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'Get involved with the forum’s work to reduce care variations'

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The power to effect change is in our own hands, says Elaine Inglesby

When told that a family member needs care, how many of us would carry on with our daily job and let the system give the care to that relative without intervening? Not many.

We see huge variations in care standards in hospitals, clinics and people’s homes. As a member of the Nursing and Care Quality Forum, I, along with my fellow members, have the chance to make a difference and try to reduce the variation. The prime minister’s personal interest and commitment to the forum is a unique opportunity to ensure its recommendations are taken seriously.

During our inaugural meeting, we agreed to focus on the key themes of leadership, culture and values, involvement and feedback response, and time to care. Across these themes, we considered the education, training, knowledge and skills needs of staff and how we can influence change across all care settings. Our overall aim is to facilitate improvement in the quality of nursing and care. To do this we are concentrating on identifying and promoting best practice.


“I want to be part of the generation of nurses who get it right for our people, their families and carers and, of course, our staff”

The key to success is held by the profession itself, not ministers or policy makers. We need nurses and support workers to get involved and stay engaged if we are to reduce variation. When we met with the prime minister in April, we were asked to offer some initial recommendations, ahead of a longer period of more detailed work.

This challenged us to build a momentum and focus on a few key issues to start our discussions with others. It was incredibly motivating to hear from staff across the country on the outstanding examples of good practice within their teams. There were, however, some difficult issues - we heard overwhelmingly that staff were concerned about staffing levels and skill mix and the impact these have on the quality and safety of care.

Evidence links staffing levels and skill mix to outcomes for patients, and some high-profile care failures point to inadequate staffing as a key factor. Why do we see such huge variations between and within hospitals when validated tools are available for most services delivering inpatient care?

We know trust boards are responsible for ensuring safe staffing levels and skill mix. But we are less confident about how they are held to account. This poses some interesting questions. Do boards know the safe staffing levels and skill mix for the organisation? Do they know how they are determined and how often validated tools are used, if at all?

The forum’s initial recommendations made it clear where accountability for safe staffing levels lies and said boards and equivalents should review staff levels and skill mix using best practice frameworks on a biannual basis, or sooner if a significant change to services is proposed. The regulators and commissioners should require evidence of this assurance, and be satisfied that the data they receive is valid.

Staffing is critical but not the sole determinant of care quality. Strong leadership is vital. Having local leaders with time to take charge, manage and role model best clinical practice is crucial, as is having staff with the right culture, values, behaviours, knowledge, skills and the time available to care. Staff must also be properly involved and able to listen to and respond to patient feedback. Our advice reflected what you told us during our consultation.

I feel proud to be part of the forum. I want to be part of the generation of nurses who get it right for our people, their families and carers and, of course, our staff. Do you? If so, share your views and work within your teams to find a way to implement the recommendations. The power to effect change is in our own hands; together we will make a difference.

Elaine Inglesby is chief nurse at Salford Royal Foundation Trust

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