1. Community Nursing within an Integrated Health and Social Care Landscape
Fiona McQueen
Chief Nursing Officer
Scottish Government

2. Integrated Community Adult Nursing key to helping delivery Policy Ambitions

3. s Policy Aspirations Right place, right time
More care and treatment at home or in the community
Maximising all contributions
Integrated teams working with people and communities
Shifting the balance of care
A focus on Prevention, Early Intervention and Supported Self Management
A focus on reducing fragmentation

4. Community Adult Nursing Teams – many teams for one Population?
District Nursing
General Practice Nursing
Care Home Nursing
Care Home Liaison Nursing
Primary Care nursing team
Hospital at Home
Hospital to Home
Intermediate care team
Specialist Nursing
Advanced Practice Nurses
Mental Health Nursing
Is One team an achievable reality?

5. Community nursing within an Integrated Landscape – what do we know?
↑ number of Older People
↑ frailty
↑complexity and co-morbidity
Aging workforce – High numbers of nurses who can retire
Recruitment and retention challenges for Nursing in care-homes
Impact of the new GMS contract
National challenges recruiting to nursing and care
Policy drive to shift the balance of care
Changing expectations from the workforce e.g. ↑ Part-time working

6. So what’s happening? Transforming Nursing Roles Programme
2030 Vision for Nursing (2017)
CNO Review (2017) Widening participation into Nursing and midwifery education and careers
↑ Student numbers and bursary
National Workforce Plan: Part 3 – commitment to grow the primary care multi-disciplinary team
District Nursing workforce review
Commitment to £3m investment in GPN education and £3.9 m investment in DN education
National Nursing and Midwifery Recruitment Campaign
Health and Care Staffing Bill for Scotland

7. Transforming Services Transforming Education
Transforming NM&HP Roles
Transforming Services
Transforming Roles
Transforming Education
A Collaborative Approach
CNOD
Scottish Executive Nurse Directors
Nursing, AHP, Medical and SW Staff
Professional bodies
Staff side organisations
NES + HEIs
ASD and ISD
Involvement and engagement

8. Transforming Roles Publications CNO Directorate

9. PREPARING NURSES FOR FUTURE NEEDS AND ROLES
NURSING 2030 VISION
PREPARING NURSES FOR FUTURE NEEDS AND ROLES
Ensuring the right number and quality of nurses are being trained with the right competencies and attributes
Nurses need to be competent and skilled to take on new ways of working to enable them to perform in a wide range of settings and in multi-disciplinary teams
Nurses will require the right preparation, supervision and support to be confident in taking advantage of the transformed roles

10. Three key themes have emerged from the Vision
NURSING 2030 VISION
Large scale engagement exercise including Twitter chats, online questionnaire and local engagement events
Over 3,200 nurses, students and nursing stakeholders
Feedback reflected in the Vision
Three key themes have emerged from the Vision
personalising care
preparing nurses for the future needs and roles
supporting nurses

11. Defining Routes Removing barriers
CNO Review – Widening Participation into Nursing and Midwifery Education and Careers
Defining Routes
Removing barriers

12. Increase in Student Numbers and new standards
Recommended a 10.8% increase in student nursing and midwifery intakes for 2018/19 – the sixth successive rise, with an extra 364 places equating to over 3,700 entry places.
This supports our commitment to create an estimated 2,600 new training places over this Parliament.
We are working on recommendations for the 2019/20 intake which includes gathering and considering available data and intelligence on:
School Nursing;
District Nursing; and
Elective Centres.
To ensure we recruit and retain the next generation of staff.
The new standards will provide key learning opportunities for:
An increased focus on a wide range of skills 
Focus on teamwork and leadership and independent working.
Larger range of skills in a larger range of settings.
Students should be as prepared to work in the community as well as in hospitals.
Creating practice learning experiences that will prepare our undergraduate students to care for people with mental and physical health needs across different care settings
Partnerships between health, care and education essential in the preparation of students and ongoing support of all practitioners.
New standards build on the strengths of our practice education network - practice education facilitators and care home education facilitators supporting the new roles of practice supervisor and practice assessor.
Increase in Student Numbers and new standards

13. Growing the Primary Care workforce
↑ the overall annual expenditure on primary care by £500 million by 2021/22.
£250 million of that investment being in direct support of general practice.
↑ of investment in the wider multidisciplinary team.
Development of GP clusters.
↑ of investment in primary care improvement.
A focus on a real shift from acute care to primary and community care.
By 2021 half of the health budget will be spent in community.

14. Marketing Campaign
In line with Nursing 2030 Vision, we are developing a National Nursing and Midwifery recruitment campaign
The CNO Commission on Widening Participation in Nursing and Midwifery Education and Training recommended that the campaign should be designed to attract young people, mature students and men into the profession
We are also seeking to attract people from disadvantaged communities, those with disabilities and ethnic minorities
We are working with marketing colleagues to develop the campaign, which will be launched next year

15. NHS HIS – Quality of Care Reviews Care Inspectorate - Inspections
Wider Policy: National Health and Social Care Workforce Plan – Parts 1,2&3
The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 – Reg. 15
“suitably qualified and competent persons … in such numbers as are appropriate for the health, welfare and safety of service users”
National Health Service (Scotland) Act Ic
“duty of every health board…to put in place and keep arrangements for the purpose of – workforce planning”
Aim: improve outcomes and create a cohesive framework across health and care services
Create a general duty to cover both health and care services
e.g. To ensure that at all times suitably qualified and competent individuals are working in such numbers as are appropriate for the health, wellbeing and safety of patients, and the provision of high-quality health care
Principles to consider when applying the general duty
Health where
-method / tools exist
Health
No method/ tool
Care services
No method/ tool
GOVERNANCE
Professional Judgement tool
Quality Measures
Local Context
Specialty Specific Tool
Staff Engagement
METHOD
Regulation making power
Regulation making power
NHS HIS – Quality of Care Reviews
Care Inspectorate - Inspections
Analysis/Risk Assess
DECISION MAKING
Escalation processes
Consider redesign
Senior professional clinical advice
Prioritisation processes
Informed staff
Improvement Support
Improvement Support
Internal reporting processes
Escalation
Senior professional clinical advice
REPORTING & MONITORING
Escalation
Intervention
Annual external reporting
Intervention

16. What next?
Lets do this together in a collective and integrated way