Foreword
The way NHS services in Scotland are designed and delivered is changing. Visible, Accessible and Integrated Care, considered in tandem with Delivering Care, Enabling Health, proposes a new service delivery model designed to enable nurses in the community to play their part in delivering change for the benefit of the patients and communities they serve.
As the Chief Nursing Officer wrote in his introduction to Visible, Accessible and Integrated Care, "Change is challenging, but change is necessary". Perhaps no one understands this better than nurses working in the community in Scotland.
These nurses know that change is inevitable and that community nursing services have to change to meet the needs of 21 st-century Scotland, as do acute services. The service model set out in Visible, Accessible and Integrated Care, which was devised following a long process of involvement and engagement with key stakeholders, provides an underpinning for a family- and patient-centred community health nursing discipline and service model.
While the service delivery model proposes significant changes to the structure and focus of community nursing services, it does not seek to devalue traditional nursing roles; rather, it aims to build on their strengths to provide a model for nursing services that will meet the needs of communities in Scotland now and in the future.
But it is understandable that the model has created concern and anxieties, particularly among community-based nurses. It offers new and innovative solutions to the problems we face in community care, but it does so by proposing a very different look to services and the way they work. That is bound to create anxiety.
I have always found, however, that a proposal that raises concerns and anxiety also raises great opportunities for positive and creative thinking. The proposed service delivery model offers such an opportunity, one that has been keenly grasped by the national Programme Board, which I am privileged to Chair, and by the wider community beyond.
The Scottish Government has confirmed through the Better Health, Better Care Action Plan its commitment to a model of nursing in the community that delivers effective nursing support to individuals, families and communities. The Government is mindful, however, of the concerns raised about the proposed service delivery model, and has instructed that it be tested in practice. A formal evaluation that will commence in 2009 will provide the evidence to determine the way forward for the future.
What we have, then, is an enormous will and energy throughout the country - from Government, communities and professionals - to develop community nursing services that work for individuals, families and communities. As this report clearly shows, that will and energy are being targeted very effectively in the Pilot Sites that are testing the service delivery model. The report describes the process that has led us to this point, records the progress that has been made to date, and looks to developments in the future.
It is fair to say that from the debates and discussions that have taken place both within and outside the Programme Board, there is as yet no clear agreement on how nursing in the community in Scotland should be configured in the future. But it is also fair to say that the service delivery model set out in Visible, Accessible and Integrated Care provides us with a carefully considered and practical platform for development that reflects the clearly articulated need for change that emerged through the Review process. The model offers a great opportunity to shape nursing services in the community to ensure they genuinely meet the needs of Scotland's population in the 21 st century, and I am delighted to see that it is already beginning to make a positive impact in the Pilot Sites.
I would like to express my thanks and admiration for the work of the national Programme Board, the staff and service users in the four Pilot Sites, and my predecessors as Chair of the Programme Board, Lesley Summerhill and Heather Tierney-Moore. As we close this opening chapter in the Programme Board's work with the publication of this report, I feel excited about the opportunity to further engage with partners and stakeholders in defining a positive way forward, and I look forward enormously to the final evaluation of the project.
Professor Margaret C Smith
Chair of the national Programme Board