Aligning Community Nursing to meet the health needs of the people of Highland

NHS Highland Area: 12,507 square miles Population: 299,000 Budget: £522m Staff: 11,500 1 District General Hospital 3 Rural General Hospitals 2 Mental Health Hospitals 20 Community Hospitals A wide range of community services throughout

“ We have nothing to fear but fear itself- nameless, unreasoning, unjustified terror which paralyzes needed efforts to convert retreat into advance

Challenges Providing safe & sustainable health services Reducing inequalities in healthcare Demographic changes Geographical area Limited internal transport and communications infrastructure Tourist season

1 Thurso Tain Badenoch and Strathspey Mid Argyll Kintyre Helensburgh and Lomond

Model of Community Health Nursing NowFuture Parallel workingIntegrated teams Lack of shared goalsClear priorities ReactivePreemptive Historical WorkforceWorkforce to meet identified needs Fragmented leadershipClear transformational Leadership

“ Ask not what the policy can do for the model but what the model can do for the policy ”

Key Policy Drivers Reducing health inequalities Getting it Right for Every Child Managing long term conditions

Reducing Health Inequalities Community Health Profiles Fit for purpose workforce- structure and skills profiles Prioritising and Planning – national and local targets Monitoring and evaluating

Getting it Right for Every Child “Getting it right for every child is the foundation for work with all children and young people and will also affect practitioners in adult services who work with the parents or carers. It builds from universal health and education services and drives the developments that will improve outcomes for children and young people…” Scottish Government. A Guide to Getting it right for every child September 2008: Version 1.1

Getting it Right for Every Child Current Position A multi agency assessment providing: An evidenced based framework to facilitate consistency in approach to the assessment of children’s needs Reduce the number of assessments that a child is subject to Breakdown professional boundaries Improve information sharing

Everyone ’ s Responsibility to ask The same 5 Questions 1. What is getting in the way of this child’s wellbeing? 2. Do I have all the information I need to help this child or young person? 3. What can I do now to help this child? 4. What can my agency do to help this child? 5. What additional help, if any, may be needed from others?

Getting it Right for Every Child As a result: Access to services will improve/better outcomes A timely and child focused response is achieved Resources are better utilised Better management information is achieved, ensuring resources are targeted effectively

Managing Long Term Conditions

Models of Care Biomedical Cure Specialist role Disease / Illness Compliance Intensive Palliative Chemo Biosocial Care Holistic Patient Autonomy Concordance Time / Choices Community Based

Key Components Identify population at high risk - Nairn Casefinder Tool Implement anticipatory care planning Improve monitoring of long term conditions Develop self care and self management

Universal Additional Intensive Advanced Practitioner CHNs Staff Nurses Admin/ Support Workers Prioritisation of Need Team Structure

“ Can we Change? ” “ YES, WE CAN ”