Caring for Patients

Elaine WhitbyRoyal College of NursingImproving Patient Care ConferenceNovember 2015

My brief With the NHS facing unprecedented financial

and resource pressures, what difficulties do front line staff face in meeting the standards and quality of care they provide?

Setting the scene for later speakers Explore difficulties + so what?

– If we understand the pressures, how do we help create the climate for staff to thrive?

Likely CSR announcements (Nov 2015)• 25/40% real cuts are expected for most departments

(Social care? Public health?) • Public sector pay capped• Treasury could define protection for health services

to only commissioned services (source: Kings Fund) • CQC budget likely to be cut by up to 40%• HEE budget could be cut – impact on bursaries

• Funding presented as being sufficient to deliver 7DC• Context is unlikely to improve

What does good care feel & look like? “Sheila’s presence reassured me … by the bed, kneeling next to me, in the doorway. She was just a ward sister who lived with a tortoise and a husband … but I believed she would make things better. It was never anything she said. It was something in her face.Outside my room … I know she took my mum and Tracey aside and gave good news as even handedly as she gave bad, and then consoled and listened.” Patient, Ben Watt 1996

Care & kindness

CompetenceTrust

Difficulties for front line staff - recent reports ….. NHS staff survey

2013 2014 difference% satisfied with quality of care they can deliver

77.75% 76.34% -1.41%

% agreeing that their role makes a difference

90.16% 89.55% - 0.61%

% witnessing potentially harmful errors, near misses & incidents in the last month

31.61% 31.05% -0.56%

% suffering work related stress in last 12 months

38.61% 39.50% 0.88%

Reports cont … Volume & pressure of work September 2015, RCGP survey of 549

practices:– 10.2% of full time equivalent positions are

vacant. Workload has rocketed - 60m more consultations than five years ago but stagnant workforce numbers. GP services under pressure & working exceptionally long hours to cope with demand.

So what do you think?

What are the difficulties you face in meeting standards/providing quality?

Tensions/issues Uncertainty about safe staffing level

guidance v ability to balance the books Volume of data collection, inspection

etc. Recruitment difficulties & new roles/role

substitution – concerns of accountability & spreading registered staff too thinly

Reduction in education & development opportunities

What might help?

No panacea Not addressing policy issues today What can staff/teams/organisations do?

Staff engagement Compelling evidence that organisations in which staff

are engaged and valued deliver better quality care including:– lower mortality rates – better patient experience (treated with dignity &

respect)– healthier and happier staff, with lower sickness,

absence and staff turnover Organisations with a disengaged workforce are more

likely to deliver care that falls short of acceptable standards

Engagement cont … NHS staff survey indicates levels of staff

engagement are increasing, but wide variation Engaged staff should be more likely to have the

necessary psychological resources to show empathy and compassion to patients, despite the pressure

Engaged staff may provide our most efficient mechanism for addressing negligence or poor standards of care.

(King’s Fund; West et al)

Innovation/guideline/programme

Problem or issue to be improved

Design & implement approach that fits local need – with the team!!

Ideas contested & debated

New, shared

knowledge generated

Summary Current context very challenging & may become

more so Aim for competent, caring staff:

– Build patient trust– Improve patient outcomes & experience

Evidence that engaged workforce = higher quality of care

Try to prioritise, choose your initiatives carefully, involve staff in the challenges & decisions

Support them as much as possible