‘We’re offering nurses the best deal in the UK in terms of pay, conditions and career choices’
Scotland's health secretary is a former nurse who says she will support nurse leaders in enforcing safe staffing legislation
Scotland’s health secretary is a former nurse who says she will support nurse leaders in enforcing safe staffing legislation
- Scottish Government is increasing the number of nursing and midwifery training places, as well as the bursary available, to fill vacancies
- A new practice adviser role will help retain nurses who are nearing the end of their career
- Nurses’ concerns about safe staffing will be raised at the highest level
When Jeane Freeman looks back on her career in nursing, it is clear there are things that she absolutely loved – and others that she found frustrating.
On the plus side there was the unpredictability, working as a team and the ability to make a difference to people. The downside, as she saw it, was the lack of opportunities for career advancement at that time.
‘I loved being an emergency department nurse’
Scotland’s cabinet secretary for health and sport trained, then worked, as an emergency department nurse in Glasgow from the late 1960s to the late 1970s, long before she entered politics in any formal sense. Nursing was in her blood – ‘my mum was a nurse, so nursing is where I went’ – and she took to it with relish.
‘I loved being an emergency department nurse,’ she says. ‘I loved the fact that you never knew what was going to come through the door. I loved the speed of it and the urgency.
‘Obviously, there were times when it was really difficult – if you didn’t manage to save a patient, or if the damage was such that the patient would stay alive, but it was going to be life-altering for them.
‘There were a lot of instances where people were in front of you because of knife crime. So, it wasn’t easy, but the variety, the urgency, the need to make quick decisions – all of that, I absolutely loved.’
Opportunity for career progression
Having reached the stage of being a charge nurse, she left nursing to take a degree, partly because she was frustrated at what she saw as the lack of opportunities for career progression while remaining in the clinical front line.
‘I left nursing because at the time when I had trained and then qualified, once you were a sister, that was it. There were no other real opportunities, unless you went into management, which I didn’t want to do.
‘There are a number of different ways that we can encourage people to come into the nursing and midwifery profession’
‘Only a few years later my older brother – who had done something completely different, he was a graphic designer – he packed that in and trained as a nurse. He ended up as a community psychiatric nurse. There were just more opportunities [by then], so he stayed.’
Ms Freeman has certainly enjoyed a varied career since leaving nursing, and political involvement has been a constant. She was a member of the Communist Party, then later joined Labour, and served as a political adviser to Scotland’s third first minister Jack McConnell in the early noughties.
She only stood for election for the Scottish National Party after becoming involved in cross-party campaigning for Scottish independence. Her star quality was quickly recognised and she was appointed minister of social security before taking on her current role in 2018.
Working as a team
The lessons she learned during her time in nursing have stayed with her and have shaped how she operates in the world of politics and in today’s health service.
‘Probably the key lesson was the importance of being part of a team and working as a team,’ she says. ‘Generally that is a lesson increasingly learned across healthcare, but it was always there in emergency departments; if you didn’t work as a team, it wasn’t going to work, and each member of that team was critical to how effective you were going to be.’
‘It doesn’t take much for me to remember what it felt like to do the job’
So, does nurse training and experience help or hinder her in her current role? Ms Freeman laughs: ‘It’s certainly not a disadvantage. It doesn’t take much for me to remember what it felt like to do the job.’
Since becoming health secretary, she has been responsible for a number of nurse-related initiatives, including Scotland’s flagship safe staffing legislation (see box, below). She is now trying to find ways of meeting the challenges that come with the legislation, including finding enough nurses to fill these ‘safe’ staffing rotas.
Safe staffing: ‘I will back nurse leaders’
On 2 May, the Scottish Parliament passed legislation aimed at ensuring safe staffing across health and social care services. The Health and Care (Staffing) (Scotland) Bill is based on the Nursing and Midwifery Workload and Workforce Planning Programme, but extends to all staff in health and social care.
‘It will make a difference to nurses whatever the setting they are working in,’ Ms Freeman says. ‘We tend to think about nursing as nurses in hospital. But nursing care is also delivered in the community, in care homes, in schools – in a range of settings. So, the core methodology behind the nursing tools that are currently used in a hospital setting to identify what the workload is and therefore what the skill mix is can be taken and adapted to a range of settings. That’s why we’re very keen that [safe staffing legislation] applies itself across the NHS and health and social care.
‘For nurses, the difference is a) the application of tools and who applies it; b) that it will be statutory, so it’s no longer a voluntary exercise.’
‘There’s no point in legislation if it’s not going to make a difference’
If an organisation’s board decides that, in order to balance its books, it cannot deliver on the level of nursing staff the nurse director believes is required then ‘it has a responsibility under the legislation to say what it’s going to do to mitigate any shortfall. Is it going to use bank nursing? How’s it going to do that?’
This will be enforceable, she says, because she and her two health ministers annually review boards and will ensure it is happening.
‘That will become part of the data that we are looking at,’ Ms Freeman says. ‘It will show us the board decisions where the nurse director advice was not followed to the letter by the board, what the rationale was for that and what did the board do to mitigate it.’
As well as the annual review, Ms Freeman says that nurse directors will have the opportunity to raise any concerns about how the legislation is implemented during regular meetings with her and the chief nursing officer for Scotland.
‘It is for them to raise, if they have concerns that their professional opinion is not being heard and acted on,’ she says. ‘That doesn’t mean they’ll always get everything that their professional opinion leads them to advise they should get, but the board needs to take it seriously and it needs to say what it’s going to do.’
She says she will ‘absolutely’ back up nurse leaders. ‘There’s no point in legislation if it’s not going to make a difference and we’re not going to follow through on it.’
More training places
In December 2018 there were 3,089 unfilled vacancies (a rate of 4.9%), with 784 lying empty for three months or longer. Asked what she is doing about it, Ms Freeman doesn’t hesitate: ‘This year is the seventh year in succession that we’ve increased the number of nursing and midwife training places. We’re busy now looking at 2019-20 and what will be the level for this coming year. I expect that to be another increase.
‘We’ve also increased the student nurse and midwife bursary – the only country in the UK that now does that. It’s non-means tested and is £8,100 from April this year and £10,000 the following year. That is specifically designed to ensure that there is that financial support for those young people to ensure they are not prevented from training and studying because of financial barriers. This is particularly important in our widening access agenda.’
She also points to efforts to encourage nurses who have stepped away from the profession to come back, by supporting them to get their skills back up to date and by creating flexible working opportunities.
‘It’s so that people can continue nursing while bringing up children, looking after relatives, or whatever else it is that they want to do,’ she says.
In addition, the Scottish Government has been working with the Open University in Scotland to support people to transition from experience in providing social care, for example, into nursing using the OU to learn as they work.
‘There are a number of different ways that we can encourage people to come into the nursing and midwifery profession,’ Ms Freeman says.
On nurse pay, Scotland has, unlike other parts of the UK, implemented Agenda for Change recommendations, meaning that pay bands are slightly higher north of the border. However, as the RCN and others have argued, this does not compensate for many years of public sector pay restraint.
Does she plan any extra money for nurses? ‘The Agenda for Change agreement we reached is a three-year agreement with a minimum 9% increase over that period. And remember that that is reached in partnership with a range of bodies, including the RCN.’
‘We’re about to test a practice adviser role for nurses coming towards the end of their career but who have a lot of experience and knowledge’
Asked if Scotland is offering nurses the best deal it can, she stresses: ‘We’re certainly offering nurses the best deal in the UK in terms of pay, conditions, our staffing legislation, and the range of potentially exciting career choices.’
She points to a new initiative for long-serving nurses who want to step out of the rota and shifts: ‘We’re about to test a practice adviser role for nurses coming towards the end of their career but who have a lot of experience and knowledge so they would effectively become the practice adviser or mentor for new nurses and midwives, working alongside them. Importantly, the health service keeps hold of that knowledge, expertise and experience.’
- RELATED: Scotland passes safe staffing law
Earlier in the interview, I noticed that Ms Freeman’s eyes brightened when she spoke about how nurse practitioner roles are a crucial part of service transformation. Would that have been something that would have kept her in nursing, had the opportunity been there? ‘Oh yes, I’d have loved to have done that,’ she says with evident sincerity. ‘That would have been good.’
‘If you want improvement, let front-line staff lead you’
Ms Freeman doesn’t bring her nursing background into speeches at conferences very much because she considers it ‘a dated experience’, she says.
She is much more inclined to draw on her more recent role, from January 2011 to March 2016, as chair of the Golden Jubilee Foundation, a special NHS health board that is home to regional and national heart and lung services and hosts the national waiting times centre, providing elective procedures for patients across Scotland.
Golden Jubilee is one of the best performing health boards in Scotland on a range of measures, including waiting times, and in other less tangible ways – it recently featured in Nursing Standard, for example, for its work to promote LGBT+ inclusivity.
‘What you see is quite evident there [at the Golden Jubilee] is an approach which is about management-enabled clinical change,’ Freeman says. ‘It is clinically led and I think that is absolutely key. Where you want improvements in how patients are treated, and how healthcare is delivered, then you need to let those who are doing the job lead you.’
Everyone involved in the patient journey
She gives as an example the fact that the Golden Jubilee Hospital has the fastest door-to-balloon time in the UK, which measures the period between a patient arriving on site at a heart attack centre and having a stent inserted and balloon inflated in the blocked artery. One of the ways they achieved this was putting together a team made up of everyone involved, including hospital receptionists and portering staff, as well as medical and nursing staff, to work out how the patient’s journey from arrival by ambulance to the cath lab or theatre could be made as quick as possible.
‘Some of the best ideas that produced that result actually came from the portering and receptionist staff,’ she says. ‘It was about a dedicated lift, about moving a pillar, moving a drinks machine – basically about literally clearing the path.
‘That encapsulates it: if you get the right people in the room, then they’ll work out how to do this best, and then management’s job is to get that pillar moved and to do these things that enable that clinical improvement.’
Jennifer Trueland is a health journalist