Evolution of Professional Nursing and Healthcare Practice

1. The evolution of professional nursing

2. History of Medicine • Medical practice can be dated as far back as the ancient Egyptians • Imphotep was the physician to King Zozer and lived in about 2600 BC

3. History of the non-medical professions • Nursing has existed in various forms in every culture over millennia, e.g. wet nurses • America’s first trained nurse graduated in 1873 • The most significant development was during war time when Florence Nightingale laid the foundation stone for professional nursing

4. History of other professions • Physiotherapy practice dates back to BC times, for example in ancient Greece and the practice of hydrotherapy • In 1894 the UK recognised physiotherapy as a specialised branch of nursing • The polio epidemic was a turning point for the physiotherapy profession and its establishment in its own right

5. So what does the history tell us? • The practice of healthcare and medicine has been around for a long, long time in various forms • The practice of healthcare and medicine has been consistently valued and has evolved in accordance with demographic requirements • The various professions have evolved in accordance with demographic requirements

6. So what does the history tell us?

7. History of the NHS • The NHS was born on July 5 1948 officially started by Aneurin Bevan • ‘Good healthcare should be available to all, regardless of wealth’ • For the first time doctors, nurses, pharmacists, etc. are brought together under one umbrella organisation

8. The Timeline • 1948 the NHS commenced • 1953 the structure of DNA was discovered • 1960 the first kidney transplant • 1967 the Salmon Report • 1978 the first test tube baby • 1980 keyhole surgery • 1988 breast screening introduced • 1990 internal market introduced • 2007 robotic intervention

9. Nursing uniforms c1890 Student nurse uniforms c1960 from Youngstown Hospital Assocation and St. Elizabeth Hospital

10. Youngstown State University student nurse uniform, 1967 Throughout the 1960s and 70s, many hospitals discontinued their nursing programs or partnered with local universities to provide some of the academic training. These new programs with colleges and universities opened up the profession to a more diverse population including married women, minorities, and men.

11. Healthcare professions of today • Doctors and dentists • Nursing and midwifery • Allied health professions • Healthcare scientist professions and the smaller professions • Healthcare support workers • Management, ancillary and other staff

12. Fields of practice • More than 15 specialties of medical practice with additional sub-specialties • 4 main branches of nursing with enhanced specialisation in practice – multiple sub-specialties • Around 12 allied health professions with multiple sub-specialisms • Over 30 healthcare scientist professions with a host of sub-specialisms • Primary, secondary and tertiary care settings • Integrated services e.g. with social care

13. Changes in practice • At one time, nurses and other professionals couldn’t take blood pressures – this was a medical procedure • We now have highly skilled practitioners who undertake a range of procedures and are also responsible for diagnosis e.g. advanced practitioners in cervical cytology

14. What does this say about current healthcare practice? • Its complex! • Its reliant on a range of practitioners in different settings and sectors with the appropriate skills • Technology advances and will continue to advance

15. Healthcare workforce – a recent history • The 1990s saw serious workforce shortages • Health Select Committee enquiry into workforce planning in 1999 • NHS Plan produced in 2000 – a 10 year strategy

16. NHS Plan Headlines • More staff, better paid • Modernisation of workforce and services • Improved outcomes • Critical targets

17. The Key Workforce Messages MORE STAFF WORKING DIFFERENTLY

18. Workforce Objectives • 150,000 more staff • Doubling in applicants and 60+% more trainees • Explosion of new roles • Delegated tasks e.g. prescribing • Extended roles e.g. nurse endoscopist • New roles e.g. advanced practitioner • Positive staff survey results • Lower vacancy and sickness absence rates • Over 90% of staff on new pay systems

19. Where are we now? • New workforce planning crisis • Graduates in some professions unable to find a job in their vocation • New Healthcare Select Committee Enquiry in 2006 • New attempts to ring-fence education and training and strengthen workforce planning

20. Swinging pendulum

21. Policies since the NHS Plan • Payment by Results • Tariff-based commissioning system • Choice and Competition • Stronger patient opinion and voice • Practice Based Commissioning • Stronger role in primary care • Commissioning a Patient Led NHS • Major reorganisation • All have had an impact on workforce…..

22. A world class NHS • Fair – equitable to all • Personalised – tailored to the needs of the individual • Effective – outcome-focused • Safe – public confidence

23. Eight defined areas of care • Maternity and newborn • Children’s health • Planned care • Mental health • Staying healthy • Long term conditions • Acute care • End of life to

24. The focus on workforce • The NHS employs over 1.3 million people • 70% of costs are staffing • The NHS spends over £4 billion annually on education and training • Need to overhaul the system and strengthen workforce planning and commissioning education and training • Need effective clinical leadership • Need to avoid repeats of the boom and bust

25. What are we aiming to achieve • We need a workforce with the right skills in the right quantity in the right place at the right time • A workforce that is appropriately educated and trained to deliver the service • A workforce that can deliver quality care to patients

26. How is the workforce planned? • Not dissimilar to history – its based on demographic requirements, however the healthcare arena is significantly more complex today • Workforce planning is designed around the patient • Based on the skills and competencies to deliver the required services • Planned in harmony with finance and services

27. 3 current key priorities in NW • 18 week wait – where are the workforce gaps? • Public health and health promotion – what are the workforce needs in terms of education and service delivery • Health inequalities – some significantly deprived areas - need to ensure appropriate workforce with correct skills is available

28. Blurring of professional boundaries • The average patient sees over 40 different people associated with delivering their care during a single episode of care • A patient is often assessed more than once • Many of the professions have overlapping skills and roles in patient care • Many of the professions dispute who should be carrying out particular roles

29. Workforce modernisation • Modernised roles focused on delivering the care pathways and targets • A workforce that demonstrates the appropriate attitudes and aptitudes • Breaking down of professional barriers where appropriate • A flexible workforce • A workforce that embraces continued professional development, advancing technology and evidence-based practice……….

30. …….A workforce capable of delivering world class healthcare in the 21st century

31. You know you work for the NHS when………… • Discussing dismemberment over dinner seems perfectly normal • You firmly believe unspeakable evils will happen when someone says ‘Wow its quiet in here’ • You have ever had a patient who looks you straight in the eye and says ‘I have no idea how that got stuck in there’

32. THANK YOU!