The evolution of

professional
nursing
 History of Medicine

• Medical practice can be

dated as far back as the
ancient Egyptians
• Imphotep was the
physician to King Zozer
and lived in about 2600 BC
 History of the non-medical professions

• Nursing has existed in various

forms in every culture over
millennia, e.g. wet nurses
• America’s first trained nurse
graduated in 1873
• The most significant development
was during war time when
Florence Nightingale laid the
foundation stone for professional
nursing
 History of other professions
• Physiotherapy practice dates back
to BC times, for example in
ancient Greece and the practice of
hydrotherapy
• In 1894 the UK recognised
physiotherapy as a specialised
branch of nursing
• The polio epidemic was a turning
point for the physiotherapy
profession and its establishment
in its own right
So what does the history tell us?
• The practice of healthcare and medicine has
been around for a long, long time in various
forms
• The practice of healthcare and medicine has
been consistently valued and has evolved in
accordance with demographic requirements
• The various professions have evolved in
accordance with demographic requirements
So what does the history tell us?
History of the NHS
• The NHS was born on July 5
1948 officially started by Aneurin
Bevan
• ‘Good healthcare should be
available to all, regardless of
wealth’
• For the first time doctors, nurses,
pharmacists, etc. are brought
together under one umbrella
organisation
The Timeline
• 1948 the NHS commenced
• 1953 the structure of DNA was discovered
• 1960 the first kidney transplant
• 1967 the Salmon Report
• 1978 the first test tube baby
• 1980 keyhole surgery
• 1988 breast screening introduced
• 1990 internal market introduced
• 2007 robotic intervention
Nursing uniforms
c1890

Student nurse uniforms

c1960 from Youngstown
Hospital Assocation and
St. Elizabeth Hospital
Youngstown State University student
nurse uniform, 1967
Throughout the 1960s and
70s, many hospitals
discontinued their nursing
programs or partnered with
local universities to provide
some of the academic
training. These new
programs with colleges
and universities opened up
the profession to a more
diverse population
including married women,
minorities, and men.
Healthcare professions of today

• Doctors and dentists

• Nursing and midwifery
• Allied health professions
• Healthcare scientist professions and the
smaller professions
• Healthcare support workers
• Management, ancillary and other staff
Fields of practice
• More than 15 specialties of medical practice with
additional sub-specialties
• 4 main branches of nursing with enhanced
specialisation in practice – multiple sub-specialties
• Around 12 allied health professions with multiple
sub-specialisms
• Over 30 healthcare scientist professions with a host
of sub-specialisms
• Primary, secondary and tertiary care settings
• Integrated services e.g. with social care
Changes in practice
• At one time, nurses and
other professionals couldn’t
take blood pressures – this
was a medical procedure

• We now have highly skilled

practitioners who undertake a range of
procedures and are also responsible
for diagnosis e.g. advanced
practitioners in cervical cytology
What does this say about current
healthcare practice?
• Its complex!
• Its reliant on a range of
practitioners in different
settings and sectors with
the appropriate skills
• Technology advances
and will continue to
advance
Healthcare workforce – a recent
history
• The 1990s saw serious
workforce shortages
• Health Select Committee
enquiry into workforce
planning in 1999
• NHS Plan produced in
2000 – a 10 year
strategy
NHS Plan Headlines

• More staff, better paid

• Modernisation of
workforce and
services
• Improved outcomes
• Critical targets
The Key Workforce Messages

MORE
STAFF

WORKING
DIFFERENTLY
Workforce Objectives
• 150,000 more staff
• Doubling in applicants and 60+% more
trainees
• Explosion of new roles
– Delegated tasks e.g. prescribing
– Extended roles e.g. nurse endoscopist
– New roles e.g. advanced practitioner
• Positive staff survey results
• Lower vacancy and sickness absence rates
• Over 90% of staff on new pay systems
Where are we now?
• New workforce planning crisis
– Graduates in some professions unable to
find a job in their vocation
• New Healthcare Select Committee
Enquiry in 2006
• New attempts to ring-fence education
and training and strengthen workforce
planning
Swinging pendulum
Policies since the NHS Plan
• Payment by Results
– Tariff-based commissioning system
• Choice and Competition
– Stronger patient opinion and voice
• Practice Based Commissioning
– Stronger role in primary care
• Commissioning a Patient Led NHS
– Major reorganisation

• All have had an impact on workforce…..

• A world class NHS
Fair – equitable to all
Personalised – tailored to the needs of the
individual
Effective – outcome-focused
Safe – public confidence
Eight defined areas of care
• Maternity and newborn
• Children’s health
• Planned care
• Mental health to
• Staying healthy
• Long term conditions
• Acute care
• End of life
The focus on workforce
• The NHS employs over 1.3 million people
• 70% of costs are staffing
• The NHS spends over £4 billion annually on
education and training
• Need to overhaul the system and strengthen
workforce planning and commissioning
education and training
• Need effective clinical leadership
• Need to avoid repeats of the boom and bust
What are we aiming to achieve
• We need a workforce with the right skills
in the right quantity in the right place at
the right time
• A workforce that is appropriately
educated and trained to deliver the
service
• A workforce that can deliver quality care
to patients
How is the workforce planned?
• Not dissimilar to history – its based on
demographic requirements, however the
healthcare arena is significantly more complex
today
• Workforce planning is designed around the
patient
• Based on the skills and competencies to deliver
the required services
• Planned in harmony with finance and services
3 current key priorities in NW
• 18 week wait – where are the workforce
gaps?
• Public health and health promotion – what
are the workforce needs in terms of education
and service delivery
• Health inequalities – some significantly
deprived areas - need to ensure appropriate
workforce with correct skills is available
Blurring of professional boundaries

• The average patient sees over 40 different

people associated with delivering their care
during a single episode of care
• A patient is often assessed more than once
• Many of the professions have overlapping
skills and roles in patient care
• Many of the professions dispute who should
be carrying out particular roles
 Workforce modernisation
• Modernised roles focused on delivering the care
pathways and targets
• A workforce that demonstrates the appropriate
attitudes and aptitudes
• Breaking down of professional barriers where
appropriate
• A flexible workforce
• A workforce that embraces continued professional
development, advancing technology and evidence-
based practice……….
…….A workforce capable of
delivering world class
healthcare in the 21st century
You know you work for the NHS
when…………
• Discussing dismemberment over dinner
seems perfectly normal
• You firmly believe unspeakable evils will
happen when someone says ‘Wow its
quiet in here’
• You have ever had a patient who looks
you straight in the eye and says ‘I have
no idea how that got stuck in there’