high-performing systems consistently shows that well-functioning teams outperform fragmented structures.
3. Create Psychological Safety and Compassionate Leadership
Staff activation depends on a culture where people feel safe to speak up, contribute ideas and challenge problems.
Leaders can foster this through:
- Compassionate and inclusive leadership behaviours
- Regular listening forums and structured staff engagement
- Visible responses to staff concerns
- Training in team leadership and psychological safety
When staff feel heard and respected, engagement and motivation increase significantly.
4. Invest in Time for Improvement and Learning
One of the most common barriers staff report is lack of time to improve care.
Neighbourhood teams need protected time for:
- Quality improvement
- Population health analysis
- Multidisciplinary case review
- Reflective learning
Without this space, teams remain locked in reactive service delivery rather than proactive population health management.
5. Empower Clinicians and Frontline Staff in System Leadership
Integrated care systems will only succeed if clinicians and frontline staff are central to decision-making.
This includes:
- Involving frontline professionals in neighbourhood design
- Supporting clinical leadership roles within systems
- Encouraging staff-led innovation and improvement initiatives
- Recognising and rewarding contributions to system change
Staff who feel ownership of the system are far more likely to help transform it.
The Strategic Opportunity
Integrated neighbourhood care within wider systems offer a powerful opportunity to reshape services around the needs of people and communities. But the success of this and wider transformation will depend less on organisational charts and more on how people work together on the ground.
If we want safer, more effective care for patients and populations, the NHS must place staff activation and real teams at the heart of system design.
Improving workforce experience is not a “soft” agenda. It is a patient safety strategy, a quality improvement strategy and a population health strategy all at once.
And perhaps most importantly, it is a reminder that the future of integrated care will ultimately be built by people- not structures.
