Policy in a changing environment

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Policy in a changing environment

• Sheila Dilks
• Commissioning Directorate DH

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The Big Questions

• What will 21st century bio-medicine and care look
  like?
• What will attract a new generation of nurses into
  the community and keep those with experience?
• How will we balance increasing need with limited
  resources?
• What organisational form is needed to deliver
  health care in the community??

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21st Century Primary Care

• Multiple information and access points
• Expanded Services
• Continuing importance of Personal Care
• The potential of the registered list
• Emphasis on Long Term Conditions Management
  including Self Management and especially of
  Co-morbidity
• Public Health oriented Clinicians
• Quality Assured
• Active in commissioning of Secondary Care
• Integrated services
• Choice for patients, clinicians and all staff
• Increasing accountability
• New forms of ownership

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Our health, our care ,our say a new direction
for community services DH2006

• Ambition
• Enabling health, independence and well being
• Better access to GP
• Better access to community services
• Support for people with longer term needs
• Care close to home
• Ensuring reforms put people in control
• Making sure change happens

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How does the policy agenda support this?

• changing services through stronger commissioning
• more and different organisations providing
  services in the community
• external regulation and inspection
• building in choice
• devolving decision making
• modernising nursing careers
• money following the patient
• integration with local authority services
• shared responsibilities for public health
• workforce reform

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Wanless Review

• Patients were fully involved in treatment and
  prevention
• Initial diagnosis was in a variety of settings
  beyond the GP surgery
• Primary care had broadened
• The majority of general hospital care was
  delivered outside of large hospitals

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Why change?

• higher levels of need (older population, more
  long term and complex conditions)
• need created by unhealthy living (obesity,
  alcohol, smoking)
• public expectations are changing (autonomy,
  knowledge, choice, standards)
• pressure on resources and staff (demand, costs
  and workload)
• global change (public health and workforce)
• technological change (treatments, monitoring,
  knowledge, communication)

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What could nursing in the community look like?

• Closer working with new forms of general practice
• Self-managed teams
• Some involved in commissioning services
• Some working in integrated health and social care
  services
• Using new technologies
• Working to deliver a contract
• Monitoring outcomes of their work which includes
  feedback from users
• Different employers or running their own venture
• Given incentives to provide services and use
  resources differently
• More nurses in the community with different
  skills, knowledge and more varied careers

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District nursing a pivotal role
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Modernising Nursing Career DH 2006Priorities and
Action

• Develop a competent and flexible workforce
• Update career pathways
• Prepare nurses to lead in a changed health care
  system
• Modernising the image of nursing and nursing
  careers

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The challenge of greater integration
international research suggest that integration
is most needed and works best when it focuses on
a specifiable group of people with complex needs,
and where the system is clear and readily
understood by service users (and preferably
designed with them as full partners). -
Integrated Care a Guide, Integrated Care Network
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Patient Centred Approach
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What will happen?

• supporting patients to be independent
• more care outside hospital
• giving people more of a say and choices
• tailoring services to individuals
• using technology for better and cheaper care
• new ways to prevent ill health
• different roles, skills and careers
• organisations will change

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Over to you

• Great opportunities to lead teams
• Continually improving patient care
• Integrating with the wider workforce and
  communities
• The individual as a partner in their care
• The individual as an informed decision taker and
  risk manager.
• Commissioning patient pathways

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Your role Your responsibility Your opportunities