Politics

1. THE CHANGING SHAPE AND NATURE OF
COMMUNITY HEALTH SERVICES – THE DRIVERS
AND IMPACT UPON THE ROLE OF THE NURSE
Lynda Carey
Senior Lecturer

2. AIM OF THE SESSION
To:
 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

3. RELATIONSHIP TO MODULE LEARNING
OUTCOMES
Learning Outcome 4:
Analyse the role of the professional nurse in
promoting self care and management of adults with
long term conditions

4. 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.ed
gehill.idm.oclc.org/docview/19
5017997?pq-origsite=summon

5. 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

6. KEY HEALTH & SOCIAL CARE POLICY SHAPING
CURRENT NURSING PRACTICE

7. 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

8. UNDER PRINCIPLES
 Prevention
 Empowering Patients
 Efficiency
 New Models of Care

9. 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

10. 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
1
0

11. 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
1
1

12. 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
1
2

13. IMPACT ON NURSING
PRACTICE?

14. NURSING RESPONSE – LEADING CARE,
ADDING VALUE

15. THE 10 COMMITMENTS

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. ANY QUESTIONS?

27. 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/