Martin Bradley, chief nursing office for Northern Ireland, believes nurses and midwives should be involved in policy and commissioning
The economic situation continues to dominate the headlines. In Northern Ireland, as in the rest of the UK, we will have some tough decisions to make. Demand for health and social care will continue to rise and it will be our job as nurses and midwives to try and ensure that all our patients and clients have access to safe and effective services as and when they need them.
Our population in Northern Ireland is ageing. The proportion of people of pensionable age is projected to increase by 11% in 2008-2013, and by 40% in 2008-2023. This larger, older population will place more demands on the system.
Demand for services will also rise as more people suffer from long-term conditions such as diabetes, hypertension, asthma and obesity. Drug and alcohol use is rising and the incidence of mental illness remains high.
People increasingly expect a more accessible, responsive and effective service, and a good experience. There needs to be a further shift to supporting people at home, and giving individuals, their families and local communities greater control over the range and delivery of services.
It is essential that a step change is secured in prevention and health improvement. This will require a new way of thinking, with people being encouraged to take more responsibility for their own and their families’ health.
Individuals need to understand the importance of lifestyle choices and the impact of those choices on the rising rates of long-term conditions. There is a need to shift from reactive hospital-based unscheduled care towards a more proactive and preventive model, which will lead to better health outcomes.
Many of our services were developed incrementally over many decades, based on the clinical evidence at that time, as well as on public opinion and how this was played out in local politics. Decisions on services, many of which were made in good faith, now date back many years, and no longer reflect needs.
We have to resist the temptation to give undue priority to areas with a high public or political profile. For example, acute care needs have to be met, but it would be a mistake to protect them from reform if they need to become more effective and cost efficient. If we fail to do this, then services with a lower profile, such as those for people with mental health problems or learning disabilities, children with complex needs and people who are terminally ill will come under increasing pressure.
I hear you ask, what can nurses and midwives do about this?
We operate in an environment where decisions are based on what resources are available and, hopefully, on the evidence of what is effective. But these decisions are also driven by political considerations, often shaped by public pressure and expectation.
If we want to influence these decisions, we need to have a view for the future of our services. We need to be more active in taking part in debates. 0n health and social care, and in discussions with local people and politicians.
Let us ensure that nurses and midwives involved in policy or commissioning are properly supported, have good access to evidence and good networks with other professionals. We need to work as a team.
In these difficult times, we do not have the resources to continue delivering services in their existing format. Let us ensure that we deliver services in a way that is not only effective but also driven by quality. We need to use this as an unique opportunity to achieve change.
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