Interview: minister Dr Dan Poulter was inspired early on by nurse leaders. He talks to Steve Ford about good care, bad culture and the future of NHS nurses.
Nurses are “absolutely at the centre” of leading the delivering of high quality care and their leadership role is going to become increasingly important in the NHS of the future, according to new health minister Dr Dan Poulter.
In his first interview with Nursing Times since being handed the nursing policy portfolio at the Department of Health last month, Dr Poulter says the importance of strong nurse leadership was something he learned early on during his experience working as a junior doctor.
Unlike his DH ministerial colleagues, Dr Poulter – known to his parliamentary constituents as “Dr Dan” – has frontline experience as an NHS hospital doctor specialising primarily in obstetrics, gynaecology and women’s health.
When asked to describe his experience of working with nurses at their best, he describes one of the first wards he worked on – a general medical ward that often had a lots of oncology patients – that was run by a senior sister who showed “very strong leadership”.
“She was very inspirational in the way that she not just led the ward and made sure that patients were properly looked after, but in terms of her attention to detail and making sure friends and family were properly supported and looked after at a very difficult time at the end of life,” he says.
“That holistic approach to care and the strong leadership she put across and always advocating the needs of the patient and their families and pulling up doctors when they fell short…. was really something that’s stayed with me. [It is] actually what good care is about and also about nurses taking a strong leadership role in the NHS,” he adds.
However, when prompted to identify a less positive experience of nursing, Dr Poulter says: “I can’t think of any nurse, midwife or health professional I thought did not have the best interests of patients at heart. Nurses become nurses because they have genuine care and compassion, and want to look after and help people.”
He chooses instead to describe an incident that “really upset me”, when a manager had told him to move a patient in order to meet an accident and emergency performance target, despite protests from himself and the senior A&E charge nurse.
“We had a woman who was in a very difficult situation who was pregnant and had come in with bleeding….[and then had] somebody come into the room, someone at management level, and tell us we had to move when I was in the middle of an intimate examination.
“That was to do with briefly at that moment in time the culture of the hospital fixated on targets rather than actually on providing high quality patient care.”
He adds: “We have the odd rotten apple, the odd person that doesn’t come up to standard…. but that’s a very rare example, and where things go wrong I think it tends to be the [hospital] culture that is set by the management.
“It is often frontline professionals who are the people who stand up and advocate what’s in the best interests of patients and actually stand up and say, look, this isn’t acceptable.”
Dr Poulter is the Conservative MP for Central Suffolk and North Ipswich, and also sat on the influential Commons’ health select committee before becoming a minister.
However, concerns have been raised by some that Dr Poulter has taken on the ministerial role previously held by former nurse Anne Milton and before that Ann Keen, also a former nurse.
Asked how, as a doctor in charge of government nursing policy, he will sell himself to nurses, he argues that, having worked in multidisciplinary healthcare settings, he understands the “vital role that all members of the team play”.
He returns to his recognition of the importance of clinical leadership: “nurses are increasingly doing more and realising a lot more potential in delivering high quality care in more specialist roles [and that] is something I’ve seen work very, very well in the NHS and something we need to do more of.
“Nurses are going to be taking a strong role in actually leading the design of services in the future and that’s got to be a good thing.”
One of the challenges facing the NHS workforce, Dr Poulter believes, is how to continue to break down the ”traditional hierarchies” and support nurses in doing some of the roles traditionally performed by doctors – but while maintaining the profession’s “underpinning of care and compassion”.
He highlights that “very important” to achieving this balance is the government’s new Vision for Nursing, which has been drawn up by NHS Commissioning Board chief nursing office Jane Cummings and DH director of nursing Viv Bennett.
One of Dr Poulter’s main tasks next year will be to oversee the passage of the government’s Care and Support Bill through parliament, which he will do jointly with Liberal Democrat health minister Norman Lamb.
An important part of the bill, which was published in July, focuses on the education and training of the future workforce in the health and care sector, including healthcare support staff.
When asked what he thinks about the issue of mandatory regulation of healthcare assistants and whether it is needed, Dr Poulter takes the government line that voluntary regulation is the way forward. But he notes “it is something we need to keep an eye on”.
Since joining the DH last month, Dr Poulter says he is trying to make sure he is “out and about” most weeks meeting nurses and other frontline health professionals, and “actually talking through some of the issues”. Last week he visited hospital nurses and health visitors in Manchester.
Possibly because of his background in women’s health, Dr Poulter talks with great enthusiasm about health visiting, which he highlights as “a key area for the government”.
He also talks with passion about the Family Nurse Partnership programme, in which 430 nurses are currently working, and Dr Poulter says the government is “looking to take further” and eventually reach around 15,000 families.
“That’s really important in not just getting that bond between mum and baby…. but also helping mum do the best for herself and realise her full potential afterwards, which helps her support her family later on.
“For me, this is a real priority to make sure that we can really give children the best start in life and have that real focus on the early years.” -
However, he says he recognises that nurses and other clinicians in some parts of the country are suffering from staffing pressures.
“Before the election… almost every midwifery unit I worked on didn’t have enough midwives and a lot of nurses and midwives who do incredibly hard, physically demanding jobs sometimes didn’t always feel supported or properly resourced. The main factor for that, from my experience, was…management culture.
“In some parts of the country we’ve got really good supportive managers who listen to and work in very strong partnership with frontline professionals,” he says. “But in other parts of the country there have been, managers….for example who haven’t necessarily supported frontline staff as effectively as they could do and it’s not very helpful.
“That’s something that does need to change and improve. We know where managers and frontline health professionals work well together in partnership, we often have a more motivated workforce, delivering high quality care, and that’s got to be the way forward.”
As we leave the DH, Dr Poulter stops to get some handgel from dispenser on the wall. “Force of habit,” he explains.
|CV||Dr Dan Poulter|
|September 2012||Appointed health minister|
|May 2012||Elected MP for Central Suffolk and North Ipswich|
|2008-10||Deputy Leader of Reigate and Banstead Council|
|2006||Qualified as doctor at Guy’s, King’s and St Thomas’ School of Medicine|