We must address a number of profound challenges to improve care, says Lord Willis
In 1860 the first Nightingale training school for nurses was opened at St Thomas’ Hospital in London. It set standards in nursing care across the globe and 150 years later the UK is still setting standards by which the world’s very best nursing care can be judged. The fact that the Willis Commission made 29 recommendations to a range of stakeholders about nursing education is testimony to the continued belief that improved nursing care equates to improved patient outcomes. However, simply moving to a graduate-educated workforce will not in itself deliver what the nursing profession, employers and patients want - we must address a number of profound challenges.
At the heart of “graduateness” must be a recognition that tomorrow’s nurses will increasingly have advanced specialist roles, leading teams, diagnosing care requirements and prescribing. They will also need to contribute to research to effect better care.
In a healthcare system where the vast majority of patients will be supported in the community, often in their own homes, educating individuals and families to self-care will be fundamental to the role of the registered nurse. Securing “quality with compassion” in a rapidly changing system is perhaps the greatest challenge the nursing profession has ever faced.
‘It is not satisfactory that no data is available on what training support staff receive, what roles they carry out and how competent they are to do the tasks’
Indeed, it was because of this enhanced leadership role the commission report put such an emphasis on the training and regulation of the growing army of healthcare support workers. Growing at a rate of 6% a year, in 2011 the number of healthcare support workers increased by 24,000 since 2001 and, given the current financial restraints, this growth is likely to continue to accelerate.
It is not satisfactory that no data is available on what training support staff receive, what roles they carry out and how competent they are to do the tasks. That conclusion is not to undermine the commitment of healthcare support workers, but to emphasise that they and their patients or clients deserve better. It is simply unacceptable that staff whose competence is neither regulated or inspected are looking after the essential needs of some of the nation’s most vulnerable individuals.
It is equally unacceptable that registered nurses, some immediately following qualifying, must take responsibility for supervising colleagues whose competency they cannot reply upon. If the modern healthcare workforce is to be re-defined, it must be on the basis of patient need and nursing and care worker competence.
However, it would be foolhardy to believe that training and regulating healthcare workers will by itself improve patient outcomes. Research evidence of the association between nurse staffing levels and patient outcomes presented to the commission was truly compelling.
The best-staffed NHS trusts have significantly lower mortality rates and reduced risk of complications. One only needs to look at the experience of Mid Staffordshire Foundation Trust to see that the negative effects of inadequate staffing can be striking.
We need both registered nurses and registered healthcare support workers, but each must have their roles and competencies clearly defined.
Finally, leading this inquiry has been truly inspiring. The dedication, intellect, compassion and altruism that shone through the multitude of submissions and presentation has been humbling, and the desire to go on seeking improvements, despite the huge challenges facing the service, is testimony to all concerned.
Lord Willis is chair of the Willis Commission on nursing education