Visible, Accessible and Integrated Care

Jane WalkerNursing Officer

‘My view you know is that the ultimate destination of all nursing is the nursing of the sick in their own homes…I look to the

abolition of all hospitals & workhouse infirmaries. But it is no use to talk about the

year 2,000.’

Florence Nightingale June 1867

Challenges facing UK health & social care system

Changes in population demography Changes in patterns of disease Changes in lifestyle Changes in public expectation Inequalities in health status Need to reconcile demand, need & access with safety

& quality

Ageing Population

Older people more likely to: Live alone, with consequent risks & need for support

services Have functional dependency & sensory impairment Have LTC’s & co-morbidities Require complex multi-medication regimes Have cognitive impairments & mental health problems Develop complications of acute illness

Population in <15 and 65+ age groups, Scotland: 1950-2042 (GAD projection)

Source: http://www.esrcsocietytoday.ac.uk/ESRCInfoCentre/Images/demography_seminar_tcm6-7919.pdf

Nursing, health and social care workforce issues

Age demographic of NHS Scotland Nursing Workforce (September 2005)

Total (WTE)

Aged under 30*

Aged 31-44

Aged 45-54

Aged 55+

N N % N % N % N % The entire NHS Scotland nursing, midwifery and health visiting workforce

55, 469 7,900 12 30,891 47 19133 29 7892 12

Acute registered nurses (G grade and above**)

2,924 (19% of

registered nurses in

acute sector)

5,930 16 18,684 51 9496 26 2824 7

Health Visitors (Grades G and above)

1,249 (84% of Health

Visitors)

13 0.9 600 40 648 43 240 16

District Nurses (Grades G and above)

1032 (50% of District Nurses)

9 0.7 474 39 535 44 192 16

* Figures reflect headcount ** Figures reflecting post Agenda for Change assimilation not available

Age distribution of the register

Age range in year ending 31 March

2002%

2003%

2004%

2005%

2006%

Under 25 years

2.24 2.10 2.02 1.94 1.87

25-29 years 8.86 8.54 8.44 8.29 8.04

30-39 years 30.63 29.37 28.30 27.35 26.72

40-49 years 32.32 33.26 33.94 34.42 64.52

50-54 years 11.46 11.46 11.62 11.91 12.42

55 years and over

14.50 15.27 15.68 16.09 16.40

DELIVERING FOR HEALTH

Current view Evolving model of care

Geared towards acute conditions

Hospital centred

Doctor dependent

Episodic care

Disjointed care

Reactive care

Patient as passive recipient

Self care infrequent

Carers undervalued

Low tech

Geared towards long-term conditions

Embedded in communities

Team based

Continuous care

Integrated care

Preventive care

Patient as partner

Self care encouraged / facilitated

Carers supported as partners

High tech

Implications of Delivering for Health

Existing focus on hospital care needs to change

Need to actively manage the most vulnerable in the community

Doing more of the same not the answer

Key Elements of Report

Generate strength from integration

Transformation through unity of purpose

Hold organisations charged with delivery accountable

Strong political, professional, public and union support

Nursing & AHP Response

Delivering Care, Enabling Health Visible, Accessible & Integrated Care Co-ordinated & fit for purpose Review Cancer Nursing National workforce project

How can Nurses make a difference?

Anticipatory care Increase support for self care & close working

with carers Early interventions to prevent hospital admissions Delivering on waiting times Increasing the range of locally available diagnostic

services

Thank you