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THE CHANGING SHAPE AND NATURE OF COMMUNITY HEALTH SERVICES – THE DRIVERS AND IMPACT UPON THE ROLE OF THE NURSE
Lynda Carey Senior Lecturer
AIM OF THE SESSIONTo:
Examine key NHS and Nursing Policy in relation to supporting care provision for people living with long term conditions
Explore the underpinning political context of health care delivery
Critically examine the impact upon nurses role
RELATIONSHIP TO MODULE LEARNING OUTCOMESLearning Outcome 4:
Analyse the role of the professional nurse in promoting self care and management of adults with long term conditions
POLITICAL IDEOLOGY AND HEALTH CARE PROVISION
Understanding the political context of practice
Reading : SPEAR H.J. 2006 Said Another Way: Nurses and Politics: What’s Your Political IQ
http://search.proquest.com.edgehill.idm.oclc.org/docview/195017997?pq-origsite=summon
WHAT IS THE UNDERPINNING POLITICAL IDEOLOGY Neo-liberalism
Economic liberalisation Privatisation Fiscal Austerity Deregulation Free Trade
Individual responsibility rather than state managed
Underpinned UK government strategy since 1980’s
KEY HEALTH & SOCIAL CARE POLICY SHAPING CURRENT NURSING PRACTICE
FIVE YEAR FORWARD VIEW
Rationale for change Close widening gaps in health of population,
quality of care and funding
Rise to demographic and epidemiological challenges
Coordinate care around people’s needs and wants
NHS spending growth of past unlikely to be a feature of future
7
UNDER PRINCIPLES Prevention
Empowering Patients
Efficiency
New Models of Care
PREVENTION• New approaches to improving health and
wellbeing
• Hard-hitting national action on tobacco, alcohol, junk food, excess sugar
• Enhanced powers for Local Authorities on decisions relating to public health policy
• National Diabetes prevention programme
9
EMPOWER PATIENTS & ENGAGE COMMUNITIES
• Support people to manage their own health (education)
• Integrated personal commissioning
• New/better ways to support carers
• Short alternative to standard NHS contract for charitable and voluntary organisations
10
EFFICIENCY AND PRODUCTIVE INVESTMENT
• Predicted gap of £30 billion per year by 2020/21 Growing demand, no further efficiencies, flat funding
• Historic NHS efficiencies of 0.8% per year inadequate
• Close £30 billion gap by 2020/21 by Target of 2-3% efficiencies per year – how? Investment for new care models – from where? Some funding growth – the £8bn
11
NEW MODELS OF CARE Multispecialty community providers
(MCPs) Primary and acute care systems (PACS) Urgent and emergency care networks Viable smaller hospitals/acute care
collaboration Specialised care Modern maternity services Enhanced health in care homes
12
IMPACT ON NURSING PRACTICE?
NURSING RESPONSE – LEADING CARE, ADDING VALUE
THE 10 COMMITMENTS
COMMITMENT 1 -WE WILL PROMOTE A CULTURE WHERE IMPROVING THE POPULATION HEALTH IS A CORE COMPONENT OF THE PRACTICE OF ALL NURSING, MIDWIFERY AND CARE STAFF
All our Health
Five Year Forward View
Public Health Outcome Framework
Act as a role model in adopting a healthy lifestyle
Share information about healthy choices
Support people to make informed choices
Be open and willing to change in response to evidence/research
Drivers Actions
COMMITMENT 2 -WE WILL INCREASE THE VISIBILITY OF NURSING AND MIDWIFERY LEADERSHIP AND INPUT IN PREVENTION
Championing health promotion
Social movement for health
Leading and shaping care especially young people and children
Promote culturally appropriate systems of prevention for sustainable change
Enable people to take responsibilities for their behaviours
Make every contact count Design and implement prevention programmes
Philosophy Actions
COMMITMENT 3 - WE WILL WORK WITH INDIVIDUALS, FAMILIES AND COMMUNITIES TO EQUIP THEM TO MAKE INFORMED CHOICES AND SUPPORT THEM TO MANAGE THEIR OWN HEALTH
Poor health of older population
Making every contact count
Working with communities
Encourage and engage individuals to make healthy choices
Co-design personalised care plans
Work with communities – harness voluntary sector
Share skills of self- management, self-esteem, social contact and build networks for resilience
Underpinning Context Actions
COMMITMENT 4 -WE WILL FOCUS ON INDIVIDUALS EXPERIENCING HIGH VALUE CARE
No decision about me without me
Putting people first
Care planning
User voices
Individuals influence all aspects of co-ordinated care – ensuring culture, difference and vulnerability is respected
Listen and respond to actual needs
Curiosity to unwarranted variation
Adapt care to “place” based care
Underpinning perspectives Actions
COMMITMENT 5 -WE WILL WORK IN PARTNERSHIP WITH INDIVIDUALS, THEIR FAMILIES, CARERS AND OTHERS IMPORTANT TO THEM
Asset based care
Integrated Services – including volunteers
Personalised care, community partnerships, equality, valuing carers, volunteering and social action
Co-design plans to provide care in the right time, in the right place to agreed outcomes
Build trusting relationships
Co-ordinate care
Coach individuals and families for care to be delivered in a way that works for them
Underpinning Approach Actions
COMMITMENT 6 -WE WILL ACTIVELY RESPOND TO WHAT MATTERS MOST TO OUR STAFF AND COLLEAGUES
What matters to you? Mental Health First
aiders Work environment Right staff support
systems Staff engagement
Sharing learning
Listen to our colleagues to ensure we deliver outcomes
Listen and create opportunities for new ways of working
Seek feedback on the quality of services
Underpinning Principles Actions
COMMITMENT 7 -WE WILL LEAD AND DRIVE RESEARCH TO EVIDENCE THE IMPACT OF WHAT WE DO
Celebrating success
Building competency and capability to identify unwarranted variation
Use metric to improve productivity
Share findings
Effectively manage resources to reduce waste
Understand local systems
Act as an agent of change
Listen to individuals to deliver measurable care
Approaches Actions
COMMITMENT 8 -WE WILL HAVE THE RIGHT EDUCATION, TRAINING AND DEVELOPMENT TO ENHANCE OUR SKILLS, KNOWLEDGE AND UNDERSTANDING
Revalidation
Shape of Care Review
Career progression
Clinical academic careers
Working across settings
Value of reflection and learning from experience
Seeking constructive feedback
Team and action learning
Acquiring right skills, knowledge and behaviours to measure our impact
Approaches Actions
COMMITMENT 9 -WE WILL HAVE THE RIGHT STAFF IN THE RIGHT PLACES AT THE RIGHT TIME
Carter Review
Working across organisational boundaries
Recruitment and retention
Evidence behind workforce decisions – local context
E-learning package to monitor and support development
Engage in development and training
Facilitate new ways of working
Flexible patterns of work
Workplace as a beacon of excellence
Driver Actions
COMMITMENT 10 -WE WILL CHAMPION THE USE OF TECHNOLOGY AND INFORMATICS TO IMPROVE PRACTICE, ADDRESS UNWARRANTED VARIATIONS AND ENHANCE OUTCOMES.
Technology literate workforce
Technology to reduce variation
Leading as early adopters
Empowering for self management
Technology to manage workforce
Embrace technology and informatics
Understand benefits to increase time to care
Technology for co-ordination
Dissemination and tool to reach hard to reach groups
Approaches Actions
ANY QUESTIONS?
USEFUL LINKS JaneCummings – Supported Self Care commentary, available
at https://www.england.nhs.uk/2017/01/jane-cummings-29/
Five Year Forward View, available at https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf
Leading Care, Adding Value, available at https://www.england.nhs.uk/wp-content/uploads/2016/05/nursing-framework.pdf
Nuffield Institute, available at http://www.nuffieldtrust.org.uk/
NHS England Self Care, available at https://www.england.nhs.uk/ourwork/patient-participation/self-care/