Comment

Nurse leaders should play a key role in reconfiguration

Safety is paramount but attempts to withdraw specialist services from local hospitals often spark fierce resistance.

Safety is paramount, but attempts to withdraw specialist services from local hospitals often spark fierce resistance. Nurse leaders need a much bigger role in these complex decisions, says Nicky Hayes

Earlier this month, NHS England announced major changes to the provision of congenital heart disease surgery.

Under the proposal, three trusts will lose their specialist heart surgery services, for reasons attributed to the need to comply with NHS England’s new minimum standards for congenital heart disease treatment. 

There has been an inevitable outcry, but the announcement is not the result of a snap decision. It is the culmination of a long and complex process, going back to the 1990s, when scandal hit the Bristol Royal Infirmary. Revelations of a high mortality rate in infant cardiac surgery led to years of public and professional contention involving reconfiguration proposals, high level reviews and intervention by the health secretary.

While no one questions the need to guard against another Bristol scandal, there is inevitably tension between issues of safety, quality and sustainability of services and accessibility for patients and families. In the case of children’s congenital heart services, there are significant issues about accessibility.

Further to travel

The latest proposals will lead to some patients having to travel further for treatment, which has knock-on implications for parents who may need accommodation to stay close to their child.

They may also find it difficult to carry on making a living while supporting their child far from home. These issues need to be carefully balanced and the optimum solution found. 

Choice for patients is enshrined in the health secretary’s four key tests of reconfiguration, and it helps us to understand what these mean before plunging into the complexities of proposals for major service change. The four key tests are:

  • Strong patient and public engagement.
  • Consistency with current and prospective need for patient choice.
  • Clear clinical evidence base.
  • Support for proposals from commissioners.

While an individual might want their specialist care close to home, or at least have a choice of where they go for it, obviously it has to be safe and compliant with quality standards, otherwise we have another scandal hitting the headlines. Standard setting helps in this respect, enabling assurance and benchmarking.

Previously it was not possible to compare like with like, leaving the door open for political manoeuvrings, media influence and passionate feelings to be at the fore. In reality, most of us are actually prepared to travel further for a life-sustaining treatment and do this willingly if we think we are going to the best place for it.   

It can be difficult for patients, the public and NHS staff to accept the outcomes of reconfigurations, especially when extensive consultations have been held and people have tried to have their say, without being sure of whether they have been heard. 

Consultation is key

The key is to ensure that consultation and communication are at the heart of reconfiguration processes, enabling all stakeholders to engage in discussion of what is reasonable, and to agree the standards that are to be applied. 

Consultations are not a vote on the proposals, but are an extremely important part of zeroing in on the optimum option.  Patients and the public are key players in this, as are our NHS staff of all levels.

Despite being the largest part of the workforce, nursing is often the quietest during reconfiguration processes, and can visibly lack empowerment. Yet with the professionalisation of nursing, including advance practice roles, there is a huge potential to unlock.

Nurse leaders need to have a much stronger voice in the process and ensure that they assert the key role of nursing in the delivery of safe and sustainable services. 

Nicky Hayes is consultant nurse for older people at King’s College Hospital, and a former member of the Independent Reconfiguration Panel, the expert body that advises the health secretary on changes to NHS services

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