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First response to the Prime Minister's Commission

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In the week following Nursing Times’ exclusive report on the Prime Minister’s Commission on the future of the profession, Steve Ford finds out what nurses think about the review

The overwhelming majority of nurses welcome the Prime Minister’s Commission on the Future of Nursing and Midwifery - that is the finding of an exclusive survey carried out by Nursing Times.

The online survey received more than 1,000 responses in two days. It represents the first yardstick of the profession’s opinions on the new review into the role of nurses and midwives, which was formally launched last week and is being tipped by some as the successor to the influential Briggs report of the 1970s.

The new commission’s remit includes defining the ‘skills and support’ that frontline nurses and midwives need to play a key part in delivering patient services, and identifying how to expand their roles - including giving them more freedom to manage and run their own services.

More than nine out of ten survey respondents said they welcomed the review, although there was less confidence over whether it would lead to positive changes for the two professions.

The results showed that while a third of respondents thought the commission would bring about positive changes for nursing and midwifery, 57% were ‘unsure’ and 11% thought its effects would be negative.

Positive comments on the setting up of the commission included: ‘nursing needs to be urgently reviewed’, ‘nurses need recognition for their complex roles’, an excellent opportunity with the changes in health’ and ‘well overdue’.

But some respondents said the review was evidence of ‘more tinkering’ with the role of nursing and that there had already been too much change to the profession and the wider NHS.

Others questioned the involvement of the government in the commission. ‘I am sceptical of government motives’, said one respondent.

On the remit to increase nurse control, the survey revealed most support for this in the fields of improving the patient experience, the design of patient pathways, nurse-led admission and discharge, and the further expansion of nurse prescribing.

Nursing Times also asked respondents to identify the barriers most likely to impede nurses from playing a pivotal role in designing and delivering services - an area the commission will also be looking at.

Nurses replying to the survey highlighted ‘lack of time’, ‘lack of resources’, ‘lack of effective nursing leadership’, ‘government targets’ and ‘lack of confidence in nurses to drive change’ among the major barriers, as well as ‘resistance from other health professions’.

One other key aim of the commission is to look particularly at how nurses can lead and manage more community and primary care services, with a nod towards the work of the Central Surrey Health social enterprise scheme.

Respondents were very supportive of such moves, with 85% saying that empowering more nurses in such setting to control their own services would improve patient care. Only 4% said it would lead to worse patient care, while 11% said it would result in no change.

The biggest barriers to the success of this goal, identified by respondents were ‘lack of support for nurse-led services within the
NHS’ and ‘lack of management and business training’, followed by the ‘current GP contract’ and ‘difficulty in nurses becoming practice partners’.

The survey reveals that nurses are relatively keen to engage with the commission, with 72% wanting to contribute their views to it, and 39% saying they would consider attending one of the regional consultation events planned by the commission.

Mr Brown started the ball rolling on engaging with the profession during a visit to King’s College Hospital NHS Foundation Trust in south London to mark the launch of the commission.

Included in the visit was a round-table discussion between the Prime Minister and senior nurses and midwives at the hospital, during which he asked them to put forward their ‘priorities for the future’.

Nicky Hayes, consultant nurse for older people, highlighted dignity in care. ‘One of the real challenges is around people who don’t have a very strong voice such as those with dementia,’ she told Mr Brown.

Maria Fitzpatrick, consultant nurse for stroke, highlighted the work of specially trained nurses at the trust in leading thrombolysis delivery, which has reduced average ‘door to needle’ times, and suggested this could be something rolled out to other areas.

Similarly, coagulation nurse specialist Lynda Bonner told the Prime Minister about the challenges she faced in trying to introduce nationally a VTE risk assessment tool - she demonstrated the test to Mr Brown during the visit.

‘A little bit more funding in this area would be very much appreciated,’ she told the Prime Minister.

Curlette Beckmann, a community midwife at the trust, highlighted the particular problems facing midwives as a priority for the commission to address.

She reminded Mr Brown of the widescale problem of national midwife shortages accompanied by a rising birthrate. She added that there were also capacity issues for hospitals trying to accommodate mothers-to-be.

‘Once they are here, you can’t turn them away, which means we are having to deliver in all sorts of places - it is very, very upsetting for the midwives and the mothers,’ she said.

Additionally, she drew attention to a popular community midwife-led service at the trust, which was now struggling to meet patient demand. ‘We would like to do more work in the community but we find it very difficult to find rooms. We were wondering if there was anything that could be done about it,’ she added.

Addressing the staff at King’s, Mr Brown said: ‘I’ve seen it again this morning just how much you are tailoring your work to the needs of the patient and we want to work with you.’

Speaking later at a TUC conference on public service innovation, Mr Brown added: ‘All our plans for the future of the NHS reflect the voice of those frontline staff that are so important and are at the heart of the health service. They are experts who know best how the services meet the needs of patients and their local communities.’ But despite the political rhetoric and apparent support from the top of the profession, the following comment from a survey respondent perhaps summarises the challenge ahead for the commission and those responsible for eventually implementing its recommendations.

‘This is a good idea, but it needs to be more than an idea. To change it needs to empower those within it to help it change,’ the respondent said.

‘Nurses have perhaps the closest patient contact and know a great deal about how things could be improved. But for as long as there are not enough of us and not enough money, equipment or time to do our current jobs, the chances are that nurses either won’t volunteer, or won’t be offered the chance to volunteer to change things,’ the respondent added.

But the last word should perhaps be reserved for another reply. ‘I would welcome the health minister [Ann Keen] or better still, the Prime Minister, joining our team for the day without senior management present to get a clear, honest picture of current practices, and the problems that are rife in today’s current NHS,’ the respondent said.

 

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