Editorial: Nursing education in the United Kingdom - clocks forward or clocks backward? (original) (raw)
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EXECUTIVE SUMMARY This paper was commissioned by the Nursing and Midwifery Council in May 2007 to inform the discussion on the options for change to the existing frameworks for the pre-registration education of nurses. Chapters 1 to 3 provide a synthesis of the relevant drivers of change in UK healthcare delivery and the education of health professionals in the period to 2015. Three alternative ‘scenarios’ of healthcare at the end of that period are presented in Chapter 4, which show how these various drivers – in combination - might have developed. Chapter 5 considers healthcare in 2015 as a set of ‘paradoxes’. Health Policy and Healthcare There will be modest overall population growth in the UK in the period to 2015, with a rapidly changing dependency ratio in the decade from 2020. In terms of the demand for healthcare, the nature and main causes of the burden of disease will change, but as yet there is little reason to be sanguine about the effectiveness of attempts to reduce obesity levels or health inequalities. A high priority will continue to be given to supporting the self-care of the growing numbers of people with long-term conditions. Demand for ‘complementary approaches’ to meeting health needs will remain high, as will patient demand for choice – on sources of advice, care packages and treatment, and access arrangements. On the supply side, there will be a growing – and increasingly diverse – role for the Third Sector, and reliance on the commercial sector to provide substantial elements of secondary care provision in England. Substantial benefits from much improved information technology will be apparent by 2015 – information for patients, about patients, on effectiveness and healthcare performance – and there will be examples of ‘personalised’ medicine derived from an understanding of the genetic basis of some common diseases. There will be growing use of telecare to support care at home, and new applications for biotechnology, bioengineering and robotics. Healthcare policy will continue to focus on measuring effectiveness, reducing variations in performance, improving safety and quality, improving productivity, designing more effective incentive systems, and engaging clinicians in all of this. There will be continuing turbulence in NHS managerial structures. Regulation (of services and the professions) will probably focus on quality and safety, reflecting the implications of devolution, and a sharing of the regulatory role between statutory regulators and employers. Substantial changes in the pattern of hospital services are likely, with further concentration of specialist services, and provision closer to home for the more generalist services. Greater coordination of effort between the NHS and Social Services will consume much attention. Nursing Within nursing itself, there are future potential workforce difficulties as a result of an ageing workforce, increased competition for nursing expertise from other countries, and financial difficulties that may affect commissioning of nurse - 3 - education. To maintain nursing numbers, it is important that recruitment and retention continues to have a high profile. Recent policy initiatives and emerging roles for nurses in response to healthcare demands dictate flexibility in the future nursing workforce. There will be an increase in specialist and advanced roles and a blurring of professional and sector boundaries. Care will follow the patient pathway, with an emphasis on community care and multidisciplinary team working. Nurses will have the opportunity to direct and lead care both within and outside the NHS and will be encouraged to take a more entrepreneurial stance. However, there is a lack of definition of roles and titles and a lack of clarity concerning career pathways and educational preparation for advanced and specialist roles. Recent developments related to the Knowledge and Skills Framework and a new White Paper on the ‘Regulation of Health Professionals in the 21st Century’ is attempting to address some of the issues surrounding the setting and maintenance of standards in the healthcare workforce. Nurse Education In nurse education, there is concern throughout the UK over the future recruitment and retention of nurses. Applications to pre-registration nurse education continue to increase, yet the rate of increase varies according to country, region and branch. The appropriateness of the four nursing branches which focus on collective groups rather than specialties has been questioned. Future health services may seek a more generic worker which is attractive in terms of meeting general health needs and offers a cost-effective approach. In contrast, there are strong concerns that generalist nursing would result in a deskilling of the workforce. Degree-level programmes could enhance the status of nursing in comparison to other health professions and provide nurses with skills needed that go beyond diploma level. Degree preparation may result in less diversity of applicants and difficulties of workforce retention. Policy recognises the importance of shared learning for health care professionals to develop integrated care services. Education will respond to the advances in global communication by providing a curriculum that acknowledges interdependent relations between countries, especially in Europe. Scenarios for UK Nursing in 2015 Some of the possible inter-play between these various drivers is captured in the three alternative, contrasting scenarios for nursing in 2015. None of them are ‘right’ or ‘wrong’, but all are plausible, and they reveal different tensions and sets of dependencies. Scenario A represents minimal change from the present state in which there are currently relatively few specialist nurses working at an advanced level, in a small number of specialist areas. The majority of nurses are working in more generalist roles supported by health care assistants. There is a fairly clear and generally understood distinction between nurses’ roles and those of other healthcare professionals. - 4 - In Scenario B there is increased demand for specialist staff in a wide variety of roles. Many of these are filled by nurses, but an increasing number are now carried out by other healthcare professionals. There are also fewer generalist nurse posts. As a result, there are fewer trained nurses overall than in option A. The demand for health care assistants remains fairly constant. In Scenario C nursing has responded to the increasing demands for specialisation by all registered nurses becoming specialists at a more advanced level. There are many more areas of specialisation (including advanced generalist nurses) and health care assistants bridge the gap in basic nursing care. However, the growth in the number of HCAs, and the loss of generalist nurse roles, has led to a differentiation in the levels of working of health care assistants. The paper concludes with a set of ‘paradoxes’ which try to capture some of the complexity of healthcare in 2015.
Four parts or one whole: The National Health Service (NHS) post-devolution
Journal of Nursing Management, 2008
Aim(s) There is a need for nurse and midwifery managers to have an understanding of devolution and its implications for them and their colleagues. This paper will explain devolution, consider some health and social care policy including similarities and differences, and assess the impact of devolution on the nursing workforce and the regulation of nursing across the four countries of the United Kingdom (UK).Background If managers are to manage effectively it is critical that they remain aware of emerging policy development and outcomes across the UK. It is now more important than ever that nurses maintain a keen eye on the impact divergent policy is having on practice as well as the UK nursing workforce.Evaluation The impact of devolution across the UK will be explored using convergence and divergence as a framework; commencing by providing an overview of devolution and health, moving on to examine health policy in action across the four countries.Key issues Healthcare is highly political in nature. Devolution has implications for all, and adds to the complexity of health and social care provision. If managers are to manage effectively it is critical that they remain aware of emerging policy development and outcomes across the UK.Conclusion It is equally important that nurses, and nurse managers, develop and draw upon their political leadership skills, actively engaging in policy debates to ensure that when policies are translated into practice their outcomes are optimal in terms of quality, efficiency and sustainability.Implications for nursing management There is a need for nurse and midwifery managers to have an understanding of post-devolution structures and how they operate in order to work effectively, as well as to learn from the experiences of other parts of the UK.
The aim of this essay is to show an understanding of political and social context underlining the foundation, running and evolution of the NHS. It looks at changes from political perspective that had a great influence on the structure and function of the organisation. It also considers changing demands from public placed upon it over the last sixty years. Furthermore, it seeks to analyse the economics of NHS funding. Last, it examines the effects of NHS on the public healthas well as a shift in the nature of public demand. Few people would argue that a free access to healthcare in the UK is taken for granted today with a limited number of exclusions at a point of entry. This has not always been the case, however. The whole range of political and social changes on a grand scale took place in the 19 th and 20 th century prior to foundation of NHS by Labour Health Secretary Aneurin Bevan on the 5 th July 1948.
Looking forward: Clinical governance and the drive for quality improvement in the new NHS in England
BMJ, 1998
sugar and adjust their insulin doses, achieving far better control than when the doctor was making the insulin adjustments. 9 You learned from Dr David Sobel at Kaiser Permanente in America, who trained chronically ill adults to provide care and education to other chronically ill adults, achieving better health status outcomes and lower cost for both teachers and students. 10 You built your programmes on evidence of the benefits of patient self care in studies of asthma treatment, 11 hypertension treatment, and self diagnosis of urinary tract infection. 12 By the early 21st century, the NHS was becoming a truly patient centered clinical care system. The emphasis today is on helping people with acute and chronic illnesses to become experts in their own care whenever they wish, able to participate fully in their own diagnosis, treatment, and monitoring. Shared decision making, incorporating every patient's values and circumstances, is now the norm. 13 NHS patients today write in and read their own medical records, receive much of their care in their own homes, and remain fully connected with their loved ones and communities. At first, your doctors resisted this trend-fearing, perhaps, that it would relegate them to second fiddle, demean their expertise, and perhaps subject patients to undue hazards. Instead, this reformulation of the respective roles of doctor and patient has helped everyone-giving patients and their families the chance to establish control over their own lives and giving doctors, nurses, and other healthcare professionals the chance to focus their time and energies on exactly those technical, pastoral, and humanitarian tasks that they are in the best position to pursue. These principles endure. You are not by any means finished. As in 1998, and as it will be in 2048, you in 2023 seek the continual improvement of an NHS full of knowledge, taking the best as its norm, growing its capacity as a full and integrated system of shared effort, wasting little, and respecting every patient as an individual. You continue to know that you started off right in 1948, and with some important midcourse corrections, you remain well on track. Maybe some day healthcare leaders in the United States will catch up. I am sure you will help them if they ask.