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

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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

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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

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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

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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

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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/