Modernising Nursing Careers: Setting the Direction

1 The context of nursing is changing

Nursing is changing almost as rapidly as the context in which it is practised. As a dynamic profession, nursing is responsive and is adapting to meet the needs of patients and the public. Across the United Kingdom nurses have taken on new roles, work across boundaries, and are setting up new services to meet patients' needs. Now is the time to take stock, consider what these changes mean for nursing careers, and ensure that nursing is fit for the future.

All modern health care systems are facing major global and societal changes. A number of factors lie behind government policies to reform the way the health service works.

• Society in the UK today is more complex, giving rise to greater social, cultural, racial and geographical diversity.
• There are more people in the older age range so long term conditions are more prevalent. As a consequence demand for health and social care will continue to rise.
• Major causes of morbidity and mortality such as heart disease and some cancers can respond well to preventative measures, but these frequently require life style changes which can be hard to achieve.
• Health is not distributed equally and inequalities continue to be a major challenge.
• The working population is smaller so fewer people are available to enter the profession.
• People's expectations of health care are changing. They are more knowledgeable and expect to be treated as partners and equals, and to have choices and options available to them.
• Rapid advances in technology mean more effective treatments as well as the ability to provide care in different settings.
• The cost of new treatments and new information and communication technologies means a greater focus on value for money.

Key changes
The number of people aged over 85 years is projected to rise by nearly 75% by 2025.
Over 15 million people in the UK currently have a long term condition, and as the number of older people is projected to increase across the UK by between 18% and 23% so this number will increase.
Obesity rates have doubled in the last 10 years and potentially lead to a rise in strokes, heart attacks and Type 2 diabetes. It is estimated that 1 in 4 people will be obese by 2010.
Infant mortality rates vary from 1.6 per 1000 live births in Eastleigh, Hampshire to 9.8 per 1000 live births in Birmingham.
Smoking is still the single greatest cause of illness and premature death in the UK, killing at least 86,500 people a year and accounting for a third of all cancers and a seventh of all cardiovascular disease.