There are tough times ahead, but flexibility and effective leadership will be key to progressing the nursing profession in a changing financial climate, according to Chief Nursing Officer, Dame Christine Beasley. LOUISE FRAMPTON reports.
Dame Christine Beasley, Chief Nursing Officer, Department of Health, recently discussed the role and future development of nursing at the AfPP Annual Congress, held in Harrogate. She warned of tough times ahead for the health service, but assured delegates that plans to focus on quality will not be “shelved”. While significant progress has been achieved, the NHS will be required to “reduce waste in the system” in the wake of the financial crisis and nurses will have a valuable contribution to delivering efficiency gains. “We have come through some troubled times in the NHS, but, through my visits around the country, I see many examples of excellent practice. We have a come a long way in the past 10 years, especially when you consider how long people used to wait for operations and how quickly and efficiently surgery happens today. Patients say they are amazed at how streamlined services are now, compared to their experiences of the NHS 20 years ago,” she commented.
However, she added that there is still unacceptable variation in the health service and said that there is much work to be done to raise quality uniformly across the NHS. Christine Beasley pointed out that when services go well for patients, they say they feel “lucky”. “They do not feel confident that the service will be like that for them every time,” she explained. “Here lies the challenge for us. Nurses are often the touchstone by which people evaluate the quality of the services they receive as they are usually present 24/7 during a patient’s care – other healthcare professionals tend to come and go throughout their interaction with the health service. We need to consider how we can get to the point where, if things go wrong, patients are actually surprised, because they expect their experience to be excellent every time.” Christine Beasley said that she had experienced variations in quality for herself when she recently visited a friend being treated in hospital. Her friend had been admitted as an inpatient and she had spent most nights by her side. “Over the course of a month you start to notice aspects of the service that you would not normally be aware of. What was particularly noticeable was the difference in the standard of care that you witnessed depending on who was in charge. There were two or three people that stood out and made you feel relieved that they were on duty because they made you feel more confident, safe and listened to. You could tell the difference when they were in charge.”
Speaking on the current financial situation, she said that although there is an assumption that the “Next Stage Review” will be shelved, the NHS Chief Executive, David Nicholson, is “absolutely clear that this is exactly the time, as the going gets tough, to hold onto Lord Darzi’s vision”. Services must still be of a very high quality, while waste and inefficiencies in the system must be eradicated, she asserted. In her view, quality is ultimately about safety. Patients want to know: “How safe will I be?” They also want to know how effective their treatment is going to be; they want to be better informed to enable them to make choices about the treatment they receive; and they want to know: “What will the experience be like? How will I feel?” Often this is an aspect of care that is not addressed, according to Christine Beasley. “When a patient’s experience of the NHS is poor, this inevitably overshadows how effective and safe the treatment has been. If people feel they are treated with indifference or that staff did not take account of their feelings, they will take the view that the experience as a whole was poor,” she warned. She pointed out that there has been significant investment in the health service in recent years, but, in the next few years, the NHS will have to be careful and plan ahead if it is to avoid “reverting to old habits by responding at the last minute to financial pressures with a policy of ‘slash and burn’”. “We are going through the worst global financial crisis since the 1930s and public spending is going to be affected. It is going to be tough. There is no easy solution, but we have a responsibility to spend the public’s pound wisely,” she exclaimed. “If the Government is to pay back the money it borrowed, in the wake of the banking crisis, we have to be realistic about public service spending and the impact this will have on the money that is available to the NHS.” Christine Beasley also highlighted the fact that there are declining numbers of people in the workplace, so there will be a limit to the amount of tax available, in the future, in light of an ageing population. “Earlier this year, a report stated that, if we are to get through the next phase of what we are doing, we are going to need to take £15 to £20 billion out of the health service over the next three years. This does not mean taking money out of the service to give to the Government for something other than healthcare, but the money is needed to maintain and reinvest in the NHS to continue at current service levels, while continuing to take account of issues such as inflation and pay. “It is very unlikely that we, as nurses, are not going to be part of that. There is no doubt about it, there is waste in the system which needs to be addressed, and we need to start thinking about how we are going to achieve these savings, without compromising quality. There is an enormous amount of duplication and waste which can be taken out of the system, and we need to ensure we become good at this,” she continued.
Training and recruitment
“Everyone has a contribution to make to ensure quality, productivity and efficiency,” she added, while highlighting the importance of nurse leadership in achieving these goals. According to Christine Beasley, organisations with excellent services usually achieve such high standards because they have good leadership throughout the nursing team and at a clinical level. “Nurses are highly qualified and highly skilled practitioners. We need to ensure that this continues – if we are to have quality services we need quality staff. We need to make sure they are prepared and supported throughout their careers. To ensure their work is efficient and effective, nurses need to work in partnership as part of a multidisciplinary team and ensure there is strong leadership,” she commented. Nurses also need to have greater involvement in commissioning roles, she believed. However, she offered some further advice in relation to effective leadership: “We must ensure that we do not stop learning; that we constantly review whether our leadership is based on best available evidence – it is too easy to get stuck in old ways of thinking. In addition, you will not become a successful leader if you do not know how to get things done – which means understanding politics both at a local and wider level. As nurses, we need to become very skilled at this,” she explained. Christine Beasley also acknowledged that there are challenges ahead with regards to recruitment issues and training: “We need a more flexible curriculum, with a strong academic foundation if we are to deliver skilled practitioner leaders and we also need to ensure there are lots of entry points into the profession allowing people to access a career via non-traditional routes.” She suggested that more needs to be done to attract people who are on their second or third careers, but said that training would need to be tailored to support such recruitment. “It is easier to recruit into teaching from other professions, as those who already have a degree can simply undertake a year’s PGCE. However, those choosing a second or third career in nursing have to undertake another three year course. We need to promote ways to gain entry through fast track schemes, while ensuring safety, if we are to encourage people to consider nursing as an alternative career option,” she commented. “We want the best people with a range of skill sets, but we also need to paint a compelling picture of nursing as a role,” she continued. In particular, she believed that the nursing profession has a problem in relation to its image, which must be addressed.
Head, hands, heart
“There is a perception that nurses have lost their way, are no longer compassionate and are performing too many technical tasks. The attitude is if only we could go back to the standard role of a ‘cool hand on a hot brow’, then everything would be right again,” she commented. She strongly disagreed with this view and stated that: “Good nursing is about head, hands and heart.” She pointed out that technical skills and compassion are both important; nursing is a very complex role – there are pharmaceutical considerations to deal with, while people are living with a range of long-term conditions and have a range of other issues affecting their health. “As a skilled practitioner and clinical leader, you really must have the knowledge and skills to understand this, in order to be effective. Of course you need to be able engage your heart, but I think that people are looking back with rose tinted glasses to an era that never existed.” She acknowledged that, in some areas, under a lot of pressure, compassion can sometimes be lost and there is a tendency to stop noticing conditions that would initially be considered unacceptable. “We should never lose the ability to feel very uncomfortable about certain aspects of our services,” she warned. “People, who are under pressure, often stop seeing the problems in front of them as they eventually become normalised. Healthcare professionals can become accepting of the status quo when they encounter the same conditions every day. But we should never lose the ability to look at our services through a fresh pair of eyes. “As we go forward as a profession, there will be lots of change and we need to be flexible about what we are doing,” she concluded. “As Darwin pointed out, it is not the strongest of the species that survives, nor the most intelligent, but the one that is most adaptable to change.”
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