Impact of Health Policy on placements & practice

1. Impact of Health Policy on placements & practice Dr John Unsworth Clinical Director (Nursing)

2. 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

3. Impact on care provision ISTC Specialist centre DGH

4. 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

5. The ward of the past

6. 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

7. The ward of the present

8. 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

9. The ward of the future

10. 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

11. The DN team of the past

12. 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

13. The DN team of the present

14. 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

15. The DN team of the future

16. 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

17. 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

18. Primary Prevention Obesity, Emotional well-being and mental health, physical activity, tobacco control Public Health Self care Improved life chances Expert patient’s programme Spearhead, tackling fatalism, children’s centres, return to work

19. 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