What implications will Brexit have for integrated care provision?

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

Brexit: the impact on health and social care and the role of community nurses

Brexit poses seismic challenges for health and social care provision in the United Kingdom concerning the on-going financial support available to fund health and social care within a post Brexit economy. Alongside funding issues there are potential concerns linked to the continued access to medical supplies and equipment which are linked to trading relationships within the European Union. Changes to the context of legal frameworks and funding for research which result from Brexit are also serious concerns. Although many of these areas may have potential detrimental impacts on patient care there is a particular concern about the loss of migrant health and social care workers which may exacerbate the recruitment issues currently facing the UK health and social care workforce. Reflections from those who work within health and social care can create insider perspectives about what Brexit means to individuals and their families. This can help organisations consider the challenges that their current EU migrant workers experience and explore ways of mitigating these impacts on both the individual and wider organisation to ensure patient care is not diluted but instead enhanced. Community and practice-based nurses and staff have a central role in providing integrated person-centred care and have an important role in advocating for their frail patients whose care may be compromised as a result of challenges created by Brexit

Supporting student nurses to develop healthy conversation skills

As advocates for health, nurses are ideally situated to deliver effective health promotion in their daily interactions with people. This work evaluates the integration of healthy conversation training, making every contact count (MECC), into a health promotion module in an undergraduate nursing degree at a higher education institute (HEI). In all, 108 students completed the online questionnaire I year after receiving healthy conversation training. 67% of students reported the regular or occasional use of healthy conversation skills and identified a wide range of scenarios where they had used the skills. 65% of students used health action planning framework in their own personal self-care. Student nurses acknowledged barriers and enablers to their use of healthy conversation skills. Having knowledgeable mentors who role modelled healthy conversations skills in their consultations was the most frequently raised factor, in addition to lack of knowledge of local resources, time and confidence. All placement settings should ensure that registered nurses, especially those undertaking mentorship responsibilities have access to healthy conversation training

Exploring an integrated palliative care model for older people: An integrative review

Purpose Due to an international ageing population, global health organisations have recognised challenges arising from fragmented interaction between health and social sectors in end of life care. This paper shall explore existing literature on integrative palliative care services for older people. Design An integrative review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA), papers included in the review focussed upon integrated care within palliative care systems (Jan 2007-17); papers were excluded when focussed on individuals younger than 65, not written in English and not being focused on integrated palliative care. Findings- Nine studies fitted the inclusion criteria and three themes were identified: Person-centred care, coordination of care, and education and training. The review identifies that integrated palliative care requires coordinated techniques that focus upon quality of life, individual needs and awareness of vulnerability rather than fixation on inevitable mortality. Research Implications- The emerging presence of the need for integrated palliative care requires further research in order to develop coherent models of integrated palliative care which can be incorporated into practice. Originality/Value- This review identified themes relevant to emerging issues in the global health sector of end of life care. The literature suggests that the optimised use of an integrated care approach to a palliative model of care is required and in need of further investigation

Species distribution modeling predicts significant declines in coralline algae populations under projected climate change with implications for conservation policy

Funding: This work was funded by a NERC iCASE studentship award to HB, PH, JB, and TF (NE/R007233/1). The Royal Botanic Garden Edinburgh acknowledges funding support from the Scottish Government Rural and Environment Sciences and Analytical Services Division (RESAS). This is a contribution to the Scottish Blue Carbon Forum.Anthropogenic climate change presents a major challenge to coastal ecosystems. Mass population declines or geographic shifts in species ranges are expected to occur, potentially leading to wide-scale ecosystem disruption or collapse. This is particularly important for habitat-forming species such as free-living non-geniculate coralline algae that aggregate to form large, structurally complex reef-life ecosystems with high associated biodiversity and carbon sequestration capability. Coralline algal beds have a worldwide distribution, but have recently experienced global declines due to anthropogenic pressures and changing environmental conditions. However, the environmental factors controlling coralline algal bed distribution remain poorly understood, limiting our ability to make adequate assessments of how populations may change in the future. We constructed the first species distribution model for non-geniculate coralline algae (focusing on maerl-forming species but including crustose coralline algae associated with coralline algal beds) and showed that bathymetry, temperature at the seabed and light availability are the primary environmental drivers of present-day non-geniculate coralline algae distribution. Our model also identifies suitable areas for species presence that currently lack records of occurrence. Large-scale spatial declines in coralline algal distribution were observed under all IPCC Representative Concentration Pathways (ranging from 38% decline under RCP 2.6 up to 84% decline under RCP 8.5), with the most rapid rate of decline up to 2050. Refuge populations that may persist under projected climate change were also identified – informing priority areas for future conservation efforts to maximize the long-term survival of this globally important ecosystem.Publisher PDFPeer reviewe