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.
Here, Professor Ann Hemingway, Public Health and Wellbeing, Faculty of Health and Social Sciences, Bournemouth University and Joanne Bosanquet, Deputy Chief Nurse, Public Health England and Visiting Professor, University of Surrey, explain how nurses must be prepared for their roles as advocates and seek to have influence over local policies which impact on health and the design of healthcare services.
I have worked in and out of community nursing since qualifying as an adult nurse 12 years ago. Although I have worked alongside a diverse range of community services, including district nursing, specialist long-term condition services and rapid response, the last six years have seen my main focus in community intravenous (IV) therapy. More recently, I have been working within the Blackpool, Fylde and Wyre community IV service, where I have worked with an excellent team of eight registered nurses and one healthcare assistant to recreate what is now an established nurse-led IV service, where we are able to provide a wide range of IV therapies to the local population, without the need for hospital attendance.
