Analysis

England’s chief nurse plans new strategy

Over the next few weeks, chief nursing officer for England Jane Cummings and her team will draw up the first draft of a new nursing and midwifery strategy


Chief nursing officer for England Jane Cummings. Picture: David Gee 

Over the next few weeks, chief nursing officer for England Jane Cummings and her team will draw up the first draft of a new nursing and midwifery strategy.

The draft strategy is set to be presented to around 500 senior nurses attending the chief nurse’s annual two-day summit in Birmingham next month (December 1-2). The nurses from hospitals, clinical commissioning groups, community providers and other bodies providing nursing care as well as academics and patient representatives will be asked for their feedback on the draft strategy.

Before then, those wanting to input can respond to six questions set out by NHS England. The final strategy is expected to be launched in March next year.

The engagement phase runs until mid-November. Nurses wanting to take part can respond to the six questions:

  • What has worked well in Compassion in Practice?
  • What are the issues you feel we are facing?
  • What do we need to do more of to create care that is truly person-centred?
  • What is your vision for care for the next 20 years?
  • What matters to you?
  • How do you see your role in supporting delivery of this vision?

Responses should be emailed to england. ourvision@nhs.net by mid-November. You can also follow NHS England’s updates on Twitter via @6Cslive! using the hashtag #ourvision.

Exploratory discussions

Ms Cummings, a former A&E nurse and national lead for emergency care, says that several themes which clinicians would like to see included in the new strategy have already emerged from exploratory discussions which started in May this year.

These include developing and sustaining the workforce, safety and staffing, the personalisation agenda, productivity, population health, service transformation and innovation and improvement.

Conversations among a range of clinicians also indicate that any new strategy should go beyond nursing and midwifery, she adds.

Nurse numbers

Debbie Mazhindu, a reader in clinical innovation in nursing practice at Buckinghamshire New University and Imperial College Healthcare NHS Trust, agrees that the emphasis of any new nursing strategy should be on nurse numbers. The former trauma unit nurse argues that unrewarding working conditions, such as ‘lack of attention’ to staff wellbeing and ‘taking advantage’ of goodwill to fill gaps in staffing levels needs to be addressed in any nursing strategy.

‘We need to protect nurses and professions allied to medicine by changing the culture of the NHS to be compassionate towards staff and better look after them. They cost a huge amount of public money to train and we need to change our working environments to keep them there.’

Jane Naish, deputy chief nurse at Milton Keynes University Hospital NHS Foundation Trust, which has 400 inpatient beds and treats more than 200,000 outpatients a year, says addressing the shortage of nursing staff and agency spend is top of every senior nurse’s agenda and is a must for any new nursing strategy.

Placements

The trust, which employs around 900 registered nurses, recently doubled the number of pre-registration nursing students it provides practice placements for, but Ms Naish adds that ‘insufficient numbers’ of nursing students are being trained nationally.

Ms Naish also points out that in some cases acute and community providers have ‘abdicated themselves’ of responsibility for training nursing students, a topic she would also like to see covered in any new initiative.

‘It is common parlance to say newly registered nurses are inadequately prepared for practice and blame universities for this. But acute, community and primary care providers should be providing the placements that help them prepare, and if we are not, we need to address this,’ she says.

Recruitment and retention

Mental health nurse Dr Niall McCrae, a lecturer at King’s College London’s Florence Nightingale School of Nursing and Midwifery, agrees and says any new strategy should focus on recruiting and retaining good nurses.

‘Making the workplace such that good nurses want to stay and develop their practice is vital. We get great nurses who find themselves in the wrong environment and who leave the profession. The new strategy needs to be one which motivates and improves morale and makes people feel good, rather than one which creates more bureaucratic burden.’

Like many nurses, Gwen Moulster, clinical director and consultant nurse at the mental health and learning disability provider South Staffordshire and Shropshire Healthcare NHS Foundation Trust, questions the impact of the 6Cs policy at the coal face.

‘The 6Cs could have been written as a description of how learning disability nurses generally work, so for me there is nothing in that strategy.’ But, she points out, the learning disability health equality framework included in the Compassion in Practice strategy has – where adopted – improved practice.

Effectiveness

‘The framework gives learning disability nurses a tool to prioritise input, measure outcomes and demonstrate effectiveness. However, under the devolved health system, trusts decide whether to use it or not.’

Deborah Sturdy, independent consultant and former adviser for older people at the Department of Health, questions the need for any new strategy.

She points out that the majority of trusts have their own nursing strategy while NHS England’s Five Year Forward View (FYFV) published by NHS England in October last year, sets out the direction of travel for the health service.

‘It may make more sense to look at the nursing contribution to the FYFV. Having a new nursing strategy when there is already a FYFV seems unhelpful to me, particularly when you think of the cost, time and effort involved.’

Clinical careers

Senior therapist Donna Swinden, a former modern matron on an acute mental health ward, says any strategy should look at bolstering clinical careers.

‘Far more nurse consultant posts are needed. Those of us who want to succeed often find ourselves having to take managerial posts when we would rather progress working clinically if the opportunity existed. We had an exodus of nurses on the ward because they could see better opportunities to go from a Band 6 to Band 7 by training as a psychological therapist and the strategy could address this.’

She says the existing three-year nursing and midwifery strategy Compassion in Practice (CiP), launched by Jane Cummings in December 2012 was hospital focused and any new strategy must be easily implemented in and out of hospital settings.

6Cs

The CiP strategy set out six areas of action for nursing teams, known as the 6Cs: care, compassion, competence, communication, courage and commitment.

With a few weeks to go until the unveiling of a draft nursing and midwifery strategy, NHS England points out that the Compassion in Practice 2014 report update shows the CiP strategy has delivered tangible improvements. These and other senior nurses expect the chief nursing officer’s new strategy to do the same.

What the profession thinks:

Sue Thomas, chief executive at Commissioning Excellence, which provides commissioning support to health and social care organisations and the voluntary sector

‘A new strategy must focus on population health and in particular long-term conditions. I have been banging this drum for nearly three decades now and feel we must pay far more attention to population management and in particular neuro-degenerative conditions that are rising with the elderly population.

These conditions cost us so much because we predominantly manage them through crisis interventions. We should be more proactive with this patient group. Valuing nursing more is key. Nurses have little capacity currently; they are stressed and feel undervalued.

A new strategy should cover how to look after nurses better, invest more in their training and well-being, develop and sustain the workforce, and not wearing it out.’

Sharon Haggerty, head of quality and patient safety at NHS North Tyneside Clinical Commissioning Group

‘For nurses working in large NHS trusts, any new strategy may make a difference because, while we have a devolved healthcare system, national nursing strategies seem to inform trust-level nursing strategies.

But there are a huge number of nurses working outside of large NHS trusts, a whole cohort of them on the sidelines, such as practice nurses and nurses in care homes, who are disenfranchised. For them, it does not matter what the CNO puts out.

I lead a practice nurse forum and we struggle to get nurses to come along, given their enormous workloads. However, we did manage to get good attendance for workshops related to nurse revalidation possibly because revalidation will directly affect a nurse’s ability to continue working in practice.’

Helen Ward, associate professor, London South Bank University and nurse practitioner at The Cuckoo Lane Practice, west London

‘I have worked in primary care for almost 27 years and have seen a lot of change. I have watched nurses develop from skills-based task masters to highly knowledgeable clinical specialists in their own right. I would like to see this develop even further with structured clinical career pathways so that newly qualified nurses can have a vision for their nursing careers, without feeling used, abused and exhausted.

Nursing matters to me, and I would like to think that most nurses are passionate about what they do. I feel upset when nurses tell me how little they are supported in their clinical practice, particularly if they are trying to further their education to provide a better service for their patients.’

Tamsin Newton Snow is a freelance health writer

 

 

 

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