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Section 1
1 Policy context in Scotland
"The modernisation of health services across Europe, where increasing amounts and a great variety of health care interventions are delivered in primary care and community settings, requires new roles and new ways of working by health care personnel."
(World Health Organisation ( WHO) Europe (2006) Report on the Evaluation of the WHO Multi-country Family Health Nurse Pilot Study. Copenhagen: WHO Europe.)
Scotland has seen a number of legislative and policy developments that affect community services since 1999, when the Family Health Nurse pilot was first proposed. The most significant of these, Delivering for Health ( SEHD, 2005), sets out the policy infrastructure to create a fundamental shift in the way the NHS works, from an acute, hospital-driven service to one that is community-based. The policy focuses on:
- meeting the twin challenges of an ageing population and the rising incidence of long-term conditions
- preventing ill-health by equipping the health service to encourage and secure health improvement and 'wellness', rather than just treating illness
- treating people faster and closer to home
- developing services that are proactive, modern, safe and embedded in communities.
The new policy agenda in Scotland sets the scene for, and demands, new kinds of community-based services.
The nursing, midwifery and allied health professions response to implementing the new policy will be set out in Delivering Care, Delivering Health, which will provide clear direction on the way forward for nursing and midwifery in relation to culture and context (underlying principles of practice), capability (nursing and midwifery's contribution to health care in the future), and capacity (competency requirements for the new NHS workforce).
The Scottish Executive is currently conducting a national Review of nursing in the community in Scotland. The review so far has found much to celebrate in nursing in the community, with participants in consultations conducted during the process praising nurses' breadth of knowledge and skills, a rich blend that enables them to undertake holistic assessments and to creatively problem-solve with individuals, families and communities.
It is important to consider this final report of the Family Health Nursing project in Scotland within the context of Delivering for Health and the nursing response to it - Delivering Health, Enabling Care. The report seeks to reflect and complement each of these initiatives. Also significant to the development of Family Health Nursing services is a raft of policy and legislative initiatives that impact on the delivery of health and social care services to communities in Scotland, including:
- Nursing for Health - a Review of the Contribution of Nurses, Midwives and Health Visitors to Improving the Public's Health in Scotland (SEHD, 2001)
- Developing the Nursing and Midwifery Workforce 2003 (National Workforce Unit, 2004)
- Rights, Relationships and Recovery - the Review of Mental Health Nursing in Scotland (SEHD, 2006a)
- Changing Lives: The 21st Century Social Work Review (Scottish Executive, 2006)
- Care 21 (OPM/Scottish Executive, 2005), and the Scottish Executive response to it (Scottish Executive, 2006a)
- Delivering a Healthy Future (Scottish Executive, 2006b)
- the Joint Future programme ( http://www.scotland.gov.uk/Topics/Health/care/JointFuture/Introduction )
- Community Care and Health (Scotland) Act 2002 ( http://www.opsi.gov.uk/legislation/scotland/acts2002/20020005.htm )
- The Mental Health (Care and Treatment) (Scotland) Act 2003 ( http://www.opsi.gov.uk/legislation/scotland/acts2003/20030013.htm )
- the General Medical Services Contract ( http://www.paymodernisation.scot.nhs.uk/gms/index.htm )
- the Agenda for Change pay modernisation initiative ( http://www.paymodernisation.scot.nhs.uk/ ).
- WHO Europe (2006) Report on the Evaluation of the WHO Multi-country Family Health Nurse Pilot Study. Copenhagen: WHO Europe ( http://www.euro.who.int/document/e88841.pdf )
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