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The evolution of


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
Americas first trained nurse
graduated in 1873
The most significant development
was during war time when
Florence Nightingale laid the
foundation stone for professional

History of other professions

Physiotherapy practice dates back
to BC times, for example in
ancient Greece and the practice of
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
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
Good healthcare should be
available to all, regardless of
For the first time doctors, nurses,
pharmacists, etc. are brought
together under one umbrella

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

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
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 couldnt
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

Healthcare workforce a recent

The 1990s saw serious
workforce shortages
Health Select Committee
enquiry into workforce
planning in 1999
NHS Plan produced in
2000 a 10 year

NHS Plan Headlines

More staff, better paid
Modernisation of
workforce and
Improved outcomes
Critical targets

The Key Workforce Messages


Workforce Objectives
150,000 more staff
Doubling in applicants and 60+% more
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

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
Effective outcome-focused
Safe public confidence

Eight defined areas of care

Maternity and newborn

Childrens health
Planned care
Mental health
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
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
Workforce planning is designed around the
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
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
A flexible workforce
A workforce that embraces continued professional
development, advancing technology and evidencebased practice.

.A workforce capable of
delivering world class
healthcare in the 21st century

You know you work for the NHS

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