Nursing & Midwifery The FuturePresented by Ruth MayRegional Chief Nurse NHS England (Midlands & East)

October 2013

Wider Policy

Context

The Keogh ReviewMain findings:

• a limited understanding of and failure to genuinely listen to patients and staff

• the poor use of data to drive quality

• the complexity of using and interpreting aggregate measures of mortality, including HSMR

and SHMI

• some hospital trusts are operating in geographical, professional or academic isolation

• the lack of value and support being given to frontline clinicians, particularly junior nurses

and doctors

• the imbalance that exists around the use of transparency for the purpose of accountability

and blame rather than support and improvement…some boards use data for reassurance

rather than, the sometimes uncomfortable, pursuit of improvement.

The Keogh Review

Dissonance between nursing establishments, staff in post and staff available on each shift

Inadequate staffing levels on night shifts and weekends

Poor skill mix

Assistant Practitioners counted in Registered Nursing numbers in some organisations

Links to Compassion in Practice Workstream

Berwick Recommendations

Government, Health Education England and NHS England should assure that sufficient staff are available to meet the NHS’s needs now and in the future. Healthcare organisations should ensure that staff are present in appropriate numbers to provide safe care at all times and are well-supported’.

‘Boards and leaders of provider organisations should take responsibility for ensuring that clinical areas are adequately staffed in ways that take account of varying levels of patient acuity and dependency, and that are in accord with scientific evidence about adequate staffing’.

Reference to NICE work and to staffing ratios

Our Vision – developing the culture of compassionate care

“The actions set out in this vision and strategy will change the way we work, transform the care of our patients and ensure we deliver a culture of compassionate care”

Jane Cummings, Chief Nursing Officerfor England

Our values and behaviours are at the heart of the vision and all we do

Care Compassion

Competence Communication

Courage Commitment

Action at all levels…

1. National Actions – a range of initiatives that will be led by national

bodies and regulators such as CQC, NMC, NTDA and Monitor.

These will also be supported by key stakeholders such as Health

Education England, the RCN and the RCM.

2. Local Actions – a range of initiatives to be led by local

organisations and be supported by national bodies, creating the

environment, providing leadership and giving the highest priority to

achieving the culture of compassionate care. There are many

examples of excellent practice in the Midlands & East region.

3. Call to Action – the overarching focus for organisations and

individuals specific to each area of action.

Six Areas for Action

Helping people to stay independent, maximising well-being and improving health outcomes

Working with people to provide a positive experience of care

Delivering high quality care and measuring impact

Building and strengthening leadership

Ensuring we have the right staff, with the right skills in the right place

Supporting positive staff experience

Francis RecommendationsEvidence to the inquiry suggested that the Trust did not have reliable nursing establishment figures

23 – NICE to develop evidence-based tools for establishing what each service is likely to require as a minimum in terms of staff numbers and skill mix

195 – Nurse ward managers should operate in supervisory capacity, visible to patients and staff, role model and mentor

205 – Seek and record the advice of Nursing Director on quality and safety on major change

Key Objectives of Action Area FiveDirectors of Nursing to agree appropriate staffing levels through the application of evidence based tools

All nursing and midwifery staffing levels and quality experience metrics should be discussed at a public board meeting

Boards to sign off and publish evidence based staffing levels at least every six months, providing assurance regarding the impact on quality of care and patient experience

Monitoring of compliance (CQC, NTDA, Monitor, Contracts)

Workforce Planning Tools

Tools for Acute Care:

Safer Nursing Care Tool Guidance and Multipliers Updated http://shelfordgroup.org/resource/chief-nurses/safety-nursing-care-tool

Work in progress to develop Safer Nursing Care tool for AMUs / A&E / Children’s In-Patients

IPAD-APP development to record SNCT acuity and dependency scores at the bedside and generate local reports – proof of concept stage

Workforce Planning Tools

Tools for Maternity –

Birthrate Plus RCM publishing updated guidance in autumn 2013

Tools for Community (by April 2014)-

Workshop session held in August

Workstream being led by the Workforce Project Board of the Community Nursing Strategy

QNI undertaking review of existing tools

Workforce Planning ToolsTools for Mental Health (by April 2014)-

Two workshop sessions held

Pilots of Keith Hurst and NHSScotland tools due to commence in next few weeks

Literature Review

Learning Disabilities (by September 2014)-

Sub group met in September

Literature Review

Working with MH group for in-patient settings

Focus on tools for community settings

Good Practice Guidance National Quality Board publication 19th November

Will include expectations and case studies

Working with CQC regarding the potential monitoring of implementation of recommendations

Themes –

responsibility and accountability

transparency

evidence base

professionalism

precautionary

Future Work

Work with NICE to establish adequate and appropriate staffing `levels for all care settings

NICE have joined Steering Group and are scoping out options `for the work programme

Scoping work around supervisory status of senior sisters / `charge nurse / team leaders

NNRU review of impact of 12 hour shift patterns due to `commence

Questions and

Discussion