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

29 June 2010

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.

Introducing Nursing Times Learning

Online training units, written and reviewed by experts. Earn two hours’ CPD and a personalised certificate for your portfolio.

Subscribers get five FREE learning units and non-subscribers can access each learning unit for £10 + VAT.

Click on the topics below to get started:

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)

Anna Lincoln | 29-Jun-2010 6:17 am
We work for free often, do the jobs of ten people because of the trust's desire to hire more expensive "facilitators" rather than front line staff. We stay over hours unpaid at the end of our shifts. We skip lunch breaks yet still get deducted pay for that time.

We make do without necessary resources or equipment. We do the jobs of pharmacy, the domestics, physio, and ward clerks as they are short staff too. But no one helps the nurses. We are getting a pay freeze and we are already on much less than nurse's in other countries anyway. The RCN and Unison knows all of the above.

We were horrid tatty uniforms which chip away at our self esteem. The trust won't allow new ones or allow us to buy our own.

Senior nurse's are already on their knees barely getting through a shift.

We cannot reduce discharge delays because the problems that cause the delays are external to the hospital.

How much money are we already saving the NHS as a result of working in these abusive conditions?

The NHS institute for innovation is completely and utterly warped.

Unsuitable or offensive?
SUSAN CLAY | 29-Jun-2010 6:38 am
well voiced, and so utterly true across every trust in the country.
Unsuitable or offensive?
Anonymous | 29-Jun-2010 8:02 am
How true, I have worked in the NHS for the past 25 years, In my trust to save money there has been e-mails saying there will be ward closed, reduduances,( I quote from e-mail don't expect any high redudancy pay outs) if you can't find yourself another job
cutting beds, no money for angency staff to cover sickness or Annual leave,
I work though my lunch breaks most every other day and stay over at least twice a week. I always said when I lose the compassion for nursing, would leave, I haven't lost that I love nursing, but I don't like the way the NHS is going, so I am now looking around for another job not nursing. Other nurses are doing the same, I do agree we should all be aware of cutting costs: but at what cost??
Unsuitable or offensive?
Monica Dennis | 29-Jun-2010 8:23 am
If nurses were treated with respect then they might feel obliged help save money. It is time that those in high places listened to what nurses were saying and acted to make their lives and those of their patients better. This would be more beneficial than a 260 page document that probably cost a fortune to produce. It is hardly an effective communciation tool as no-one is likely to have the time to read it!
Unsuitable or offensive?
Anonymous | 29-Jun-2010 8:45 am
I agree that there is a lot of wastage on the wards, the highest is probably the amount of paper that gets binned, for example printing blood results for ward rounds, that can't be filed in medical notes and just get put into confidential waste and the reams and reams of leaflets that we have to give to patients in pre-assessment or anytime they move in!
I am a Specialist Practitioner, I already do the job of at least 4 people, I also back fill for the House Officers when they are on leave or busy, I prescribe, write discharge letters, pre-assess and have more scope and clinical skills than you could shake a stick at. I don't mind all the hard work I put in to maintain my skills, but sometimes I feel that they are trying to wring every last ounce of expertise out of me. With every new degree module I gain or scope I maintain I get more and more pressure and with no extra remuneration for the effort put in. I have just completed my nurse prescribing, probably one of the hardest things I have ever done. I will not get any extra money for this, yet I will be expected to take on the responsibility of this role along with the pressure from House Officers who see me as a leaning post already in their busy schedule.
Along with paying to keep my registration, car parking, milk for my tea (perk that has gone) and now my prescriber status, I wonder when we shall be expected to start paying in part for our uniforms!
I love this job and could not think of anything else I would rather be doing, but if Trusts want to save money, they need to start looking at the Management systems and the amount of site managers, bed capacity, discharge leaders, agitators - yes thats a new one, they have wandering around the ward, pressuring the nurses with a clip board, many doing the same job as the other so called managers.
I have no doubt that we have a genuine need for good nurse managers, but our hospital is fast becoming 'top heavy' and we badly need to see some balance on the wards in the shape of nurses.
The other cost effective way of saving money is to offer staff proper remuneration for working extra shifts, staff would gladly do extra shifts if they were being paid better than bank rates, why would anyone want to work on a bank holiday alongside an agency nurse they know is getting double the pay. If they were offered overtime, it would be less than the agency charges but still more than what they currently are offered.
I think a lot of the problems lie in the fact that when decisions are made, no-one asks the important people and that is the staff who work on the front line for their opinion, half the decisions made are bad because they are unworkable, unrealistic and unpopular. We need to get common sense back into nursing.
Unsuitable or offensive?
Anonymous | 29-Jun-2010 8:49 am
if we shed some of the increasing layers of management and lots of those in commissioning which quite frankly seems to be a job creation industy for band 7 and above posts who appear dto do little. we might acheive some cost savings tha tcan be ploughed back int front line care. If the public only knew half of the crap taht goes on they would be scandalised
Unsuitable or offensive?
Anonymous | 29-Jun-2010 10:04 am
Savings are always possible, but it is hard not to make savings at the expensive of quality. Power needs to go back to ward level and away from non nursing project leaders who seem to think patient care is a tick box exercise.
Unsuitable or offensive?
Anonymous | 29-Jun-2010 10:36 am
Some excellent points raised. Can NT pass these on to Christine Beasley and Nick Clegg/D Cameron - think it addresses the issue comprehensively.
Unsuitable or offensive?
Anonymous | 29-Jun-2010 10:49 am
i think giving the staff option to work overtime with a pay lesser than the agency but much better than the regular rate is another way of saving nhs money,people behind the idea of saving nhs lots money should look everywhere and every angle not only in the nurses.
Unsuitable or offensive?
mike | 29-Jun-2010 11:40 am
Absolute cheeky bastards!! I'm sorry I know my language is strong but it is deserved here! This is yet another example of the management using emotional blackmail to wring that final drop of blood out of us!

How dare they!

I totally agree with Anna lincoln and others.

Nurses already do this by working free overtime, doing the jobs of other disciplines who should be on shift 24/7, we work through breaks, etc and yet we STILL do not earn anywhere near as much as we should be doing because of pay freezes.

And they expect more?

Just where the hell do these people think they can get off asking more out of us, and using emotional blackmail by saying it is our moral duty to do so? Who the hell do they think they are?

I think every single Nurse should work to rule, watch the NHS and these moronic idiots crumble under the pressure as they FINALLY realise exactly how much money Nurses working practices ALREADY save the NHS!!!

Be very, very careful Christine Beasley, you are treading on thin ice already with the amount of pressure you are piling on Nurses. Before long, something has to snap. Lets see how much an all out strike costs the NHS eh?

Unsuitable or offensive?
Sajid Hussain | 29-Jun-2010 2:08 pm
Nurses told of 'moral duty' to save money...but not at the expense of lives (There should be a caveat).
Unsuitable or offensive?
Anonymous | 29-Jun-2010 2:24 pm
I totally agree with all the above comments and would love to think that these might be passed on to Christine Beasley and all the other gov quangos who keep saying how much they respect frontline staff and yet have no thought for the amount of pressure they pile on us. Why do people forget what its like to be a nurse when they get onto that political career ladder? I thought Christine Beasly was supposed to be on our side and that of the patient, not the government and their stupid quotas!!!!

I too don't remember what a lunchbreak is and i'm getting fed up of telling my kids i'm going to be late home yet again!!!

Seriously will any frontline staff have the time to read a 260 page document along with all the others we are supposed to read to keep up to date!!! I'm spending my day off today studying for yet another module that is expected of me and which will make not an ounce of difference to my pay or conditions!!!

I'd love to know how much the people who put together this pointless document got paid!!!

I love my job, I really do but I've only been qualified 2 years and I'm already getting worn down by the politics of it all. I really did come into nursing as I felt I could make a difference!

So please just let us get on with caring for our patients and have a look at the top management level when considering cuts. Lets face it when you are sick and in need of some care will you want a professional, caring nurse who has the time and resources to help or a manager with a clipboard?
Unsuitable or offensive?
Anonymous | 29-Jun-2010 2:29 pm
In this economic climate, we now have another layer of management,deputy matrons (band 8As) from the start of this month. Just another tier of management to deal with before you can action anything! But then they have to have it ok'd with the 2 tiers of managers above them.
Has ALL common sense fled from the NHS,along with millions of £ they pay the managers. When common sense Prevail !!!!!
Unsuitable or offensive?
Yvonne Bates | 29-Jun-2010 2:42 pm
Mike....BRAVO mate for outlining the obvious with strong words! I now live in Melbourne Australia and I have read so much on here and commented on so much especially on your pay cuts and now the NHS financial crisis which appears to now being shoved into the nurses "scope of practice" also! Its a bloody disgrace. The knowledge of the thousands of nurses working overtime and working breaks ( happens here too! )without pay saves the NHS literally millions a year....plus still being on the lower scale of the pay bracket.
THEY will continue to bleed you and slog you more untill you as a united profession decide to act. Sadly you have a PITTANCE of a union,(unlike we have here who have fought for all the nurses in Victoria and continue to do so). Your union appears to work for the government and what makes them happy.....I would not put my dollars there.....they have to earn nurses respect again.
I suggested working to rule way back on here with the pay cuts......I agree with you again and planned well it would be very effective....very. We have had a few work to rules here, and back in 84 there was a work to rule which was not as effective as such, and so the strike came, and with that a major turn round for Victorian nurses in so many ways.Without a union behind you I think you have a tuff job to get the ball rolling......but I hope you can all stand strong, and stop the crap that you keep getting shoved on you...Good Luck!
Unsuitable or offensive?
Anonymous | 29-Jun-2010 3:04 pm
Its so frustrating that no matter how often we voice the same concerns the 'powers that be' don't seem to take the slightest bit of notice. We really need to do something to make them listen and make things change.
Unsuitable or offensive?
Matthew Lloyd | 29-Jun-2010 3:52 pm
We always try to save the NHS money, its all the managers that don't take any notice of us or listen to our feedback that seem to waste all the money on unnecessary things.
Unsuitable or offensive?
Anonymous | 29-Jun-2010 5:25 pm
Is demand for services in the NHS outstripping the resources? Don’t forget the population has dramatically increased over the last few years but resources in some areas have stayed static. Perhaps now is a good time to reflect upon the NHS, learning from those areas that are doing it ‘right’ and standardising this quality throughout, concentrating on getting the basics from the quality of nurse training to providing services that are relevant to any sustainable modern NHS. In my opinion the problems have been caused by the past years of target led initiatives and change for change sake, when the focus should have been on quality and standards of care. Status and responsibility need to be given to qualified and experienced nurses on the same footing as doctors, moving away from creating tiers of management oblige to justify their own existence by uncalled for change. Nurses in senior positions working with their patients will be able to identify where savings can be made and implement these savings without using reams of paper and attending management meetings.
Unsuitable or offensive?
Anonymous | 29-Jun-2010 6:46 pm
I agree with all of the comments above, it strange when you get managers who never visit the wards/frontline staff implementing some new idea which 90% of the time does not work but cost the NHS more money. Frontline nurses already save money no lunch breaks to speak of, majority of us have to double up as OTs, psychologist, dietitians, physios, escorts etc and I am talking about mental health nursing so I can imagine adult/child nursing have the same scenarios. Nurses are willing to save money but at least listen and implement some of the ideas that have been put forward by frontline staff.
Unsuitable or offensive?
Phil Dup | 29-Jun-2010 6:57 pm
Like may of the previous posters I have saved the NHS countless thousands of pounds over the years with unpaid overtime and missed breaks.
Perhaps I could do more by coming in on my days off and doing even more unpaid work - maybe that would satisfy this damned Beasley woman who spews out a lot of meaningless sound bite rubbish from her well paid comfy office job......pah! the woman is a disgrace!
Unsuitable or offensive?
mike | 29-Jun-2010 7:00 pm
Thanks Yvonne, I'm moving to Australia myself as soon as possible. It is nice to hear that over there you have a Union that actually is in your corner (that is something Nurses in this country can only dream of!)

It is also good to hear of examples where working to rule and striking have worked.

I fully endorse striking, despite all the emotional blackmail, and endorse working to rule as a more logical first step up to that. Many Nurses agree with me. What is needed in this country is real leadership in Nursing. It needs something or someone to start the ball rolling. Our so called unions are not up to the job, and you have read the comments from the moronic leadership we have in palce at the moment in this article, they are obviously not on our side. So who exactly do we turn to? Perhaps Nursing Times could start a rally cry?
Unsuitable or offensive?