Clare Chapman is charged with overseeing the NHS nursing workforce. She tells Steve Ford about developments in nurse leadership, education and why the economic downturn could be good for the profession
The economic downturn means now is the time to recruit more nurses for the NHS, says Clare Chapman (pictured), director general of workforce at the Department of Health.
Ms Chapman has been in post for around 18 months, having come from the supermarket chain Tesco, where she was group personnel director. Before that she worked for Pepsi Cola International in central Europe (see box).
Clare Chapman’s CV
While other sectors are deciding to lay-off staff, directors of nursing should be seeking to be proactive in the jobs market, she told Nursing Times.
‘I think the credit crunch makes nursing even more attractive,’ she said. ‘Now is the time to do the really proactive recruitment campaigning because I think we’ll be able to attract people who wouldn’t necessarily have thought first that this is an opportunity.’
She added that the Department of Health is also considering running a national advertising campaign to cash in on the availability of talent from the wider workforce. ‘The nature of nursing has moved on a lot and the sort of roles that nurses can do has moved on a lot and, therefore, I think we’ve got a lot of news to get out there.’
Her view, supported by evidence from previous recessions when the public sector became seen as a safer career option than the independent sector, represents a remarkable turnaround on the impending nursing shortages predicted by the NHS Workforce Review Team last year.
She added that nurse pay was unlikely to be revisited in the current climate, reinforcing the rejection late last year by the NHS Pay Review Body of union calls to reopen negotiations on the three-year deal.
‘One of the reasons we said we wanted to do a three-year pay deal was to give us the time to be able to focus on a lot of things, which is about improving services and improving workplaces. We’ve now got to do it.’
Two of the key themes in nursing that Ms Chapman is keen to prioritise are quality and leadership. Both are central to the NHS Next Stage Review, with quality earmarked as the main focus of the health service and clinicians called on to be ‘practitioners, partners and leaders’.
As well as the indicators – or metrics – that are to be rolled out to measure the quality of services, including nursing, Ms Chapman cited the role of the new NHS Constitution.
A Nursing Times survey, carried out in December, suggested that around a quarter of the profession considered the development of the constitution – which sets out the rights and responsibilities of patients and staff – to be a waste of time.
However, the document, which was open to consultation in draft form between July and October, will become legally binding for the NHS when the forthcoming health bill, expected to be published this week along with a final version of the constitution, has been passed by parliament.
Sceptics may want to take note of its contents as it will be linked directly to NHS quality checks for the workforce in the future. Ms Chapman said the annual NHS staff survey, usually conducted between October and December, was being redesigned to reflect the pledges made in the constitution.
‘We’ve been able to do something that virtually no other sector in the UK has pulled off and that is describe in the constitution what matters to staff if they are going to be free to deliver quality,’ Ms Chapman said.
‘The staff survey will be retooled to demonstrate that is being delivered. And then the regulators have agreed that evaluation of trusts is going to partially depend on how well a trust is delivering against these commitments. What you’ve got is that hard-wiring of what staff told us all the way through to the regulator,’ she said, adding that it would be an ongoing process.
‘We’ve set up a staff survey improvement board, which we’ve now invited other people from the system to come and influence, including chief nursing officer Dame Christine Beasley, so that what we’re able to do is agree every year to make this more and more useful – we’ll just keep improving it.’
Ms Chapman acknowledged that the gloomy economic situation would mean the health service would need to tighten its belt and take a close look at its productivity – but suggested that this was not necessarily a bad thing.
‘A lot of people stop me and say “will the commitment to quality be under threat given the credit crunch?” and actually I’ve certainly seen since I’ve been here that high-quality care is cheaper than poor-quality care, because you’ve not got all the rework either for staff or patients involved in getting it wrong in the first place.
‘My own experience of working in Europe at a time of very, very tight pricing restriction was that what it does is it means you are really, really open to spotting waste so that you can reinvest that back – because if you are going to improve services the only way you can to do it is by spotting something you don’t want to do anymore and reinvesting.’
Ms Chapman was keen to highlight the success of the Productive Ward programme, describing it as a ‘bit of a blueprint for working our way through the credit crunch’. The efficiency programme, which has been rolled out across the acute sector over the last 12 months, has been extended to cover community and mental health hospitals. Three trusts are also developing ‘productive theatres’ and work is under way to develop the programme for nursing in the community.
Ms Chapman warned that the success of these community pilots would depend more than the other settings on nurses demonstrating strong leadership. ‘I think what you’ll see in the case studies outside of acute is a similar methodology but
it really, really, really requires a strong leader,’ she said.
She added that a lot of work was currently under way on encouraging clinical leadership. As Nursing Times revealed last week, nurses will soon be able to train for a Leadership for Quality Care certificate, which is set to be launched by the Department of Health in the next couple of months. The certificate will allow staff to train across three levels, from basic management training to becoming a director of nursing.
In addition to this there will be leadership awards, metrics and a council – all designed to create a ‘new culture in leadership’, said Ms Chapman.
‘With leadership it’s one thing to say you want leaders who are more confident to wrap services around patients when actually most of the people running a lot of the services in England have got very, very good at being very, very successful about delivering targets. Therefore, investing in the development of people that’s going to equip them to be able to do the local responsive services is important,’ she said.
She suggested the new metrics for leadership would, in particular, help measure and subsequently increase the diversity of NHS managers.
‘You will know what percentage are clinicians including nurses, what percentage of those are reflective of the communities they serve in terms of ethnic background and age. It puts a sharp spotlight on that and really what you are then doing is pushing year-on-year improvement,’ Ms Chapman said.
However, she identified other areas that needed more work, such as the development of services and careers around the eight clinical pathways in the NHS Next Stage Review.
‘If I had a challenge it would be that with some of the new clinical pathways the implications for patient services really need to be worked through. Now nurses have been talking for a very long time around how no individual profession can deliver a service – it’s integrated teams that deliver services – and I really would love nurses to really push hard on what that’s going to mean for teams.
‘It is also important in terms of opportunities for people because that’s how careers evolve as well,’ she added.
But Ms Chapman confirmed the findings of a recent investigation by Nursing Times, which showed that the NHS in most areas had so far failed to substantially increase its recruitment of community nurses ready for the government’s proposed shift of services away from acute settings.
‘There’s quite a lot of work to do though if we’re really going to transform services and community settings are a very important part of that because, actually, a lot of the settings where these new services get delivered is in the community. That is increasingly becoming a place where we’ve just got to get more pace,’ she said.
Ms Chapman said changes were also needed in the commissioning of nurse pre-registration training, with a review currently looking at how standards could be brought up to a more uniform level.
A system of ‘variable pricing’ looks set to be introduced to reward courses that provide quality as well as quantity with more lucrative contracts. ‘Those education providers that deliver things that are attractive to nurses and deliver nurses who are really employable by the service are going to be ones who get paid more,’ she said.
High course attrition rates and newly qualified nurses entering the profession with inadequate numeracy and literacy skills has become a growing problem for the NHS. Ms Chapman noted, however, that there are many education institutions that are good role models.
‘They provide good support, the pre-selection to make sure people are going into it with their eyes open and there are safety nets to enable people to get the sort of support if their circumstances change,’ she said. ‘The things you need to do to reduce attrition rates is not rocket science.’
She also hinted that savings made from investing in better courses might be ploughed into support initiatives, such as bursaries for degree students. ‘If we were able to reduce the amount of attrition what that would do is free up all sorts of extra money to enable us to invest back,’ she said.
Additionally, last September, the NMC ratified proposals to make nursing an all-graduate profession across the UK by 2015.
A government-commissioned risk assessment of the historic move is currently being finalised, according to Ms Chapman, which looks at how it can be implemented affordably and how nurses can be supported through the period of transition from dual entry to degree only.
‘There is a recognition that more and more of the English workforce is going to be getting degrees. Moving with that big social trend is an important part of obviously staying up there in terms of offering the right sort of opportunities but you need to do it over time.
‘The risk assessment will help us work through what would be some of the transitional issues that need really careful management, and we need to give that very thoughtful consideration,’ she said.
Joining all these different workforce areas up will be a new Centre of Excellence, the details of which are due to be announced very soon, which will offer intelligence and data on how the whole system is working towards improving quality.
‘The workforce planning and the service design, and the education commissioning – you have got to join them up, it won’t get joined up through wishful thinking,’ said Ms Chapman. You’ve actually got to put some infrastructure in place,’ she added.