Impact of Health Policy on placements

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Impact of Health Policy on placements practice

• Dr John Unsworth
• Clinical Director (Nursing)

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Create Over Supply Competition
Foundation Trusts, Specialist Centres, 3rd Sector
Market Reforms
Choose Book Consumer market reform
Transaction Reforms
Control Demand
PbR, Fixed Tariffs
Developed Primary Care, Community Hospitals,
Referral Management
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Impact on care provision
ISTC
Specialist centre
DGH
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Impact on care provision

• Downsizing of DGHs
• Some specialisms only available in specialist
  centres
• Some procedures only carried out in ISTCs
• More care closer to home
• GPs central role in managing demand and driving
  through secondary to primary care shift

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The ward of the past
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Impact on placements

• Large numbers of students 8 to 12 per ward
• Students part of workforce
• Wide range of experience
• Variation in patient dependency time available
  for teaching and learning

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The ward of the present
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Impact on placements

• Large numbers of students 4 8 per ward
• Students supernumerary
• Greater differentiation of patients provides less
  experience
• More patient dependency less time available for
  teaching and learning

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The ward of the future
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Impact on placements

• Large numbers of students 4 8 per ward
• Students supernumerary
• Students get a limited range of experience about
  the illness trajectory but extensive critical
  care skills
• More patient dependency less time available for
  teaching and learning

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The DN team of the past
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Impact on placements

• Small numbers of students
• Students part of workforce out for very short
  period of time e.g. 1 week!
• Students get a range of experience which was
  essentially of health social care
• Very little urgent care, routine care delivery

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The DN team of the present
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Impact on placements

• Small numbers of students
• Students part of workforce out for longer periods
  of time
• Students get a range of experience within PHCT
• Stronger emphasis on palliative care and more
  complex nursing procedures

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The DN team of the future
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Impact on placements

• Need to increase placement capacity
• Students out for longer periods to experience a
  range of care e.g. admission avoidance, case
  management etc
• Students will get a range of experience including
  experience of some care previously provided in
  hospital
• Less registered staff increasing reliance upon
  assistant practitioners

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Impact on Practitioners

• Up-skilling of all staff
• More registered nurse tasks to assistant
  practitioner grades
• Registered nurses taking on roles previously done
  by specialist practitioners
• IV drug administration, management of
  exacerbations of chronic diseases, cannulation,
  diagnostics etc
• Specialist practitioners taking on medical
  roles
• Advanced practitioner skills to avoid unnecessary
  admission to hospital

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Primary Prevention
Obesity, Emotional well-being and mental health,
physical activity, tobacco control
Public Health
Self care
Improved life chances
Expert patients programme
Spearhead, tackling fatalism, childrens centres,
return to work
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Impact on placements

• New placement capacity outside of traditional
  health environment
• Possible direct entry to Part 3
• Wider menu of learning opportunities
• Co-ordinated by public health nurses
• Students will get a range of experience outside
  of nursing ?should be reserved for those
  specialising in public health
• Less registered staff increasing reliance upon
  health development workers e.g. health trainers,
  leisure centre staff etc

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