The nursing voice must be heard
© 2014 MA Healthcare Ltd
ast week, NHS England Chief Executive, Simon Stevens, launched the Five Year Forward View (5YFV) (NHS England et al, 2014). Mr Stevens told an audience of key stakeholders: ‘Healthcare in this country has improved dramatically over recent years and has weathered recent financial storms with remarkable resilience, thanks to protected funding and the commitment and dedication of NHS staff ’. (NHS England, 2014). Mr Stevens outlined that action needs to be taken on four fronts: ■■ Do more to tackle the root causes of ill health. The future health of millions of children, the sustainability of the NHS and the economic prosperity of Britain all depend on a radical upgrade in prevention and public health.The 5YFV backs hard-hitting action on major health risks ■■ Give patients more control of their care, including the option of combining health and social care, and new support for carers and volunteers ■■ Change the NHS to meet the needs of a population that lives longer, for the millions of people with long-term conditions, and for patients who want person-centered care. It means breaking down the boundaries between family doctors and hospitals, physical and mental health, and health and social care. The 5YFV sets out new models of care built around patient needs, not historical or professional divides ■■ Develop and deliver the new models of care, local flexibility and more investment in our workforce, technology and innovation. These actions have been finalised following the submission of 5-year plans from all NHS organisations. The actions required from the 5YFV don’t feel that innovative to many of us. In fact, while they may feel right in a variety of healthcare settings, we feel like we have been talking about this for some time. So, if we have all been working towards the future plans, why do many nurses still feel that, as we approach winter, traditional cost-improvement programmes delivered through headcount reductions, decommissioning of services and reduction of beds, mean that across the NHS we face another difficult winter? Is the NHS truly patient-centred, and where is the nursing voice in all of this? Across all settings I hear nurses of all levels challenging consultations to redeploy staff, following plans to reduce beds, and community teams worried for groups of patients with long-term conditions whose specialist nursing teams are under review; with a likely outcome of service cuts. As nurses, we pride ourselves on our practice being guided by a strong evidence base. So why do we fail to succeed in the patient-centred debate to protect safe care, and why do so many efficiency programmes that frequently lack an evidence base continue to progress? Most organisations have some form of strategy
British Journal of Nursing, 2014, Vol 23, No 20
group that considers reconfiguration and pathways. Many organisations, including my own, have senior nurses in these groups around the table with patients, discussing long-term conditions, service redesign, and reconfigurations; but what about winter? Winter comes annually. Winter plans are duly prepared, and every year we appear to be in denial that we may need to increase our services. Many colleagues feel that winter is already upon us and, across many services, block agency contracts are hastily being booked, equipment ordered and locum medical staff hired; much of the work of cost improvement of the previous 10 months is undone. This year, the regulators have sent sudden bailout funds to trusts. In its exclusive article, the Health Service Journal (2014) reported that the government would release a further multi-million pound bailout for winter. In March 2014, a joint letter from the Care Quality Commission (CQC) and NHS England was issued to all hospital trusts with inpatient areas (CQC, NHS England, 2014). The letter followed guidance from the National Quality Board (NQB) to ‘optimise nursing’. The guidance sets out ten expectations of commissioners and providers, to ensure compliance with the NQB paper How to ensure the right people, with the right skills, are in the right place at the right time (NQB, 2013). The Operating Framework for the NHS 2012–13 (Department of Health, 2011) required NHS trust cost improvement plans to be agreed by medical directors and directors of nursing, and include in-built assurance of patient safety and quality. Trusts were advised that they should also be aware of non-clinical schemes that could have a quality impact, for instance, changes to the frequency of ward cleaning. The nursing voice is crucial at every level to ensure that, while continuing to make appropriate efficiencies, if there is not a robust evidence base for decision making, plans should not progress to the final stage of quality impact assessment. If poor plans have not had a strong nursing voice to challenge them at local level, there is a risk that when they reach the executive level these plans will not be fully explored, BJN and care may suffer. Care Quality Commission, NHS England (2014) Staffing letter http:// tinyurl.com/ngc4awr (accessed 28 October 2014) Department of Health (2011) The Operating Framework for the NHS in England 2012-13. http://tinyurl.com/nzn92ds (accessed 28 October 2014 Health Service Journal (2014) Exclusive: Government set to release more A&E rescue funding (online)15 October 2014 National Quality Board (2013) How to ensure the right people, with the right skills are in the right place at the right time. http://tinyurl. com/o7olnje (accessed 28 October) NHS England (2014) NHS leaders set out vision for healthcare in England (online) 23 October 2014. http://tinyurl.com/n3asyvq (accessed 28 October 2014) NHS England, Public Health England, Monitor, Health Education England, Care Quality Commission, NHS Trust Development Authority (2014) Five Year Forward View. http://tinyurl.com/ kcjenmc (accessed 28 October 2014)
Sam Foster Chief Nurse Heart of England NHS Foundation Trust @safetySamFoster
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