1.  Visible, Accessible and Integrated Care Jane Walker Nursing Officer

2.  ‘My view you know is that the ultimate destination of all nursing is the nursing of the sick in their own homes…I look to the abolition of all hospitals & workhouse infirmaries. But it is no use to talk about the year 2,000.’ Florence Nightingale June 1867

3. Challenges facing UK health & social care system  Changes in population demography  Changes in patterns of disease  Changes in lifestyle  Changes in public expectation  Inequalities in health status  Need to reconcile demand, need & access with safety & quality

4. Ageing Population

5.  Older people more likely to:  Live alone, with consequent risks & need for support services  Have functional dependency & sensory impairment  Have LTC’s & co-morbidities  Require complex multi-medication regimes  Have cognitive impairments & mental health problems  Develop complications of acute illness

6. Population in <15 and 65+ age groups, Scotland: 1950-2042 (GAD projection) Source: http://www.esrcsocietytoday.ac.uk/ESRCInfoCentre/Images/demography_seminar_tcm6-7919.pdf

7. Nursing, health and social care workforce issues Age demographic of NHS Scotland Nursing Workforce (September 2005)

8. Age distribution of the register Age range in year ending 31 March 2002 % 2003 % 2004 % 2005 % 2006 % Under 25 years2.242.102.021.941.87 25-29 years8.868.548.448.298.04 30-39 years30.6329.3728.3027.3526.72 40-49 years32.3233.2633.9434.4264.52 50-54 years11.46 11.6211.9112.42 55 years and over 14.5015.2715.6816.0916.40

9. DELIVERING FOR HEALTH Current viewEvolving model of care Geared towards acute conditions Hospital centred Doctor dependent Episodic care Disjointed care Reactive care Patient as passive recipient Self care infrequent Carers undervalued Low tech Geared towards long-term conditions Embedded in communities Team based Continuous care Integrated care Preventive care Patient as partner Self care encouraged / facilitated Carers supported as partners High tech

10.  Implications of Delivering for Health  Existing focus on hospital care needs to change  Need to actively manage the most vulnerable in the community  Doing more of the same not the answer

11. Key Elements of Report  Generate strength from integration  Transformation through unity of purpose  Hold organisations charged with delivery accountable  Strong political, professional, public and union support

12.  Nursing & AHP Response  Delivering Care, Enabling Health  Visible, Accessible & Integrated Care  Co-ordinated & fit for purpose  Review Cancer Nursing  National workforce project

14.  How can Nurses make a difference?  Anticipatory care  Increase support for self care & close working with carers  Early interventions to prevent hospital admissions  Delivering on waiting times  Increasing the range of locally available diagnostic services

15.  Thank you