Rosemary Cook explains why creativity and inventiveness must be encouraged to meet the profession’s challenges
A perfect storm at sea occurs when wind, rain and tide rapidly combine to produce exceptional conditions that can be deadly, even for experienced sailors in sturdy vessels.
A similar storm is heading for the health service, and community services in particular - but at least we have the advantage of seeing it coming.
Several elements are building this particular storm.
First, there is the global health challenge: the World Health Organization’s list of the top threats to health puts ischaemic heart disease, chronic lung disease, cardiovascular disease, the unipolar depressive disorders, lung cancer and alcohol related disorders among the top 10 threats to health.
These are all diseases of significant morbidity in the UK. Worse, they are linked to “wrong direction” trends in lifestyles - more drinking, less exercise and less healthy diets, which have proved quite resistant to health promotion and social marketing campaigns.
‘Entrepreneurs remain a very small minority. Clearly, there is a disconnection between the rhetoric of modern nursing and the reality that is not being addressed’
Add in the increasing survivability of formerly deadly diseases, leading to more people living with long term conditions, and pandemics of infectious disease, and we have, to put it mildly, more work to do than ever before.
Second, from a community services perspective, we have the movement of care out of hospitals into people’s homes and community settings. This is a necessary economic strategy, given the affordability predictions of Derek Wanless’ reports, and the demographic changes in the UK population. We simply will not be able to afford to provide the volume of care required through hospital beds.
More positively, changes in treatment technologies mean that lengths of stay are shorter, and some conditions that would once have required admission can now be treated outside hospitals.
The demographic issues are important. In 2008, for the first time, people of retirement age outnumbered young people under 16, according to the Office for National Statistics. The population of people over 65 has increased by nearly half a million over the past decade, and is predicted to rise by 23 per cent to 12 million by 2017.
Bearing in mind that, currently, one in four people aged over 75, and one in two aged over 85 require some nursing care in their own homes, this implies a major increase in the baseline need for community services. Meanwhile, the number of younger people who will make up the future workforce is not rising at the same rate.
The community workforce is also a concern. Although the overall number of nurses and midwives employed in community services rose by 38 per cent in the decade to 2006, the numbers of qualified community specialists has been falling: district nurses by 23 per cent and health visitors by 11 per cent. Practice nurse numbers started to fall in 2006
for the first time since monitoring began, and have fallen by 7 per cent in two years. Meanwhile, the number of healthcare assistants more than doubled in the decade to 2006. Therefore we have increasing numbers but a more dilute
And, with community nurses on average older than hospital nurses - and demoralised by uncertainty over their future employment - the coming bulge in retirement is set to remove more of the most experienced and highly qualified from services.
The financial squeeze, in both healthcare and the economy, means that we cannot buy ourselves out of this situation. Hence the increasingly fierce pressure to work smarter, adopt new technologies, transform old ways of working, and engage the public in prevention and self care.
And nurses are better equipped than they have ever been to do this. Most of the old barriers around who can hold which roles and skills, and who can run organisations and provide services, have come down. Nurses are positively encouraged to lead services, and there are innovation funds galore available to kick start local changes.
Yet, to the frustration of policymakers, the innovators, change agents and entrepreneurs remain a very small minority in the profession. Clearly, there is a disconnection between the rhetoric of modern nursing and the reality on the ground that is not being addressed.
The Prime Minister’s Commission on the Future of Nursing and Midwifery needs to consider how to galvanise
the profession in a way that has not been done before, to make the most of the opportunities that spring up when so many things are in flux together.
Desperate times require inventive measures, and creativity and inventiveness are represented in nursing, at individual level - when encouraged, supported and protected. The Queen’s Nursing Institute will be focusing on doing this for community nurses, in particular those who nurse people in their own homes, as they step up to be part of the solution to the great challenges ahead.