The Role and Experiences of Frontline Support Workers in Integrated Care

Background: Integrated care in England had been a policy focus for decades and was formalised through the Health and Care Act 2022. Despite this emphasis, the roles and experiences of frontline support workers, who deliver much of the person-centred care central to integration, remain under-researched and undervalued. Without their perspectives, integrated care initiatives risk being designed and implemented without insights from those directly supporting service users, potentially undermining integration goals.

 

Giving voice to support workers is essential for improving workforce collaboration, recognition, and the delivery of integrated care, supporting the Quadruple Aim of better patient experiences, improved outcomes, reduced costs, and enhanced workforce wellbeing. Exploring their experiences also offers international lessons, as many countries face similar challenges in integrating health and social care and optimising frontline roles to strengthen system efficiency and patient outcomes.

 

Approach: This study used a qualitative case study methodology to explore support workers’ perceptions, attitudes, and experiences in integrated care settings. Participants included support workers providing direct care across health and social care services, representing varied tenure, professional backgrounds, exposure to integration, and understanding of integrated care. Data was collected through semi-structured interviews, capturing rich insights into participant interactions with registered professionals, strategies for facilitating integrated working, and organisational and local factors influencing their roles.

 

This approach enabled an in-depth exploration of workforce dynamics, relationships, and both barriers and enablers of integrated care, addressing the study’s two main research questions: what role do support workers play in the integration of health and social care, and what are the experiences of support workers working within integrated care and alongside registered professionals.

 

Results: Findings: revealed that support workers see themselves as playing essential, person-centred roles in integrated care, influencing both service users and overall service delivery. Participants expressed strong commitment to integration principles and a desire for recognition as valued partners. They reported benefits and challenges in working with registered professionals, including personal development and teamwork opportunities, alongside hierarchical pressures, power imbalances, and feelings of being undervalued.

 

Participants highlighted how support workers facilitate integrated care through communication, flexibility, versatility, and discretionary decision-making, adapting to complex organisational and local contexts. Factors such as limited resources, fragmented services, leadership, training, staff tenure, and Covid-19 shaped their ability to contribute effectively. Participants highlighted the importance of trust, relationship-building, and collaboration, while noting that poor relationships or structural barriers could undermine person-centred care.

 

Implications: The study fills a gap in integrated care research by giving voice to support workers, emphasising the need for recognition, workforce development, and equitable multidisciplinary relationships. Organisational support, effective leadership and sufficient resources are essential to strengthen collaboration and enable high-quality care. By demonstrating how discretion, adaptability and communication facilitate integrated working, this study provides practical, policy-relevant insights. Addressing structural and relational barriers can enhance the Quadruple Aim, improving patient experiences, outcomes, workforce wellbeing, and system efficiency, and inform broader integrated care planning in England.