A move towards integrated health and social care provision has been a key policy driver in the UK since 2010, underpinned by a belief that this is essential to provide holistic, person-centred care while transforming service provision. Progress towards achieving integrated care has been slow, and now Brexit poses a further challenge, as attention is focused on preparations for a ‘no-deal’ scenario. Ensuring that the NHS and social care systems are able to continue to function after March 2019 is now a key concern for those leading and managing frontline services, and measures are being put in place to deal with potential disruptions caused by a no-deal Brexit. This includes dealing with issues related to the recruitment and retention of European economic area (EEA) staff into the NHS, disruptions in the supply of medicines across European Union (EU) borders, challenges to the recognition of professional qualifications and patient safety, and health protection and health security within the UK post-Brexit. The imperative to prepare for a worse-case scenario diverts attention away from other key policy drivers, such as integrated care provision. It may also serve to reinforce a view of integration as a cost-cutting exercise, rather than as an approach to promote better care for patients. A move towards the transformation of care through integrated provision offers real potential for improved patient outcomes in the future, and a revitalised health service. However, Brexit has the potential to disrupt the integration agenda as financial resources and staff time become focused on dealing with the fall-out from Brexit, rather than on frontline patient care. Community and practice-based nurses and staff are in the frontline of integrated service provision, and in the next few months may be some of the first staff to witness the negative impact of Brexit preparations on the provision of integrated care.
Excess weight can become a particular health hazard with age, triggering cardiovascular disease, diabetes, cancers, joint problems and other inflammatory conditions. This article looks at what can be done to help the elderly population maintain a healthy weight, while avoiding problems such as sarcopenia and bone loss. Weight tends to be carried more around the middle in the older person, which poses more of a risk for metabolic diseases than excess weight elsewhere — why this happens and how it can be avoided is discussed. This paper also looks at appropriate calorie intake and activity and explores weight loss and why it is harder and slower to lose weight with age. Preventing loss of strength and mobility is also important with aging, and, as immune function can decrease with age, how to avoid this declining significantly is also touched upon.
Prevarication is a terrible thing. It’s 11.00am and I’ve been sitting at my desk trying to write this piece for two hours. Even though I know what I want to say, I always struggle to start. I’ve completed a number of other (less important) tasks on my ‘to-do list’ as well as some that weren’t on the list but offered a distraction from the blank page in front of me.
This study explored district nursing teams’ perceptions of the current chronic conditions management model in a specific locality in Wales. Chronic diseases are now the leading cause of illness and disability across the UK, placing an increasing demand on public services as healthcare staff try to meet the needs of those with long-term conditions. The author used action research to conduct the study, encouraging the nurse participants to critically review their practice. The findings indicated that a major overhaul of the current model of care was not required; the foundations were there and just some small steps and a shared vision led to sustainable changes for an efficient and effective chronic conditions service.
Due to changes in national healthcare policy community staff, including nurses, are being asked to care for ever-larger and more diverse groups of patients. However, the challenge for staff and service providers is how to deliver higher standards of clinical care while ensuring that patient safety remains a priority. One of the answers is to ensure that staff who deliver any clinical skill do so competently, but reports have highlighted technical skills gaps that need to be addressed. No failings should be regarded as acceptable as they can impact on patient safety and there is a responsibility to address any areas for improvement through education and skills training. The study outlined in this article attempted to capture the perceptions and experiences of community staff to gain an insight into the gaps in clinical skills training and make recommendations for improvement.
The recent and ongoing changes to the NHS were instigated to absorb the increasing costs of an ageing population: the NHS needs to save £15–20 billion by the end of 2013/14 for reinvestment into frontline services (Department of Health [DH], 2010a; 2010b).
David Gray, Professor of Tissue Viability, Tissue Viability Practice Development Unit, Birmingham City University, and Clinical Nurse Specialist Tissue Viability, NHS Grampian, Aberdeen
The senior level gained by advanced nurse practitioners (ANPs) means they are in a strong position when it comes to representing the population. Nurses have had to educate themselves beyond post registration with Masters and Doctorates to support the client group, because of the growing population and 24-hour healthcare requirements. This is in support of the NHS’s commitment to care for patients from the cradle to the grave. There have been obstacles to the ANP’s advancement, but the five drivers of heath care are firm and supportive and likely to have a great impact in the future for ANPs as service deliverers.
Elizabeth Haidar, Senior Lecturer, Non Medical Prescribing Programme Lead, Middlesex University, London
In 2010, Andrew Lansley, Secretary of State for Health, pledged that the public would be at the heart of everything that is done within the NHS — not just as beneficiaries of care, but as participants in shared decision-making (Secretary of State for Health, 2010).
Anita Fatchett, Associate Senior Lecturer Nursing
Liz Clark, Principal Lecturer
Dawn Taylor, Senior Lecturer, Health Visitor Course Leader, all at Leeds Metropolitan University
Smoking has been identified as one of the major causes of cardiovascular disease (CVD), and smokers are almost twice as likely to have a myocardial infarction compared to non-smokers This article, a JCN Writing Award entry, will analyse the smoking-related disease process associated with nicotine. An appraisal of the cost of smoking prevalence on the National Health In relation to government strategy, an exploration of its efficacy, cost and uptake of the programme across the socioeconomic groups will be analysed.
Emma Sadler RGN, Staff Nurse, Leighton Hospital, Crewe
