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

Create Over Supply & Competition Transaction ReformsControl Demand Market Reforms Foundation Trusts, Specialist Centres, 3 rd Sector PbR, Fixed TariffsDeveloped Primary Care, Community Hospitals, Referral Management Choose & Book Consumer market reform

Impact on care provision Specialist centre DGH ISTC

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

The ward of the past

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

The ward of the present

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

The ward of the future

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

The DN team of the past

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

The DN team of the present

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

The DN team of the future

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

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

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

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