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Practice team blog

Improving public health requires a whole-society approach

1 September, 2014 Posted by: -

Public health has long been the poor relation in the healthcare family. While preventing ill health may seem an obvious candidate for generous funding, too many aspects of this important area of healthcare have been largely sidelined for decades.

Unfortunately, most public health interventions can be seen as making long-term investments. It takes years to reverse trends such as rising obesity and type 2 diabetes. In the absence of results to justify funding, public health has tended to lose out to the services dealing with patients who have already developed these conditions.

Now the NHS has a body responsible for public health in each of the four countries in the UK. Hopefully this means ring-fenced funding and dedicated focus will begin to make inroads into the long-term causes of ill-health that will otherwise eat up the lion’s share of NHS budgets.

However, as the chief executive of Public Health England recently acknowledged, most causes of poor health are not related to healthcare, but to economic and social issues such as employment, housing and companionship.

Nurses and other professionals working in public health do great work, but they need more than just serious funding for long-term initiatives.

They need our increasingly unequal society to realise that a long-term investment in reducing poverty may involve some short-term financial pain for the more comfortably off, but that in the long term we will all benefit.

When was the last time you really talked about suicide?

18 August, 2014 Posted by: -

If anyone ever needed irrefutable evidence that depression doesn’t discriminate, the death of Robin Williams is surely it.

When the news broke last week, you couldn’t move on twitter for people offering their condolences and the hashtag #depression littered every other tweet. Depression stopped being a hidden illness to be swept under the carpet and became something peoplecould feel confident talking about.

But this hasn’t always been the case. The word “depression” in itself is not a scary word- how many times have you heard someone, or even said yourself, “Oh I’m so depressed!” when what you really mean is “I’m disappointed that I forgot Tesco closes at 4pm on a Sunday”?

Depression has become an everyday word. Pre-fix it with the word “clinical”, however, or add suicide into the equation and you’ve got a whole different story.

I’m a registered mental health nurse and volunteer on a mental health helpline. At least once a week I ask a stranger “When you say you ‘feel like ending it’, do you mean suicide?” And yet, on a personal level it feels uncouth saying the ‘S’-word out loud.

In fact most people I know would be surprised to hear that my life was changed by suicide when I was 18. Just writing that sentence makes me feel like I’ve over-shared, I’ve been back over it again and again, trying to somehow make it more comfortable to write – and more comfortable for you to read.

Yet, if I told you I’d lost someone from cancer, would that be more palatable?

In our open society, with all the doors social media has opened and every topic under the sun being blogged about on a daily basis, suicide remains one of the last taboos. A subject that feels uncomfortable to bring up.

But open discussion is important. It makes it ok for people to ask for help, to express how they’re feeling and recognise that others feel the same.

By openly talking about his illness, Robin Williams has helped us take a huge step towards changing how society views depression and suicide. Even, perhaps, towards depression being recognised for the debilitating, involuntary, and sometimes terminal, illness that it is.

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In healthcare, local doesn’t always mean best

11 August, 2014 Posted by: -

Whenever NHS services are reorganised to offer specialist services in centres of excellence there tends to be a public outcry about the loss of local services, with accusations that the reorganisation is an attempt to cut spending. Local MPs vociferously defend those on their patch – often when the reorganisation is the result of their own party’s policies.

It’s great, therefore, to see the effect of such a reorganisation on stroke care in London.

According to a study published in BMJ, the creation of specialist stroke units and hyperacute stroke units offering quicker intervention and intensive rehabilitation is saving an average of 100 lives a year in the capital and cutting the average length of admissions.

In Manchester, public opposition led to compromise arrangements whereby no hospitals stopped providing stroke care, and only patients presenting within four hours of the onset of symptoms receive hyperacute stroke care. The study found no reduction in mortality, although length of hospital stay was reduced; the researchers estimate that if Manchester had adopted the same approach as London, around 50 lives a year would have been saved.

What’s more, the reconfiguration in London was undertaken at strategic health authority level and took account of the fact that older people tend to live in the suburbs, so the eight specialist centres were spread widely to ensure they were as close to patients as possible.

Although it is too early to say how it has affected morbidity, the study results suggest the rest of the NHS should move to adopt the London model. Perhaps this example can also be used to illustrate to worried members of the public that sometimes, closing beloved local services is the only way to ensure patients get the specialist care they need.

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'We can't all set off to Sierra Leone or Liberia to look after people with ebola'

4 August, 2014 Posted by: -

I can’t imagine what it is like to look after someone with ebola but I got an insight last week when BBC news interviewed a nurse who had just seem a baby die from the virus.

On the point of tears she demonstrated care and compassion for her patients but what really struck me was her immense bravery working with a high risk group of patients.

After watching the clip I was left with so many questions about her motivation to work with people with ebola and why she had put herself in such a high risk situation. I was also left feeling guilty that I have never done something as amazing and self-sacrificing.

We can’t all set off to Sierra Leone or Liberia to look after people with ebola, but that short news report made me reflect on what motivated me and others to become nurses and why the system sometimes knocks it out of us.

In the busy and sometimes chaotic world of clinical nursing it can be easy to lose sight of that original motivation.

Sometimes getting the job done is the only achievable goal but as Florence Nightingale said: “The tasks can all be done but the patients receive no care”.

Yet, despite all of the barriers and obstacles, I meet nurses all the time who are doing amazing things for patients. Such as the nurse who organised a singing group for people with COPD and the nurse who made an activity board for her patients with dementia.

Inspirational nurses whose work is guided by the needs of patients. That is how nurses make a difference every day.

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Are you ready for a cardiac arrest?

28 July, 2014 Posted by: -

Inevitably nurses in some areas such as cardiac care and casualty are more ready than others. Are you ready for such an event? 

Months and even years can go by in some wards and departments without the resus trolley and equipment being used. But it can happen.

Someone can have a cardiac arrest in the street and passersby will do all they can to help. The more widespread availability of portable defibrillators – in major railway stations for example — is helping improve survival rates.

Anyone having a cardiac arrest in a healthcare setting – a hospital, outpatient department or GP surgery stands a far better chance of survival. But that does depend on appropriate response from staff on hand.

Every nurse needs to have a good understanding of what is in the resus trolley and how to use it – wherever they work. This familiarity and skill will help to save lives. Of course some specialty areas see far fewer patients in cardiac arrest each year. But the risk is always there and nurses need to be prepared.

To that end we have just published a two-part series on the cardiac arrest trolley. Part one details  at the equipment in the trolley to maintain airway management and breathing while part two focuses on circulation and in particular the drugs used in emergency situations.

Don’t wait until it is too late to make sure you and your resus trolley are up to date.

Comments (4)

Nurses don’t grow on trees: will NICE’s new safe staffing guidelines improve safety?

21 July, 2014 Posted by: -

The second I walked onto the ward I knew something was wrong.

I’d been qualified seven months, one of those incredibly keen, yet still incredibly unsure, nurses.

“Hi Fran,” Rachel smiled at me as I walked into handover, ready for the late shift to start. “So… err… Ann and Michelle are both sick. You’re the only qualified on this afternoon.”

She went from being my best friend, who’d just signed off my preceptorship paperwork, to my worst enemy.

I was 22 years old, how could I run a busy acute mental health ward? I wasn’t old enough to make decisions!

Yet for some reason, the trust was happy to let me take full responsibility of the keys and keep 20 patients alive for the next 7 hours and 23 minutes.

A nurse-to-patient ratio of 1:20 is not unusual in mental health, it should be, but it’s not. I survived the shift, as did all my patients, and I got through it the next time it happened, and the next. But the care that I and the three HCAs working with me gave was not what service users should expect.

No-one could use their escorted section 17 leave as the HCAs were permanently on special obs and I wasn’t able to leave the ward in case there was an emergency. I had to cancel the one-to-one sessions I’d planned with my named patients to prioritise giving everyone their medication and when a doctor arrived on the ward and wanted a chaperone while he saw a patient I had to say no, I needed to discuss prn with a service user who was clearly escalating.

In theory, when NICE’s new safe staffing guidelines come into force, this sort of experience will be a thing of the past. Fewer than two registered nurses on a ward during any shift, day or night, will be deemed a “red-flag”. This will “prompt an immediate escalation response”, such as allocating additional nursing staff to the ward.

Some of you reading this will be asking “but where from?” Nurses don’t grow on trees, if one ward is short-staffed, it’s unlikely that another has an abundance of nurses sat around twiddling their thumbs.

But the guidance makes it clear that it is unacceptable for acute wards to be run with fewer than two registered nurses. That acknowledgment is a huge step towards safer wards and safer patients. The red-flag events will still happen, but maybe if they keep being pointed out, trusts will be forced to do something.

Please report your red-flag events. Let your trust know the guidance isn’t being followed. It’s five minutes that you can’t afford to spend on paperwork but if it puts pressure on your trust to make wards safer then it’s worth it every second.

Comments (5)

Should we charge for GP appointments?

14 July, 2014 Posted by: -

A few weeks ago nurses at RCN congress hotly debated a controversial resolution to introduce a standard charge for GP appointments. Thankfully it was overwhelmingly rejected.

My concern is charging, while dressed it up as an attempt to discourage non-attenders, is just a strategy to control supply and demand.

What happens when a patient with difficult asthma or COPD puts off seeing their GP, ends up in A&E and is admitted with uncontrolled asthma?

The recent report on asthma deaths provides clear evidence of poor outcomes for patients who fail to access services and we need to be wary of putting barriers in their way. We need primary care to be more open and accessible for these patients to prevent them becoming trapped in the revolving door of readmission with its associated costs.

“We have a problem with funding health care, but charging for GP services is not going to resolve it.”

We already see patients rationing their own health care because of worries about prescription charges. GPs and pharmacists report incidents where patient ask to prioritise the most important drugs and take a chance on not taking the others because of costs.

We all have to resist this steady creep towards rationing state-funded health care services and ensure that the NHS remains true to its founding principles of free at the point of access. We need to think carefully about the effects of charging on our most vulnerable patients and for the public health of the nation and make sure we speak up for the people in our care.

We have a problem with funding health care, but charging for GP services is not going to resolve it.

Surely, this will just put pressure on another part of the system. What we actually need is a grown up conversation about how we pay for healthcare through taxation.

But once charging is introduced the system will no longer be universal and those who can afford will benefit most. Is that right? Is it just?

Comments (2)

Can Morecambe Bay lead the way in raising concerns?

7 July, 2014 Posted by: -

As a board member of a trust put into special measures after a series of high-profile problems including patient deaths, a director of nursing’s first instinct might be to stay below the media parapet – even if the problems didn’t happen on her watch. However, Sue Smith of University Hospitals of Morecambe Bay Foundation Trust has come out fighting to change perceptions of her trust and in particular its nurses and midwives in an exclusive interview with Nursing Times.

Ms Smith is making it clear that the trust is learning from the tragic errors in its recent past, and using the lessons to improve care and patient safety. She is also pointing out the “cracking job” frontline nurses and midwives are now doing, keen for them to get recognition for their achievements.

And Ms Smith is determined to ensure the trust continues learning from problems and adverse incidents. However, in future she wants that learning to take place at an early stage, before minor problems escalate and lead to tragedies.

Sue Smith

Sue Smith

She believes the trust, an early supporter of our Speak Out Safely campaign, has now created a culture in which staff are encouraged and helped to raise concerns and that these will be addressed rather than ignored or covered up.

The trust still has much to do to get a clean bill of health from the Care Quality Commission. However, it’s refreshing to see a director of nursing so determined to help it move on from the tragedies of its past without forgetting them or their impact on patients, families and the wider community.

Perhaps Morecambe Bay will become one of the first healthcare providers where staff who raise concerns are celebrated and acknowledged as crucial to maintaining quality and safety.

Comments (1)

Health promotion needs to be of this planet to be effective

30 June, 2014 Posted by: -

A suggestion by doctors on how to prevent teenagers smoking was made for a different utopia than the one we live in

I loved the recent proposal by doctors to ban anyone born after 2000 from smoking. At last week’s British Medical Association annual conference delegates voted overwhelmingly in favour of a ban on the sale of cigarettes to any individual born after the year 2000. It has a delightful simplicity and protects the future generation from the many harmful effects of smoking by producing a “smoke-free generation”.

If only changing health behaviour was so simple and so easily administered. If so I would propose that pubs that have served anyone more than three units of alcohol in one day should refuse to serve them any more. And that anyone buying sweets or fatty foods can only do if they also buy fruit and vegetables at the same time.

Unfortunately with these proposals and that of the BMA there is one problem, well actually two. First it would be impossible to police, and second people would take no notice.

Changing health behaviour is a complex issue and one that nurses grapple with every day as they use their relationships with people to promote health. More and more nurses are taking on this responsibility and taking opportunities for brief interventions where they can – making every contact count.

This week on 1 July sees the second national public health conference for nurses, midwives, health visitors led by Public Health England.

Nursing Times will be reporting on the event, which includes details of the Population Health Framework – which will help to shape the work of nurses in the future in this essential area. The title of the conference “At the Heart of it All” says it all. Nurses are at the centre of any initiative to change and improve the public health. But as nurses know, that task is not as simple as doctors would like it to be.

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Do politicians play on the fact many nurses would feel striking is "abandoning" their patients?

23 June, 2014 Posted by: -

When we asked this question last week on twitter, we were stunned by the unanimous “yes!” we received from nurses and other healthcare professionals.

 

 

I’ll admit, it was a leading question, but interesting that not one person in the chat argued that politicians don’t take advantage of nurses’ altruistic natures. It seems the coalition government has lost a lot of friends with its move to give nurses a real-time pay cut, while awarding MPs an 11% pay rise.

In his RCN Congress keynote speech, Peter Carter acknowledged nurses’ anger over the government’s decision to ignore the Pay Review Body’s recommendation of a blanket 1% pay rise. But rather than pushing for industrial action, Mr Carter put forward plans to pressure ministers and their shadows through lobbying and protesting. In fact, he urged nurses to consider the consequences of striking and voiced a belief that this option isn’t wanted by the majority: “I would rather set out my stall that when it comes to crunch time, [nurses] are not going to be walking out of wards and leaving patients, they are not going to do it because they are not that type of people”

Cue a flurry of comments on our news story disagreeing strongly:

Don’t you dare, Carter, don’t you dare. Of course we know the consequences of striking.” – Anonymous, 16 June

STRIKE, STRIKE, STRIKE It is all we nurses have left. Please don’t listen to the clap trap from Carter et al at the RCN. They’re in cahoots with Govt.” – Anonymous, 17 June

What a surprise the RCN rolling over AGAIN!!” – Anonymous, 17 June

I could go on, but I think you get the picture.

When we asked nurses on twitter however, many agreed with Peter Carter stating that patient safety comes first and they would never choose to strike. Others accepted this but argued that industrial action with the aim of improving standards would benefit patients and enhance safety in the long-term.

You can see a transcript of the heated discussion here: Should nurses ever strike?

While our twitter followers were split on whether industrial action should be the next move or not, the one thing everyone seemed to agree on was that something needs to happen, and soon. It feels as though nurses have been pushed too far this time and whatever happens next, I strongly suspect Cameron et al are going to regret annoying 400,000 voters in one fell swoop.

Where do you stand on this debate?

 

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