Practice team blog
The increase in liver disease is startling with it now being the fifth biggest killer in England and Wales with around a 25% increase in deaths in the last decade.
The UK’s drinking culture has its part to play with younger people now affected more by liver disease as a result. Rates of hepatitis C are increasing but unfortunately the level of treatment has not kept pace. Last month Nursing Times reported a steep rise in deaths from this virus in the UK with experts saying that the rate of treatment for hepatitis is “unacceptable”.
Nurses can help identify those at risk and boost the numbers treated from this disease. However it is a disease area which nurses sometimes feel they do not know enough about.
The Royal College of Nursing has produced a competence framework for nursing to provide professional quality standards to support nurses, regardless of their own clinical background, to offer appropriate, timely and quality care for people with and at risk of liver disease.
Two of the authors of this framework have worked with Nursing Times to produce a learning unit which is free for all to access. Liver Disease: risk factors and treatment is aimed at nurses working in all healthcare settings; it will enable you to identify patients at risk of liver disease, offer them health education to reduce their risk, and recognise those who require referral to specialist liver services.
And of course it will add to your CPD hours with a certificate that you can print off and keep in your portfolio.
Most nurses experience it right at the start. It could be on the bus to your first day of placement, when you have the urge to lean over and tell a stranger that you’re a nurse by the way.
Or the butterflies you get when you put on your uniform and realise there’s a real-life nurse staring back at you in the mirror.
Or maybe it’s that first time you answer the ward phone and introduce yourself as “student nurse”, trying not to grin from ear to ear.
For me, it was in the months leading up to starting my nursing degree. I was working as a carer and had gone to the shops to pick something up for a resident wearing my uniform. I was in a rush to get back and frustrated to find a queue trailing right round the shop.
But then a man near the front clocked my uniform and insisted I was served first. No one in the queue complained. In fact they all smiled at me warmly.
What was this power my uniform possessed?
Was this… respect?
Our #proud2nurse campaign developed from discussions in the NT office about whether nursing is losing that respect.
We worry that a little bit more pride is lost from the profession every time a negative headline accuses nurses of lacking compassion or suggests training is not fit for purpose, or a story about one nurse carries the implication that nursing as a whole has “lost its way”.
It frustrates us – and we’re not the ones out there on the frontline experiencing a fourth year of pay freeze or below-inflation pay rises. And you do it while managing growing expectations and seeing much of the blame for the ills in healthcare cast in your direction.
Hearing negativity about the job you’re proud of, the career you joined to make other peoples’ lives better, must be disheartening.
So, we’re fighting back. We’re going to show the world that nurses are proud and why they have every right to be.
Add your voice and share your stories. There’s loads of ways you can get involved - here’s just a few:
- Take a selfie and email it to us at the address below – print off our #proud2nurse sign and add your reason, making sure it can be clearly read in your picture
- Tell your story – email us your short stories of what gives you that buzz of pride (no more than 100 words please!)
- Tweet us – since we started this campaign, there’s already been hundreds of tweets with the #proud2nurse hashtag
- Make a video – we’re not looking for Oscar-winning performances, simply tell your camera phone why you’re #proud2nurse, then email it to us
- Appreciate what you and your colleagues do – it may seem sentimental, but take a moment to appreciate the fact that every day you come to work you make someone’s life better
Send your contributions to our campaign to: firstname.lastname@example.org
Over the past few weeks I have edited a five-part series on blood transfusion, which has reminded me of the multiple points at which things can go seriously wrong, from taking a cross-match blood sample to administration of a blood transfusion.
I was surprised to see how often Serious Hazards of Transfusion (SHOT) receives reports of patients being given the wrong blood. In 2012, 252 incidents were reported and, of these, 151 errors originated in the clinical area.
The consequences of receiving incompatible ABO blood products can be life threatening, and NHS England has labelled these errors never events.
Yet in 2012, 10 incidents occurred and three of these patients went on to experience severe harm as a result of the inadvertent transfusion of ABO-incompatible blood components. In two-thirds of cases transfusion errors were caused by human error, often due to misidentification of the patient.
Interestingly, NHS Blood and Transplant and SHOT are seeking to empower patients with a campaign encouraging them to ask health professionals “Do you know who I am?”. They make it clear that patients should understand what the blood samples are being taken for and give their consent.
It is surprising that despite policies that dictate rigorous checking procedures and careful observation of patients, errors continue to occur. Clearly we can’t rely on patient empowerment to ensure that the right patient gets the right blood, but we have a responsibility to ensure we are up to date with the latest evidence on the management of transfusion.
To support you in this Nursing Times is publishing a five-part series on blood transfusion written by experts from the NHS Blood and Transplant Patient Blood Management Team. It aims to help you provide evidence-based care to your patients and help avoid errors that can lead ultimately to loss of life.
The series covers:
- Consent for transfusion (published 3 September)
- Processing, storage, testing and selection of blood components (10 September);
- Safe administration (17 September);
- Transfusion reactions (24 September);
- Patient Blood Management(1 October)
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.
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.
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.
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.
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.
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.
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?
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.
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.
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.
When we asked this question last week on twitter, we were stunned by the unanimous “yes!” we received from nurses and other healthcare professionals.
— Dan (@gracenglorydan) June 18, 2014
— N!NJA (@Miss_NinjaStar) June 18, 2014
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?
I have two teenage children who have been through a school system that claims to educate them about the dangers of drug and alcohol misuse. In year five of primary school they both graduated from the Drug Abuse Resistance Education programme and have regular PHSE classes at secondary school.
So when I quizzed them recently about legal highs I was surprised how little they knew. They were able to name a few (Spice, Bubble Bud and Khat) but had no idea about the potential dangers associated with using these substances.
Last month we published an article discussing the management of legal highs or party drugs. These drugs produce stimulant effects similar to those of cocaine and ecstasy and are legal, cheap and widely available on our high streets.
The author of the article, David Solomon, described the problems of legislating to prevent the sale of these dependency forming drugs; as one formula is made illegal, manufacturers simply make minor molecular changes to the make-up of the drug and manage to circumvent the legislation.
While a game of cat and mouse is played out between policy makers and manufacturers people’s lives are at risk as user of these drugs associate the word “ legal” with “safe”.
People are exposing themselves to side effects including reduced inhibitions, drowsiness, excited or paranoid states, seizures and even death. While users of these drugs may appear naïve it is easy to see how they can be dragged into believing they are safe when the law appears to be on the side of the manufacturers. This makes the health education message more difficult to deliver effectively.
As the use of legal highs increases, health professionals are likely to see more and more patients attending emergency services with complications. We all have an important role in educating the public about the dangers. Our schools and colleges also need to ensure that they are providing young people with up to date and relevant information about using these substances.
So would you feel confident discussing the dangers with patients and signpost them for specialist help if this is required?
If not, you may find the following article useful. I certainly did.
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What makes people want to go into nursing?
Compassion? A wish to make a difference? A recent article in the Independent suggested something far less positive. The article reported on a study examining the effects of parents’ gender roles at home on their children’s aspirations, and proclaimed that the daughters of men who do their share of household chores are more likely to want to become doctors and accountants rather than nurses or teachers. It went on to equate careers in medicine and accountancy with ambition and, by implication, nursing and teaching with lack of ambition.
My first instinct was to lambast the researchers – who were they to decide that nursing (or teaching for that matter) was a career for the unambitious? They had obviously not bothered to look at the career opportunities open to nurses, or the influence the profession now wields.
But when I looked at the original study it didn’t mention specific careers, or use the word ‘ambition’ – that interpretation was all the journalist’s own work, and seemed to be based largely on earning potential. The study simply examined how parents’ roles in the home predict children’s aspirations. A key finding was that daughters of fathers in more egalitarian households express a greater interest in non-stereotypical roles, and the researchers concluded that a more balanced division of labour among parents might promote greater workplace equality in the future. Nothing about nursing, and nothing about ambition – lots about equality at home and at work.
I’ve come to expect some sections of the press to use nursing as shorthand for many insults, but what has The Independent got against two professions that contribute so much? Its attitude can be summarised as ‘why make a difference when you can make money?’ People who go into nursing are ambitious – they just don’t limit their ambition to whatever does most for their bank balance.
The policy message has been transmitted and understood. Delivery of care needs to shift from the hospital setting into the community. Where possible, it is best for patients to be cared for in their own home. Shorter stays in hospital, delivering what patients want, enhances recovery, reduces risk of hospital-acquired infection.
This all makes sense. If you were in charge of this policy what would your first step be? How is care delivered? By nurses of course. So you would increase not only the number of nurses delivering care in the community but also ensure that they had sufficient skills and training to give increasingly complex care. And to do that you would strengthen and reinforce the backbone of community nursing – district nurses. How hard is that? Well impossible apparently.
A major new survey has found that community nurse teams report they lack staff with the right skills and qualifications to deliver care needed by patients.
The Queen’s Nursing Institute survey of 1,035 community nurses found less than a third thought their teams were adequate for the work that they cover. And compared with five years ago, 36% said the proportion of qualified nurses on their team had fallen, 54% said it had stayed about the same, while just 10% said it had increased.
The number of district nurses has fallen by 44% between 1999 and 2012, down from 11,500 to 6,400. This decline has taken place as care has shifted into the community. This is so obviously going to impact negatively on the care that patients receive that it is hard to believe. But this is the reality. More community care – fewer community nurses. Action needs to be taken urgently to address what any thinking person can see is madness.
How many of us watched Jamie Oliver taking on school lunches and wished he’d do the same for hospitals?
We all know the important role nutrition plays in recovery, and if meals look or taste unappetising, of course our patients are going to either eat less or resort to other sources to satisfy their hunger. This could result in a slower recovery and more time in hospital. It’s not rocket science.
When I worked on an acute mental health ward, it was so frustrating to see patients ordering take aways every evening because they (often understandably, in my opinion) couldn’t stomach the food we were serving them. I’m sure I’m not the only nurse to look at the food trolley and wonder where the hospital managers’ priorities lie.
With budgets being cut, catering teams are having to do more with less, but opting for cheaper meals can often mean losing out on nutrition.
So is it possible to make a nutritious, appetising meal that suits the NHS budget?
NHS Scotland is on a mission to find out. Some of the pictures on this BBC News story are enough to turn your stomach, and it’s difficult to imagine eating these meals when you’re well, let alone when you’re already feeling rotten.
The NHS Good Food Challenge 2014 challenges chefs and catering teams to provide locally sourced meals for 100 people that meet nutritional guidelines. The winning menu is then going to be rolled out across the whole of NHS Scotland.
Granted, many hospitals provide meals for more than 10 times that many people on a daily basis, so the logistics of this mammoth task are questionable. But at least positive steps are being taken to provide consistent standards, something that can only benefit patients. Let’s hope this initiative finds more lasting success than similar ones in the past. [changed this because the NHS has had numerous initiatives before that were then quietly dropped]
What do you think of this “Masterchef-style” competition?
As part of my job I get out to conferences and meet nurses who have taken some time out to learn and network with others. I also spend too much time looking at Twitter, which gives the impression that everyone who works in the NHS spends most of their time at conferences.
So it was a stark reminder when a nurse recently told me that it cost her £700 to take her asthma diploma – and she had to do it in her own time.
For many nurses the opportunity to spend a couple of days at a conference is unlikely. Even getting an afternoon off to attend a link nurse session is a luxury and many do these roles in their own time. While dedication should be applauded, and as professionals perhaps it is accepted that some study is done in our own time, I wonder if the “good will” approach is sustainable.
Since the Francis Report there has been a considerable amount of rhetoric around education and staffing levels but very little in terms of tangible change. The results of our survey published a few weeks ago showed that nurses still feel undervalued overworked and underpaid.
The problem is that as trusts throw money at increasing nursing numbers and addressing training needs, demand on services continue to rise and we are just running to catch up.
Nursing numbers and training opportunities have been forced up the list of priorities in many trusts but the reality is they are often paid for at the expense of another part of the service because, let’s face it, there is no additional money.
So where does this leave my friend who is paying £700 for her asthma course?
To be honest, I’m not sure. It is possible to argue that training not only benefits the service you work in but is also part of personal professional development and the financial cost and time should be shared.
An interesting argument if salaries keep pace with inflation, but I am sure many of you have felt the pinch in the last few years.
So what is the alternative? I would be interested to hear.
If it feels like governments have been discussing the shift towards providing a greater proportion of healthcare outside of hospitals for years, that’s because they have.
When Labour came into power in 1997 it set out to give primary care a lead role in commissioning and providing services with Our Health, Our Care, Our Say. Nine years later it tried again with Transforming Community Services; like its predecessor, this initiative failed to achieve the government’s aims.
Fast forward to today and the latest government initiative, the Better Care Fund, is in trouble before it has even launched. The Cabinet Office has demanded more robust evidence on how the promised cost savings will be achieved.
I don’t underestimate the enormity of the task of shifting services out of hospitals – particularly if social care is also to be integrated, but it mustn’t be dropped because it’s too difficult.
We know hospital care is expensive, we know patients prefer to receive care at home where possible, and we know that the lines between health care and social care are often blurred. Properly integrated care provided wherever is most appropriate would be cost-effective and popular with patients and their families.
However, “cost-effective” doesn’t necessarily mean cheaper, particularly in the short term when new services need to be up and running before the old ones can be remodelled or dispensed with. And it’s not just about where you put the money – expanded community services need more staff to run them. So why did the district nursing workforce shrink by 40% in a decade while successive governments talked about expanding community services? Surely these nurses will be crucial, however new services might be configured?
The revision process for the Better Care Fund should include an investigation into how to rebuild community nursing services. If care really does transfer into the community, unless they have the support of these highly skilled practitioners patients with long-term conditions will simply end up needing hospital care that no longer exists.
I must admit, when I first saw the headlines about the health atlas – a map showing which areas are most affected by certain illnesses and conditions – I was intrigued.
The map has been developed by researchers at Imperial College London to show an area’s health risks compared with an average for the rest of England and Wales.
So it shows how likely we are to develop certain conditions, right? Wrong.
The researchers state: “It is important to note that we are not making direct causal links between the mapped environmental agents and disease outcomes.”
Ok, fair enough: this isn’t a tool to predict my own personal health outcomes, but the statement “Relative Risk above average” certainly sounds like it.
I like to think I’m fairly calm about health scares – I’m not the type to read about an illness and declare I have every symptom – but I found this map strangely addictive. My “quick look” turned into an hour of me mentally clocking my likelihood of becoming unwell; thinking things like “good, so I’m not going to get skin cancer”– dangerous thinking for someone prone to sun burn at the best of times.
I can’t be the only person to read it in this way. I even wonder if, despite the reminders that the researchers are not making causal links, this will trigger hypochondria in some people and result in increased pressure on health services as the general public turn to them for reassurance.
Perhaps I’m being overly dramatic. Perhaps everyone who stumbles across it will see it merely as an interesting piece of research with no real relation to them. Then again, perhaps being overly dramatic is human nature.