Tag Archives: Nursing

4813-stressed-nurse

Nurses in Britain are Buried by Paperwork

Nurses in Britain are Buried by Paperwork

Nurses in Britain buried in paperwork planningforcare.co.ukNurses in Britain spend an estimated 2.5 million hours a week on “non-essential” paperwork that’s where Planning for Care can help

The Royal College of Nursing believes nurses are burdened with too much paperwork and too many targets.

I think every nurse would support that belief.

The view adopted by the inspectors and auditors appears to be ‘if it’s not written down, it’s not happening.’

In reality, there can be a well written Care Plan but the quality of care might bear no resemblance to what is set out within the Care Plan.

Nurses would much rather spend their time caring for patients or residents than completing paperwork such as care plans.

Unless nurses are producing excellent Care Plans, Care Home grades will suffer.

30 years ago written Care Plans did not exist, but the care delivered was, in the main, very good or excellent.

Perhaps this was because nurses did not have to spend much of their time producing the volume of paperwork that is necessary today.

I do very much believe in the benefit of care plans today.

It is the way forward and if written well, can really have the capacity to have a substantial effect and improve the quality of care.

Documentation is a crucial aspect of care, which facilitates the continuity of care and it forms an accurate record of care provided. It is now vitally important that the quality of resident’s care and nursing documentation is of the highest standard.

How Our Care Plans Can Help

A good system of Care Planning undoubtedly can help the nurses and carers complete the paperwork far quicker and more comprehensively.

A system of personalising care planning for the elderly, which Planning for Care provides, can vastly improve the delivery of care and help Care Homes improve the grading they are awarded by the Care Inspectorate by helping them meet their regulatory requirements.

“The challenges facing everyone in the care sector are growing exponentially with constant changes in law, increased regulation and the potential threat of litigation.”

The focus on nursing appears to have changed and, instead of it being a wonderful, satisfying and fulfilling occupation, it is now very much a race against time.

It is in everyone’s interest that the standards of care improve.

The National Health Service, and nurses in Britain are wonderful institutions which have to survive and flourish.

Progress is a great thing, but there needs to be a balance to ensure there is no deterioration in the very core standards and values of nursing. We need to rethink the path we are taking.

The days of placing massive importance on positioning each pillow case with the closed end facing the entrance door of the ward have gone!

But was it really such a pointless exercise?

In those days every nurse knew every detail about every patient, and every aspect of patient care was delivered with precision and thought.

Patient care may have been delivered in a task orientated way, but attention to detail was everything.

The pride nurses had in their job was tangible.

A mixture of the nursing cultures of yesteryear and today is, I think, needed to help elevate nursing to the high standard of profession it should be.

View our free sample Care Plan or our full range of Care Plans here. 

Nurses in Britain spend an estimated 2.5 million hours a week on “non-essential” paperwork – Planning for Care Can Help

Britain’s nurses spend an estimated 2.5 million hours a week on ‘non-essential’ paperwork and clerical tasks, according to research.

The Royal College of Nursing believes nurses are burdened with too much paperwork and too many targets.

I think every nurse would support that belief.

The view adopted by the inspectors and auditors appears to be ‘if it’s not written down, it’s not happening.’

In reality, there can be a well written Care Plan but the quality of care might bear no resemblance to what is set out within the Care Plan.

Nurses would much rather spend their time caring for patients or residents than completing paperwork such as care plans.

Unless nurses are producing excellent Care Plans, Care Home grades will suffer.

30 years ago written Care Plans did not exist, but the care delivered was, in the main, excellent.

Perhaps this was because nurses did not have to spend much of their time producing the volume of paperwork that is necessary today.

I do very much believe in the benefit of care plans today.

It is the way forward and if written well, can really have the capacity to have a substantial effect and improve the quality of care.

Documentation is a crucial aspect of care, which facilitates the continuity of care and it forms an accurate record of care provided. It is now vitally important that the quality of resident’s care and nursing documentation is of the highest standard.

A good system of Care Planning undoubtedly can help the nurses and carers complete the paperwork far quicker and more comprehensively.

A system of personalising care planning for the elderly, which Planning for Care provides, can vastly improve the delivery of care and help Care Homes improve the grading they are awarded by the Care Inspectorate by helping them meet their regulatory requirements.

“The challenges facing everyone in the care sector are growing exponentially with constant changes in law, increased regulation and the potential threat of litigation.”

The focus on nursing appears to have changed and, instead of it being a wonderful, satisfying and fulfilling occupation, it is now very much a race against time.

It is in everyone’s interest that the standards of care improve.

The National Health Service is such a wonderful institution and it has to survive and flourish.

Progress is a great thing, but there needs to be a balance to ensure there is no deterioration in the very core standards and values of nursing. We need to rethink the path we are taking.

The days of placing massive importance on positioning each pillow case with the closed end facing the entrance door of the ward have gone!

But was it really such a pointless exercise?

In those days every nurse knew every detail about every patient, and every aspect of patient care was delivered with precision and thought.

Patient care may have been delivered in a task orientated way, but attention to detail was everything.

The pride nurses had in their job was tangible.

A mixture of the nursing cultures of yesteryear and today is, I think, needed to help elevate nursing to the high standard of profession it should be.

Nurses to follow ‘moral compass’ on poor standards

As reported in the Nursing Times, Liz Redfern, a former deputy chief nursing officer who joined the NHS as a cadet nurse in 1970, was speaking after receiving an honorary doctorate from the University of Brighton.

    “Some of my proudest moments are when I have spoken up against poor practice whatever the consequences for me”

    Liz Redfern

“There will have been times already that have made you uncomfortable when you have seen practice that fell short of your own personal standards,” she told an audience of newly-graduating nurses.

“You know what you are witnessing is wrong – either technically or morally – and sometimes you will have spoken out and sometimes not,” she said.

People should not be nurses if they do not have a love of the job.

Nursing is a wonderful profession but it has changed drastically over the past 30 years and if the news headlines are anything to go by the changes are not for the better.

More and more cases of neglect and abuse.

Nursing used to be about patient care and supervision of care staff and the delivery of care.

Nursing is now very much a written paper trail of evidence and a disproportionate amount of time is spent ensuring paperwork is kept up to date.

The delivery of care and supervision of staff is now the lesser part of the job but is it not the most important?

Of course it is!

Excellent patient care is the goal for the CQC, NHS, UK government and it is very much the goal for nurses but with poor staffing levels and so much paperwork, how is it possible to do everything? 

An elderly person can have anything from 5 to 15 nursing care plans for a multitude of health and physical issues and numerous assessments to be completed.  

These care plans are basically in depth essays of each issue and how in agreement with the person the nurse or carer is going to deliver the care specific to that issue. Time consuming!

Click here to check out our Nursing Care Management Solution

Helping nurses and carers to write excellent detailed, person centred, Nursing Care Plans quickly and easily. 

NHS in Scotland ‘needs former nurses to fill shift gaps’

Scotland’s biggest nursing agency has warned there are not enough qualified nurses in Scotland to fill rota gaps.

ScotNursing says it is only able to fill around 40% of available shifts, whereas in the past it was able to fill 90%.

The company is calling on former nurses to consider doing occasional shifts.

The Scottish government said it had taken measures to support nurses, and increase the numbers of nurses and midwives working in the NHS.

ScotNursing chief executive Ann Rushforth said the problem was down to the lack of school leavers joining the profession.

She said: “It takes four years to train a nurse. Sadly school leavers these days don’t seem to want to be nurses. They want to be veterinary nurses and supermodels.”

Mrs Rushforth urged nurses who are still registered but may have taken a break to have a family or to work in a care home to consider updating their clinical skills.

‘Severe shortage’

“People can make a significant difference by doing just one shift a month,” she said.

“There are hundreds of vacancies we can’t fill but this work still has to be done by someone. People may not realise they’re not getting the support they should have.”

During the general election campaign, both the Scottish Labour Party and the Scottish Conservatives promised to employ an extra 1,000 nurses in Scotland. However, Mrs Rushforth said the problem is a severe shortage of qualified staff.

“Nurses are not like instant coffee. You can’t just make them. In particular, nurses willing to do occasional shifts have become as rare as pandas.”

ScotNursing is in discussion with further education establishments about offering easy routes for nurses to update their skills.

Nurses must work a minimum number of hours per year and have completed appropriate training in order to work in the NHS. ScotNursing said occasional shifts can help them achieve this.

In September last year there were 58,000 nurses and midwives employed in the NHS in Scotland, compared to 55,000 in 2005.

‘Under tremendous pressure’

Figures from the NHS statistics department, ISD, suggested an extra 429,000 people were seen as inpatients and outpatients over the same period.

This indicates there is only one extra nurse for every 143 attendances.

The Royal College of Nursing (RCN) has warned that health boards are under “tremendous pressure” to fill vacancies, but that staff numbers are failing to keep pace with the increase in patient numbers.

Director of RCN Scotland Theresa Fyffe said: “There is no doubt that there simply aren’t enough nurses to fill the gaps.

“This is a result of growing patient demand, significant cuts to the number of nursing students recruited in 2011/12 and 2012/13 and high rates of retirement from the nursing workforce.

“And the withdrawal of return-to-practice programmes over the years makes it difficult for nurses to come back to the workforce. However, where these programmes are still available they are one way of filling these gaps.

“Ultimately, though, what we need is for health boards to robustly apply the nursing and midwifery workforce and workload planning tools. This is the only way in which we will get the right number of nurses with the right skills working in the right places.”

‘High quality care’

The Scottish government said it was committed to giving nurses the support they need to meet “the increasing demands on the health service”.

Health Secretary Shona Robison said: “We have increased the number of nurses and midwives working within the NHS in Scotland by 2,300 during this government, to a new record high level of more than 43,000 WTE qualified nurses and midwives.

“We have recently announced £450,000 funding for a return-to-practice scheme over the next three years, at the same time as a 3% increase in pre-registration student intake which will encourage former nurses and midwives to return to the profession. This scheme will help bring around 75 former healthcare workers back into the profession each year.

“We are also continuing to invest in a range of work to ensure we recruit and retain the right number of staff, and equip them with the skills they need to provide high quality care.

“Through NHS Scotland’s ground breaking Nursing Workforce Planning Tools, which were developed in partnership with nurse unions, health boards are able to inform decisions about the number of nurses needed for particular clinical areas.”

Source BBC News

Nurses warn of mental health services strain

Staff cuts and bed shortages are leaving mental health services “under unprecedented strain”, says the nurses’ union.
The Royal College of Nursing says there are now 3,300 fewer posts in mental health nursing, and 1,500 fewer beds, than in 2010.
At the same time demand has increased by 30%, the RCN said.
A Department of Health spokesman said mental health was a “priority” for the government.
But a mental health charity said cuts were damaging the care patients received, leaving them needing long-term support.
According to the RCN’s figures, mental health nursing posts declined by 8% in the past four years in England.
In Scotland, Wales and Northern Ireland, posts were cut by 1%.
However, the total number of nursing posts has increased since 2010 in all countries of the UK.
Mental health nurses are specifically trained to work in mental healthcare settings and treat and care for people with a wide range of illnesses and complex needs – from dementia to schizophrenia.
Mental health is widely recognised as a specialist area of nursing.
‘Money is tight’
Dr Peter Carter, chief executive and general secretary of the Royal College of Nursing, said cuts to mental health services could have a real and lasting impact.
“We are running the serious risk of turning back the clock and undoing all the good work that has gone before.
“Money is tight in the NHS but if we are serious about treating mental illness in the same way as physical illness, then people must be offered what they need before reaching crisis point.
“If staffing levels and services are cut back further, then services will continue to crumble, which would be a tragedy for us all, to say nothing of all the thousands of private tragedies that could result.”
Mark Winstanley, chief executive of mental health charity Rethink Mental Illness, said: “Our nursing workforce is increasingly ill-equipped to give people with mental illness the specialist, recovery-driven care they need.
“Nurses are being forced to take a risk-averse approach to care which prioritises keeping people safe, rather than helping them get better.
“Not only is this detrimental to the quality of care that people receive, it makes little financial sense.”
He added that reducing nursing staff levels and skillsets would end up with more people needing long-term support, including expensive hospital treatment.
The RCN wants the government and healthcare providers to ensure that they have enough staff with the right level of skill to deliver the care needed.
With almost one-third of mental health nurses aged over 50, the RCN says a long-term strategy is needed to recruit and train more of them to deliver care in the community and inpatient units.
A Department of Health spokesman said: “Mental health is a priority for this government which is why we announced last month an additional £120 million to improve care and introduced the first ever waiting time standards, which underpins our legislation on parity of esteem.”
Source BBC News

NMC pledges to monitor impact of fee rise on size of nursing workforce

The Nursing and Midwifery Council has said it will monitor the impact of its decision to increase the annual registration fee from £100 to £120, which unions have warned could persuade tens of thousands of staff to leave the profession.

Speaking yesterday after the regulator approved the fee rise, NMC chief executive and registrar Jackie Smith said that the nursing regulator would keep track of its impact on the numbers of nursing staff “as best as we can”.

However, she added that the previous fee increase, which saw it rise from £76 to £100 in 2013, did not appear to have caused a reduction to the workforce.

Ms Smith said the NMC currently had around 680,000 registrants, more than it has ever had before.

“That would suggest that the 2012 increase didn’t result in a falling of numbers, but we cannot be complacent about this,” she said. “We need to monitor it [the impact of the fee increase to £120] and will do.”

However, Unison’s head of nursing Gail Adams warned that the new fees, which will be introduced from March 2015, could see tens of thousands of nurses choosing to leave the profession.

She said those aged 55 and over could potentially decide to retire, leaving a “massive shortfall” in nursing staff.

The NMC’s own consultation exercise on the fee rise, held earlier this year, appeared to support her concerns. Analysis of responses to consultation found 56% of nursing staff aged 55 and over said the increase would be likely to affect their decision to continue working.

The NMC currently has 132,000 registered nurses in this age group. Ms Adams warned that the majority of this group could decide to stop working.

Ms Adams told Nursing Times: “Registrants will be absolutely horrified by the NMC’s decision. I have a genuine concern about the impact this will have but in particular nurses and midwives who are 55 and over who could vote with their feet.”
 
Speaking during the NMC council meeting yesterday, she urged the regulator to monitor the impact of the fee increase on a more regular basis than its current annual review.

She added: “It does little to protect the public if you lose the nurse and midwives and health visitors who are looking after some of the most vulnerable in our society.”

Howard Catton, head of policy at the Royal College of Nursing, said the registration fee increase – against the backdrop of pay freezes, the introduction of revalidation next year and work pressures – presented a “significant” and “potentially quite immediate” risk to the size of the nursing workforce.

He said: “This isn’t an issue solely about the NMC and regulation – the implications and consequences are wider than that and potentially quite immediate.”

Mr Catton also warned that if nurses decided to quit or retire earlier than planned, this would add to the pressure for those remaining at time when there is already a shortage of workers.

Asked by Nursing Times if the NMC had a contingency plan for the potential loss of nurses and midwives from the workforce,  Ms Smith said: “If we had a 10 or 20% fall off the register then we would have to understand the financial implications and where  it leads us, so that is the contingency. That is why it’s really important to monitor this closely.”

Ms Smith added that the regulator had committed to looking at the possibility of reducing the annual registration fees in the future, if it met its financial targets.

“Something we need to come back to at a later date is whether we can bring the fee down. But it is predicated on the essential changes that we need in fitness to practise legislation,” she said.

NMC chair Mark Addison confirmed that the council had also committed to looking at setting the annual registration fee in future years according to a nurse or midwife’s pay band.

He said: “We have said we will look sympathetically – but don’t want to make any commitments – about the fee in relation to different salary levels.”

Source Nursing Times

As a nurse I don’t feel equipped to treat patients with mental health problems

Nurses qualify with little training in mental health. Is it surprising that sometimes care falls short as a result?
Nursing staff are the closest thing a patient will experience to a constant presence, but we need more training to take it more seriously. 
I once heard a nurse tell a patient, who was half dressed and standing in a corridor screaming, to stop acting like a child. 
I wondered how somebody committed to caring could show such a lack of empathy to somebody so unwell. 
After years of working in and around the NHS and having qualified as a nurse, I am no longer surprised that the care of people with mental health problems in hospital sometimes falls short. 
I know that I too have fallen short.
I look after the same people in hospital now whom I met working untrained for mental health support groups. 
People struggling to cope with poverty, people without support networks, people with chronic illness, people who have lived through awful things. 
According to Mind, one in four people experience mental health problems each year. 
This statistic covers a complex range of problems which are as varied and profound as physical illness.
My nursing course, which I think was excellent, contained no more than three days’ structured education on caring for patients with mental health problems. 
The Nursing and Midwifery Council says nurses “must be able to deliver care to meet essential and complex physical and mental health needs”.
But there is a lot to cover on our newly degree-level syllabus. With the exception of dementia, which has a uniquely high profile, nurses qualify with little training in mental health.
Specialist mental health staff are an expensive, overstretched resource and they are often not available. 
In the ever-shifting hospital environment, the nursing staff of a ward are the closest thing a patient will experience to a constant presence. 
We could improve what we offer. I still find myself struggling to care for mentally unwell patients despite my best efforts, and despite my previous experience. I get frustrated and tired. 
Sometimes I am not as kind as I would like to be. I know that I have colleagues who feel the same; doctors, healthcare assistants and other nurses. Additional training would be helpful.
Our failure to have a proper public conversation about mental health perpetuates prejudice. People conceptualise people with mental health problems as difficult. 
“They are a difficult patient” is something we say far too often when faced with aggression or refusal of treatment. I have said it myself, and the sentiment comes from a lack of education and understanding as much as from pressure and lack of resources.
Many of the behaviours that make caring for patients hard are not inherent but are the understandable result of an alienating environment and loss of autonomy. 
Basic strategies for engagement and communication would help. 
We urgently need to be listening to the stories of people who have suffered poor mental health, and such listening could be part of our training, both initial and ongoing.
Services are being cut and are fragmenting. The incoming president of the Royal College of Psychiatrists has described a crisis of care in mental health.
Properly funded community services are absent. We are going to be looking after patients who are both physically and mentally unwell, and we should be empowering them to look after themselves. 
We should know what support is available for them, their families and their friends outside of the hospital. 
There could be more training for this. We need to take it more seriously, as healthcare professionals and as a society.
Source The Guardian

Unions call NICE guidance on safe staffing a ‘positive step’

Health unions, regulators and other nursing organisations have largely welcomed the publication of safe staffing advice for nursing care on adult inpatient wards in acute hospitals.
The National Institute for Health and Care Excellence has today published the final version of its much-anticipated guidance on safe staffing levels for acute inpatient wards.
The guidelines state that nurses in charge of shifts should monitor for the occurrence of “nursing red flag events” during each 24-hour period. Where one occurs, it should “prompt an immediate escalation response”.
The red flags set out by NICE include having less than two registered nurses present on a ward during any shift, day or night, also represents a patient safety “red flag”. Where there is a shortfall of more than eight hours or 25% – whichever is reached first – of registered nurse time available compared with the actual requirement for the shift is another red flag, according to NICE.
In addition, NICE said nurse managers must check staffing levels are safe on hospital wards where each registered nurse is caring for more than eight patients during day shifts – though it was keen to point out that this ratio was not a red flag by itself.
The Royal College of Nursing described the NICE guidance as a “positive step” forward for the NHS.  
Peter Carter, RCN chief executive and general secretary, said: “These guidelines are based on best evidence and managers should be using this evidence alongside the expertise of nursing staff.
He added that the red flags set out in the guidance “must not be ignored” by trusts.
“Nursing staff have long recognized the importance of safe staffing levels and consistently provided evidence of the danger to patients where there are too few staff,” he said. “It is good to see that this is now being recognised across the NHS.”
“The NHS can’t carry on like this. Ministers must intervene to ensure safe staffing levels”
Mr Carter also warned trusts not to save money by cutting staff, which had been the case in the recent recession and helped drive the widespread staff shortages that many trusts are now seeking to address with overseas recruitment.
“The needs of patients should be the only thing determining staffing levels – not finances. Patient care must not be compromised because of short term financial cuts and a minimum safe staffing level should not become a default staffing level,” he said.
Gail Adams, Unison’s head of nursing, also described the NICE guidelines as a “step in the right direction”, but repeated the union’s call for nurse to patient ratios to be made mandatory.  
“A ratio of one registered nurse per eight patients across the health service should be the absolute minimum and in many circumstances this will need to be higher,” she said.
“By not introducing mandatory safe staffing levels the government is putting patient safety at risk and without any additional funding the NHS will struggle to implement the guidance,” she said.
“Having staff working through their breaks and beyond their hours is not sustainable. It is bad for patients and bad for staff whose morale has already hit rock bottom,” she added.
The Care Quality Commission’s chief inspector of hospitals also welcomed the guidance, saying he supported the principle that ward staffing “should be based on the needs of patients”.
“Staffing isn’t just about numbers. Under our new approach to hospital inspections, we assess whether staffing levels and the skills and training of staff are appropriate in each of the services we inspect,” said Professor Sir Mike Richards.
“We know that staffing levels impact both on safety and on patients’ experience of care,” he said. “If we judge that staffing levels are impacting adversely on the quality of care, we expect to see improvements.”
Michael Adams, associate head of the school of nursing, midwifery and social work at Birmingham City University, also backed the NICE recommendations, noting that the responsibility still remained with trusts to protect patients and staff with safe staffing levels. 
“I think this is a good step forward and there are some interesting points made inthe guidance published,” he said.
“NICE haven’t gone as far as to state a minimum staffing at all times in all environments and have still left it to organisations to monitor and decide on appropriate staffing levels – the responsibility still remains with NHS trusts to protect patients and staff with safe staffing levels,” he added.
“A ratio of one registered nurse per eight patients across the health service should be the absolute minimum”
Gail Adams
The development of NICE guidance on staffing was recommended by the Francis report on care failings at Mid Staffordshire Foundation Trust.
As well as the work by NICE, the new commissioning body NHS England has told trusts to put new staffing transparency systems in place by the end of June as a further response to the Francis report.
But Labour shadow health secretary Andy Burnham called on ministers to “intervene” directly to ensure safe staffing levels.
“Hospitals across England are operating way beyond recommended capacity levels and, because of this, too many do not have enough staff to provide safe care,” he said in response to the NICE guidance on staffing.
“The government has trapped the NHS in a vicious circle,” he said. “Huge cuts to nurse training have left the NHS relying on agency staff but that in turn has deepened financial problems.
“Last year, trusts spent £2.6bn on agency staff – this short-sighted policy amounts to nothing less than gross mismanagement of the NHS,” he added.
Source The Nursing Times

Care home move ‘breached woman’s human rights’

The human rights of a woman with dementia were breached when she was moved from her house to a care home, a court has ruled.
Milton Keynes Council failed to get proper authorisation, a judge ruled.
The Court of Protection, which deals with cases where people cannot make decisions for themselves, said handling of the case was “woefully inadequate”.
The council said it has apologised to the 81-year-old former magistrate and her son.
A council spokesman said it would work to ensure vulnerable citizens are protected.

Limited access

The council alleged that the woman’s son had been neglecting her – allegations which were never pursued.
In his judgement, District Judge Paul Mort said the council behaved unlawfully when they moved the woman from her own house to a care home because they failed to get authorisation from its own specialist panel and had not applied to the Court of Protection.
The local authority also failed to tell her son of where she was for 19 days and he was then only allowed limited contact whilst the council investigated neglect claims.
Judge Mort’s findings have just emerged after the case was heard in April.
The judge concluded the woman had been “unlawfully deprived of her” liberty when removed from her home by the council and her son was “devoted to his mother”.
He also said her human right to family life had been breached.

‘Flabbergasted’

The son, who has not been identified, told BBC Radio 4’s Today Programme he was “flabbergasted” to find his mother had been taken into care.
He said: “I returned from a short trip to the local town, to pick up a valve radio I’d bought for mum at auction.
“On my return mum’s carer told me two social services people had been and taken her to ‘a place of safety’.
“I was flabbergasted. Everyone was.”

NHS needs ‘radical change’ in the wake of scandals

Nursing has changed dramatically in the 150 years since Florence Nightingale founded the first nursing school in London – undoubtedly for the better.

While compassionate care is still the guiding principle, advances in science and technology and changing health needs have seen nursing roles change dramatically.

Most nurses now either have a degree or are studying for one.

This is testament to advances in nursing and the skills needed to be a nurse.

Nursing will never be an easy career option – we care for patients from birth to death, supporting them through the best and worst moments of their lives. It can be hard, emotionally draining but an enormous privilege.

In recent years the number of nurses continues to rise, although at the same time, demand is greater than ever. In the decade since 2002/03, emergency admissions staggeringly rose by almost a third.

Nurses are seeing more patients, with more complex and serious conditions than ever before.

The modern nursing challenge is to deliver consistent and improving high quality care despite this growing demand.

I spend much of my time with nurses and I see the pressure they face. I am consistently overwhelmed by their determination to do the very best for their patients. I am as proud today to be a nurse as I was when I qualified over 30 years ago.

In the face of these pressures, it is clear that we need to change and transform the service. We need to up the pace of radical change if we are to truly respond to the lessons of Mid Staffordshire, Winterbourne View and the needs of our population.

The pressures are not insurmountable and NHS England is determined to meet the challenges and drive up the standard of patient care.

While nationally, we have a duty to provide guidance and leadership, the specific response needs to be locally determined in partnership with patients and the local population.

We need to think and do things differently right across the health and care sector – each of us and every organisation needs to step up to the plate and be accountable.

It is unanimously agreed that we need better, integrated and preventative person-centred care – supporting patients in their communities and homes and reducing the need for hospital care.

What is less tangible is a need for widespread cultural change in the way we approach healthcare.

Nurse staffing is a prime example. The public debate around staffing levels quite rightly continues.

This is a priority in the nursing and care strategy and at the end of last year, I published guidance on nurse staffing with the National Quality Board.

With the Department of Health, we have also commissioned the National Institute of Health and Care Excellence to look at the evidence on adult hospital wards and make recommendations on determining nurse staffing. This will be published for consultation imminently.

This is part of the sophisticated, evolving approach to staffing that we need. Each ward in each hospital around the country is different in size, number of patients, the type of patients and acuity of condition.

Likewise, each community is different – rural Cumbria is very different from inner city Birmingham.

We need a culture of using hard evidence and local professional judgement to determine the right team of staff with the right experience in each situation and we need a widespread culture of support in the NHS where staff concerns are heard and acted on.

Nurses know when something isn’t right or isn’t working.

We have moved a long way since Mid Staffordshire and across the country there are great examples of feedback being directly and routinely channelled from ward to Board as part of continuing improvements.

However, more needs to be done so everyone feels supported to speak out.

Public accountability will intensify – more trusts are publishing actual versus planned nurse staffing levels shift by shift and are being publicly held to account. Together with the CQC we have asked all Trusts to ensure they are doing this by the end of June.

We also need an NHS that is truly representative of the communities it serves and Equality and Diversity week this week reinforces that we must step up the pace on this.

Society is now more multi-layered and multicultural. Yet the NHS seriously lags behind in its BME representation, particularly in the most senior positions.

There is increasing evidence that diverse teams make better and safer decisions which leads to better patient outcomes and better staff experience.

Why? Because these teams are more representative of the communities they serve when making decisions. The NHS must reflect and act on important works such as Roger Kline’s recent publication, “The snowy white peaks of the NHS: a survey of discrimination in governance and leadership and the potential impact on patient care in London and England.”

What comes through strongly is that widespread cultural change is needed. As NHS Leadership Academy Guidance underlines, it is not enough to simply change the membership or diversity of Trust Boards to make them more representative of local communities and the workforce they lead.

We must continually challenge ourselves. We need a culture of reflection and learning and of respect and understanding. While these may seem like woolly concepts, the most difficult transformation often isn’t easily tangible – which makes is so hard to grasp. We need an NHS that truly embraces equality and diversity and represents all demographics.

This is a priority for me and there needs to be continued challenge across the health and care sector, in the media and through academia and social commentary.

This week I had the privilege to celebrate International Nurses Day with qualified nurses, student nurses and military nurses from around the country at the Florence Nightingale Service in Westminster Abbey. It was a fabulous experience and truly recognised the significant role nurses play.

Over the years, healthcare demand has changed beyond recognition but the remarkable job that these inspiring individuals do remains. It would however be glib to ignore the real pressures nurses are under.

Change is needed and central to this is having the right workforce, in the right place, not only with the right skills and time to deliver patient-centred care but one that is representative, from board to ward, of the patients we serve.
 
       
Source The Telegraph