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This is the perfect time for nurses to spearhead change

We live in unprecedented times. Every day we hear that the NHS and other public sector settings face a dramatically different future, with less resources and a compelling need to do things differently. Over the next five years as budgets shrink there is, we are told, a once in a generation chance to reinvent the health system to deliver care differently, more effectively and more efficiently.

In 2002 Derek Wanless set out a vision for a very different health system, one whereby individuals are in control of their own health needs, a system designed to keep people well rather than manage illness as it arises. Although published eight years ago there has been little genuine progress towards achieving this. Now there is a demand to radically reduce costs in the health system, while meeting the agenda to deliver high quality services, there is a real opportunity to achieve the Wanless vision. The publication of the Department of Health’s NHS 2010-2015: From Good to Great. Preventative, People Centred, Productive provides a framework for a Wanless style NHS transformation.

So, what place does nursing have in all this and how are nurses to respond? In The Innovator’s Prescription, a treatise on how to get innovative change to happen in healthcare, Clayton Christensen characterises much of what has been innovative social change as “disruptive innovation”. It is a term that refers to those things that have widespread impact, that create disproportionate levels of change. These usually involve a new technology - one that may not be better but is cheaper and works in a very different way to the “old” technology. He cites the mobile phone as a classic example - they undercut the more expensive standard fixed phone by offering a different possibility and, although they were not necessarily better to start with, were a radically different way of communicating that ultimately changed all our lives. Christensen suggests that, once standardised, medical treatments can largely be provided by non-medical practitioners, and long term conditions can be managed well by patients in supported networks. This means doctors and hospitals can preserve their expertise and facilities for conditions that require high order decision making and intervention. Here is an important message for nursing.

‘Develop yourself. Acquire the skills that will free you to manage care pathways without others having to assess, prescribe, make decisions or “permit” what is needed’

Could nurses and nursing interventions be like mobile phones and act as a disruptive technology within the health system, creating change that we haven’t imagined to date? Can nurses invent new low cost service models reaching into communities and people’s homes supported by technology? Can nurses create networks that help people who need care or advice to manage their own care so they need less input from hospitals and clinics? Can nurses mobilise people to better manage care for themselves? Are nurses able to act as disruptive innovators - adopting practices traditionally in the realm of medicine so much so that the NHS is radically altered? If so, we will spearhead potential disruptive innovation - transforming health and healthcare.

Wanless estimated that 20 per cent of the work of doctors, GPs and junior doctors could shift to nurses without compromising quality or safety. It is time we saw a step change in this shift of caring responsibility. Nurses and nursing need to move fast to take on skills such as prescribing, assessment and clinical decision making, alongside the high order skills needed to provide support for self care such as motivational interviewing and coaching, providing psychological therapies and leading service transformation. We need to become vocal champions for the best way to deliver high levels of patient satisfaction as this will, for the first time, carry financial rewards for NHS providers. We need to work as an energised collective doing everything we can to achieve our potential.

As a nurse you need to develop yourself. Acquire the skills that will free you to manage care pathways without others having to assess, prescribe, make decisions or “permit” what is needed for individuals. Remove the barriers to your practice. Be imaginative about what could change to improve quality, reduce waste of precious NHS resources and help people to manage their own care.

Our nursing leaders need to make change happen by being demanding and acting as a single, united and politically effective voice for change. We must tirelessly work to remove the barriers for individual nurses to take responsibility and transform outcomes for individuals. We must create new and different roles for nurses embedded in communities to deliver critical elements of care pathways rather than in monolithic NHS institutions.

Finally, we need to rapidly expand the training of high calibre individuals to lead this agenda - from new entrants to the profession to our leaders of services, not forgetting nurse researchers who develop the knowledge and technologies on which “disruptive” nursing expertise will depend. These are challenging but exciting times - join the mission to deliver our disruptive potential.

Jessica Corner is head of the school of health sciences, University of Southampton

Readers' comments (5)

  • But are nurses able to stand up to intimidation by doctors and others? This disturbing case has failed to attract any outcry outside of nursing organizations. That is disturbing

    http://rethinkingpatientsafety.typepad.com/my-blog/

    lee tilson@gmail.com

    I welcome suggestions

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  • Nurses- do be careful what you wish for. When, in 2002, Sir Derek Wanless was having his 'vision' for the NHS, he was a Director of Northern Rock Bank. He also had a vision that the innovative Northern Rock would scale great heights. In the case of Northern Rock, Sir Derek woke up from his dream in 2007. He was ousted from the Board, and the report of the Commons Treasury Select Committee found Sir Derek highly culpable for the banking crisis.
    But back to the NHS, and Nursing empowerment. Nurses should remember that the NHS's extra Euro level funding, was pledged by Blair on the Sunday Frost program. Chancellor Brown needed someone to sign off a highly plagiarised Funding Report. Sir Derek duly obliged, and was rewarded with his dubbing. With all this extra funding sloshing around in the NHS purse, the mandarins awarded GP's with ludicrous new contracts. Nurses pay since 2002 has languished miserably in comparison to GP's. Now, it appears that the mandarins would like nurses to pick up the work that GP's are no longer prepared to do. This is not empowerment or development, it is getting work done on the cheap, and it is known as 'skills escalation'. Sir Derek has not a single days experience in the NHS system. He is, and only ever has been, a banker - recall again his time at Northern Rock. This skills escalation was introduced in banking also. Who remembers the Captain Mainwaring stereotype bank manager, who was thoughtful, knowledgeable, experienced and autonomous. Skills escalation has replaced him with callow young salespeople, with spiked up waxy hair, many of whom do not know the difference between a percentage and a pork pie. Are these young empowered bankers paid Mr Mainwaring's salary - well what do you think ? Has it produced ‘loadsamoney' for the Bank Executives at the expense of an appalling customer experience - well what do you think ?
    Skills escalation will see nurses doing the work that GP's shun, and they will not receive commensurate pay for their extra responsibility or 'development' - that is the ‘vision'. bankers like Sir Derek Wanless have, they call it skills escalation. Nurses be warned.

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  • peter jones

    It is high time nursing had recourse to a 21st century conceptual framework that would free them from the 'tired' and tested habits of old. We need integrative tools that can span as you suggest here the social humanistic aspects of care and the technical.
    There is a UK tool - Hodges' model a developed in health and social care, with a blog and website:

    http://hodges-model.blogspot.com/
    Hodges Health Career - Care Domains - Model
    http://www.p-jones.demon.co.uk/
    Best regards,
    Peter Jones
    Community Mental Health Nurse NHS plus Independent Scholar & Informatics Specialist
    RMN, RGN, CPN(Cert.), PGCE, BA(Hons) Comp/Phil, PG(Dip)COPE.
    Central & West Lancashire
    England

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  • Most if not all nursing services within primary care are now up for commissioning.....so all the above is clap-trap.

    Commissioners are in effect accountants (very few have any previous knowledge of the NHS or what services consist of or of how they are delivered).

    So for nurses within primary care this is really irrelevant. If a private tender states he can provide the service you currently provide for cheaper then the nurses are out of jobs. Simple economics...cheapest bidder wins.

    Employment with the successful bidder is always an option..but at a more than likely reduced wage!

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  • Anonymous 18 Feb 12.48pm should be more respectful of others views, irrespective of his non-alignment with them. Are all NHS services now up for sale to the highest bidder ? We all remember when private parking was self controlled, and those human qualities of discretion, judgement and ‘nous' were applied. Now it is invariably commissioned out, and we have the parking facilities run by automaton and rapacious wheel-clamping cowboys - is it a better service, or is it simply a cash cow dreamed up by those accountants ? I am sure I know. Are we really going to have an NHS run by nurses and clinicians, who are rented out by the hour ? If we are, then you can forget any notion of humanistic care, as there will be nil accountability, such is our human nature. They will merely be shift workers, with no knowledge of local protocols, no time to develop working relationships, and no continuity in the work place. However, those accountants, who have never worked in NHS care services will gleefully point to the improved bottom line, that has earned them their gilded bonus ! If the reader is the sort that will always buy the cheapest washing machine, regardless of its ability to do the job properly, and perform reliably, then perhaps commissioning is for you.

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