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No opt-out: nurses told of 'moral duty' to save money

Nurses have been told how to fulfil their “professional and moral responsibility” to help the NHS cut waste and save money, in comprehensive guidance shared exclusively with Nursing Times.

The 260-page document has been published to show nurses how they can implement and measure the eight “high impact actions” aimed at saving more than £9bn.

Produced by the NHS Institute for Innovation and Improvement, High Impact Action for Nursing and Midwifery – The Essential Collection draws on lessons learnt from trial sites.

It states: “A few nurses and midwives may still think that money is someone else’s business, but those that think this are, quite frankly, out of touch with reality - opting out isn’t an option.

“Addressing financial inefficiencies is a key personal, professional and moral responsibility.”

The “high impact actions” were announced last November and include areas such as improving patient nutrition, reducing pressure sores and falls and cutting staff absence.

A major theme in the document is the importance of good communication methods. At one trust, infection control teams carried out trolley dashes through the wards, handing out themed “goodies” to get people talking about catheter care.

Another trust designed a giant floor game to disseminate important information.

The guide also sets out how cost benefits can be calculated. For example, by using the Department of Health’s estimate that the daily cost of care for a patient awaiting hospital discharge is £100, nurses can identify savings from reducing delays.

Chief nursing officer Dame Christine Beasley urged nurses to read the document, saying  senior nurses such as matrons and ward sisters would be “absolutely pivotal” in achieving the drive.

She said: “We have seen that’s the case from productive ward work, where ward sisters and ward leaders at that level have really taken it on and made it their own.”

She told Nursing Times that successful pilots had often addressed two or three areas together such as pressure ulcers, falls and nutrition.

But work to date had also shown that nursing leaders also needed the backing from their organisations to ensure change actually happened, she stressed.

NHS South Central chief nurse and director of clinical standards and workforce Katherine Fenton said it was vital nurses took action now to avoid “slash and burn policies.”

She said: “Nurses have got to get involved otherwise we will suffer.” Unless senior nurses were engaged, “others haven’t got a chance.”

Some might be worried about schemes appearing to pit ward against ward, but Ms Fenton said the work had shown nurses could be “energised” by an element of competition.

However some improvements, such as nurse led discharge and nutrition, had proved particularly tough to crack, she said.

NHS County Durham and Darlington took action on nutrition, involving enforcing protected meal times, gathering patient feedback on menus and ensuring hot, fresh meals were available 24 hours a day.

Modern matron Karen Dyson said patients were happier and catering costs had fallen.

Another case study in the guide is East Kent Hospitals University NHS Foundation Trust, which used routine falls risk assessments, sensor alarms and falls “champions”. One ward reduced its falls rate by 85 per cent in a year.

Readers' comments (72)

  • Hear hear Phil Dup!

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  • Okay.........How about " EVERYBODY OUT???!!! " I agree with all of the above. After 30 years of unstinting service, in a job that I have loved, I am sick and tired of the likes of Beasley pontificating to those of us who have already saved the NHS an ABSOLUTE FORTUNE in unpaid hours. Wake up and smell the coffee. Get out of your Institute and wise up. The natives are restless. How very dare you, Christine Beasley...How very dare you!!!

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  • Exactly Margaret, heres another idea too, why don't we calculate exactly how much Nurses have saved the NHS on average over the last 20 years or so, then we can order our useless union to send a bill to these pathetic managers, to be paid with immediate effect.

    God I can't wait to get out to Melbourne. This country is taking the piss out of us!

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  • I'm bored of should, moral and duty used as as an imperative for nurse or nursing. Please stop it NT.

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  • I whole-heartedly agree with the above comments. Camero, Cleg and Osbourne are multi millionaires.. They are obviously very patriotic and caring. I am sure a pay freeze for them won't hurt

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  • How much money and time was squandered by a subcommittee of non medically skilled untrained business people in coming to the conclusion that once again Nurses hold the key to saving the NHS from failing in its duty of care. Not a duty of care to our patients but a duty to save money.

    The answer is tragically simple.... reduce administration posts. There are far too many amateurs in positions beyond their capabilities their knowledge and expertise using inappropriate skills to set ludicrous and meaningless targets for too few real professional care givers to meet.

    Let us return the NHS to a service which supplies a safe efficient system of care to our patients not a top heavy service which is financially geared to jobs for administration and IT systems, a service which would rather use agency Nurses than provide appropriate numbers of NHS staff on each ward.

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  • Anonymous | 29-Jun-2010 8:39 pm, I agree with you, but I have seen petitions like this put forward in the past only to be ignored. The RCN actually has a no strike policy. What is needed is a NATIONAL movement straight from the off.

    Roger Hodson I totally agree pal, but we are not going to get that because to few people are willing to fight for it.

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  • Martin Gray

    Don't you feel that those in power think that a nice pat on the back and a supprting word or two is all they have to do to get frontline staff to back down? It's like giving a puppy a treat for doing as it's told! 'Patronising' is a word that springs to mind because that's the atitude that management and politicians have to workers.

    Having a 'no strike' policy is a cop-out for the unions; they take millions in membership fees, pay their staff higher than a clinician, squander money on bureaucracy, and don't do anything positive to support their membership. I can't help but feel they are all secretly in cahoots with the NHS management and Government.

    Perhaps we should all just STOP filling in the paperwork and concentrate solely on giving practical patient care, refuse to do clinical tasks that ought to be done by house officers and registrars, make doctors get their own tea, do their own bloods, own cannulatuions and own observations on their patients. Yes that is working to rule rather than an all-out strike but boy would it be effective!!!!

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  • Martin, you make Doctors a cup of tea?

    Seriously though you are right, a simple work to rule, if everyone did it would be unbelievably effective!

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  • Peter Goble

    Nursing Times will not issue a rallying cry and no leader will emerge to start a ball rolling. But there is a tide in human affairs and it will eventually turn. The effects can't be foreseen but they will be momentous, you will be caught up in them, you will know that a certain destiny calls you to action, and that you are called upon to choose whether to act or whether to remain aloof: a mere bystander.

    The important thing is to be aware that there is always a tipping point, and to be ready to act in solidarity with others when the time comes. You will know what needs to be done, and you will find the courage - with others - to do it.

    We are talking about the NHS here, aren't we? We are talking about how it has been ruined to line the pockets of the unscrupulous, and to feed the egos of careerist ideologues, aren't we? We are talking about exploitation and contempt of human values, aren't we?

    But the writing is on the wall, here on this forum, and has been for several years. Somewhere in history, a clock is ticking........

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  • Couldn't agree more with all the above. How about we all learn self catheterisation so that prior to duty we can insert and go, avoiding the need to take time to sit, therefore saving untold millions in wasted pee time? Along with the missed breaks, unpaid overtime, and always going that extra mile, we should be able to save a fair wack. Here our pay has been frozen along with increments resulting in the longterm effect of a ward sister eventually working on a top band 5 salary. Unsocial pay on a Saturday is being removed along with all bank staff. We are working 60+hrs a week. All funding for toys for use in play therapy has been stopped and the nurses are buying toys out of their own pay. However, let us not forget that 'we are all in this together' - thus spake the multi-millionaires. Anyone for major walkout?

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  • Mike,
    Those who use the service should also be prepared to do something about the NHS spending more on bureaucrats, administration, IT and contracted out workers than it does on those who provide patient and family care.

    Let the public take a hand in deciding who is worth more to the Health Service. It does after all belong to the Nation not the shadowy overpaid accountants who try to run it on the basis of a profit making enterprise. These people probably use private health care anyway seeing the same NHS trained consultants and Nursing staff in their private clinics.

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  • Roger, too true mate. What you are saying, that basically it is up to the public as a whole who they want in the NHS, is the exact reason why I think a strike would be so effective. The public on the whole would back us, we are after all fighting for their services here against those beauracrats and managers, alongside better pay/status and working conditions for ourselves. The two go hand in hand in my opinion.

    And Peter, I haven't read quite such an eloquent post in a long while, but I hope to hell that tipping point is soon.

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  • And I hope someone sends all these comments to that turncoat Beasley.

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  • Hi again..Can I offer some more advice seeing as you have the "Pittance Union" to do ZILCH for you in your fight, and who really should be the backbone in this.
    ( I am still amazed that nurses have not banded together to make their union work for them! Stop paying the fees! ) Anyway with them classed as not available and nurses over there on their own, my first thought would be a major rally in a major city. Getting multiple speakers that would let the public and MEDIA know exactly what is going on and what you demand now as a still caring PROFESSION of Health Care . I feel this would start the ball rolling for you. How difficult would it be without the union who should be the main orginisers and more so supporters of your cause ..its a disgrace. However with the amazing WWW now....communication can roll to every hospital and nurse! Major planning and time, but I believe would be very effective for you. No one wants to strike....absoluatly. Thats always been a thing nurses have been known for.not doing in UK...and thats where the government will always have you unless you make a stand not only for your rights as nurses, but for those you are caring for. They have rights too, and they are suffering too.
    However nurses Work to Rule can cripple a Health Service very quickly without patient compromise...and be very costly in the process.
    Canada did a strike I believe, but I havent looked much into it, however I think it was super fast effective. Here in Melbourne we did strike in 1984 with the results we needed. We have also had a few rallies since ( organised and atteneded for the nurses by our union!! )The ANF ( Australian Federation of Nurses ) Victoria Branch do not like such militant action, but there again they protect their nurses...Fees I am happy to pay in to at a cost of approx $370 a year tax deductable.
    You can either continue with the tears.....or rally round all the great nurses who deserve better
    Get Googling for some feedback on Canada and Melbourne ....:)

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  • I agree with the above comments, we all have to do something and stick together or stop moaning about it and accept it! I to am fed up with never getting off on time, skipping meal breaks and working dreadful shift patterns with little time off between 12 hour shifts. I too love caring for the patients but fel everydy I am letting them down due to limited resorces and too much time spent on repetative paperwork that was really designed to make auditing easier. Not patient care. I prefer to spend more time with my patients who I feel are getting neglected. It all about meeting targets nowadays, get them in and shunt them out regardless off wheather they are actually fit for discharge! then low and behold the same patient is back again within days sometimes. What I have noticed more and more is that corners are being cut with paperwork as we simply do not have the time to do the amount that we are now pressurised in to doing by our auditing line managers.

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  • They can stick their moral duty paradox where the sun doesn't shine.

    Chris Beaseley has a moral duty to fight for nurses across the country yet she is just another 'jam making traditionalist' who having made it financially herself sees nothing wrong with the rest of us starving.

    She and the others of oour unions should have legal action brought against them for continually ignoring the central issues of nursing; for making no headway in fair and realistic pay (which should be £25-28000 on graduation)

    Never mind that we are paid the worst for doing the most work and having the least recognition for it.

    my job involves doing work that many other people ought to be doing ;

    physios:- who often pick and choose who they will se and go at a snails pae around the ward.

    dieticians:- who don't order meals, check patients nutritional status or even offer advice. ours just prescribes TPN

    pharmacists and their techs:- who do office hours and don't empty my CD cupboard of dead patients CD's/

    doctors:- who seem less and less willling to cannulate, properly assess (how any times have you seen them coach patients through the MMSE?!) prescribe adequate IV fluids or ignore me drawing attention to declining patients - especialy the post-op ones
    (if you're not worried, why do you keep coming back?)

    She is not up to the taskand should be let go without a pension for utterly failing to meet objectives beneficial to the profession

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  • Hear hear Jjez! Does anyone have any idea where or how to send all of these comments to Beasley and the ridiculous NHS institute? I can't seem to find a contact email, but I'd love to hear their self serving responses!

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  • jjjez@hotmail.com

    Christ, A&E nurses look happier and healthier than those working in acute medicine, why do it?

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  • I am going to contact my union and ask why they haven't bothered to contact members since the government announced a 2 year pay freeze. With this, and talk of a demolition job on the pension Christine Beasley has just about finished me off!

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