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Florence Nightingale Foundation Conference 2015: summary

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Jenni Middeton and Nicola Merrifield talk you through the highlights from the two-day Florence Nightingale Foundation Annual Conference

10:30 - Jeremy Hunt takes to the stage

Being put in special measures does not create a loss of morale in trusts in the long term, according to Jeremy Hunt. He said he worried about the impact on the trusts but said he believed that after an initial shock, the 20 trusts that had gone into special measures had improved morale because the focus was on them getting better, and getting more nurses and doctors.

“Mr Hunt joked with delegates that it was their chance to look at him and wonder if he would have a job two months today”

The health secretary opened the Florence Nightingale Foundation conference by talking about his first job as health secretary, which was to respond to the tragedy of Mid Staffs. He praised Sir Robert Francis QC for his handling of Mid Staffordshire and praised NHS staff for not denying that the tragedy could have happened at their trusts.

He said that staff could have denied that those problems were possible where they worked, but instead said it wasn’t as bad as at Mid Staffs, but they did find their jobs challenging.



Mr Hunt joked with delegates that it was their chance to look at him and wonder if he would have a job two months today. But he said he very much hoped he would.

“He then outlined the achievements of this government for the NHS”

He then outlined the achievements of this government for the NHS, which he said included 8,000 more nurses and a new inspection regime. He name checked the Sign up to Safety campaign led by Sir David Dalton of Salford Royal Foundation Trust, and said that this was reducing avoidable harm in trusts.

He said the results of this focus was that bosses put far more emphasis on safety concerns. He said he did not want an NHS with any whistleblowers, and said he hoped they would not be necessary because everyone should feel safe to raise concerns.

He said the NHS had changed and was safer, but that this change needed to continue. 

- Jenni Middleton



10:45 - Professor Steve Peters



Every time you decide to have a square of chocolate and end up having the whole bar, it’s not your fault, says Professor Steve Peters. The consultant psychiatrist and author of The Chimp Paradox said that when this goes on it’s your emotional brain that takes over.

“The chimp, your emotional brain, jumps to a conclusion”

The chimp, your emotional brain, jumps to a conclusion, searches for facts and truth and evidence to support the conclusion, and then irrationally defends its conclusions. The human will search for facts, truth and evidence and try and construct a logical conclusion from that.



He says this is why you resolve to go jogging every day as a new year’s resolution, but on new year’s day you open the curtains, it is rainy and the chimp says only a fool would jog on slippery pavements. You go back to bed, resolving to jog double the distance tomorrow. Professor Peters says new year’s day is the chimps’ entertainment day.

In an engaging and funny presentation, Dr Peters showed examples of footballer David Bellamy and snooker player Ronnie O’Sullivan when their inner chimp had taken over or a gremlin had got in the machine. They did not behave impetuously, he said, their inner chimps took over or their gremlins got in the way of what they, the human inside, wanted to do.

“We should recognise that emotional hijacks are normal”

He talked about how to manage your emotional chimp and the six destructive beliefs that the average person hold – he called it “gremlins”.

Professor Peters said we should recognise that emotional hijacks are normal and it is not you but a hijack. “It’s not you – it’s the chimp,” he told the audience.

The forthright and funny Yorkshireman described how it works, why it works and how to mitigate the times it happens – and when to listen to your emotional brain for your own benefit.

- Jenni Middleton



Master class session on ‘caring for populations through the life course’

Director of nursing at the Department of Health and Public Health England Viv Bennett spoke about a new digital tool that will help nurses and midwives promote and deliver public healthcare at all levels, which will be available on a dedicated website by the summer.

The framework has been drawn up by the Department of Health and Public Health England, as part of the ongoing Personalised Care and Population Health programme.

It ties in with the Five Year Forward View and will provide a quick route for health care staff to access an evidence  base for their practice.

Professor Bennett said the digitised version of the framework should be used by organisations in England to assess their own public health profile and identify specific areas they want to tackle.

She said it applies to all nurse and midwifery staff - including those in acute settings - and would help them to devise new ways of promoting public health and hoped it would also be available as an app in the future.

Find out more on the government website

- Nicola Merrifeld


Ensuring Safe Staffing: the approach in Northern Ireland, Scotland and Wales

Angela Drury, Senior professional officer, Northern Ireland, practice and education council for Nursing and midwifery (NIPEC)

Fiona MacKenzie, manager of the Scottish Government’s nursing and midwifery workload and workforce planning programme

Helen Whyley, nursing officer, Department for Health, social services and children (Wales)

Safe staffing in England may have got all the focus in the UK after the introduction of NICE guidance on certain areas in acute trusts, such as midwifery and adult general wards, but Florence Nightingale Foundation trustee Elaine Maxwell introduced representatives from Scotland, Wales and Northern Ireland to discuss their approaches.


All three introduced a range of approaches including evidence-based workload assessment, and looking at skill mix.

They discussed the issues of ensuring you could fill vacant nursing posts and highlighted the universal problems of planned and unplanned absence and using data to evidence your need for staff at certain periods.

The audience asked how the different countries were validating the tools they were using, and the response was that working groups were used to ensure that, say, midwives were happy with midwives tools.

The professional judgement of the ward sister was heralded as crucial to getting staffing right, and finding ways to strengthen the role was regarded as vital.

- Jenni Middleton


Fringe session - International Perspective on Safe Staffing

Bronagh Scott, deputy chief nurse, NHS England London region

Elaine Inglesby-Burke, executive nurse direction and deputy chief executive, Salford Royal NHS Foundation Trust

Christine Pearson, chief nurse, East Lancashire Hospitals NHS Trust

Lisa Smith, assistant director of nurse education and workforce, The Whittington Hospital NHS Trust

Elaine Inglesby-Burke said that mandated levels “should be a base camp” and were not a guarantee of safer care.

She and the other senior nurses on the panel described their experiences of travelling to and examining different countries with mandated staffing levels, but revealed that these places with fantastic resources and workforce numbers were not linking this to the outcomes.

They felt it was nurse-centric, “we found it was all about me” said Elaine Inglesby-Burke, who visited New Zealand and Australia with Christine Pearson.

- Jenni Middleton


Creating a just culture for safety

Suzette Woodward, campaign director, Sign up to Safety

Suzette Woodward continued the health secretary’s theme this morning by discussing how currently human error coupled with harm to a patient usually results in social condemnation disciplinary action. She says this must change, and while she doesn’t advocate a blame-free culture, she wants to create a learning culture, which is undermined by disciplinary action being the response to mistakes.

“She wants to create a learning culture”

She spoke about an incident early in her career where she had been involved in a situation where a child had received ten times the drug dose. She said she was disciplined, and everyone knew she had been disciplined and that meant staff said that if they were involved in a similar incident, they would cover it up.

Human reckless behaviour and at risk behaviour are the “main three” reasons why things go wrong according to Ms Woodward.

“Human reckless behaviour and at risk behaviour are the “main three” reasons why things go wrong “

She highlighted that human error can never be eradicated – all the time you forget your keys, your ID, miss a motorway turn-off, that is human error. She said it was hard to explain this to patients and the public. They don’t’ think everyday error can translate itself into healthcare. “They think we should be angels who don’t make mistakes when we change into our uniforms,” she says.


- Jenni Middleton


Masterclass: the role of the specialist nurse

Professor Alison Leary, chair of healthcare and workforce modelling, London Southbank University

Alison Leary spoke about the problems for specialist nurses in explaining their worth to employers, which when faced with service budget cuts often turn to this part of the workforce to try and make savings.

Professor Leary said a wide range of job titles relating to specialist nurses, a lack of developmental posts leading  to the job and difficulty in tracking and analysing the complex workload they deal with were among the issues.

“This part of the workforce - and nurses in general - are almost invisible within government policy”

She also stressed that this part of the workforce - and nurses in general - were almost invisible within government policy.

This was despite their good return on investment in terms of reducing other health conditions such as diabetes and MS, and presentation at services such as A&E.

Professor Leary emphasised specialist nurses were a “safety critical” workforce and should be treated as such rather than an “extra” role.

- Nicola Merrifield


Patient stories: Contrasting experiences

Melanie Reid talks about the fantastic care and “human connection” she received on a surgical HDU.

“Never assume because somebody appears to be unconscious, lost, brain damaged or desperately ill that they can’t hear you and that they can’t experience a sensitive touch”


Melanie Reid and Katrina Dixon share their experiences of being a patient in a session facilitated by Nursing Times editor Jenni Middleton. While Ms Reid had had an exceptional standard of care, remembering the nurses who looked after her and showed humanity and sensitivity, Ms Dixon had a poor experience , feeling that she was ignored by nursing staff, her hair left unwashed and not helped to the bathroom, as well as many other episodes that felt “brutal”.

“her hair left unwashed and not helped to the bathroom”

The audience were mesmerised by the pair as they revealed their experiences of dealing with their severe spinal injuries. 

At #FNF15, Times journo Melanie Reid behind Spinal Column talking abt patient exp says ‘you can regulate the humanity out of nursing’

— Nicola Merrifield (@nic_merrifield) March 12, 2015

Several members of the audience apologised to Ms Dixon on behalf of the nurses, while many said that the care hailed as exceptional by Ms Reid should be standard.

The pair ended by giving some takeaways for nurses including “you can regulate the humanity out of nursing”, “kindness is free”, “smile – they’re free too” and “don’t just do something, stand there”, alluding to the need to stop and just chat.



Opportunities for nurses and midwives given the UK healthcare plans over the next five years

Dr Peter Carter, RCN chief executive

Dr Peter Carter gave what will be his last speech to the conference in his current role as chief executive and general secretary of the Royal College of Nursing. He praised the Five Year Forward View and said the RCN welcomed this document and approach to nursing.

“He praised the Five Year Forward View and said the RCN welcomed this document”

He said the Lansley reforms had distracted people at a time that they should have been focusing on the public health agenda and trying to improve the health of the nation. He spoke about the important role nurses could play in that.

He also bemoaned the lack of detail politicians gave in their vision about integrating health and social care and said they needed to better articulate the detail of how they would fund this and make it happen.

“He felt that most NHS staff went into the service to give excellent care”

Dr Carter also said that while the government was right and there were more acute nurses, he felt this was at the expense of mental health and child and adolescent nurses, which he said had “been decimated”. He said that although he acknowledged the poor care Katrina Dixon had received, referring to the previous session, he felt that most NHS staff went into the service to give excellent care and that nurses should be rightly proud of the great jobs they do.



Wilfull blindness and its antidotes

Margaret Heffernan

Whether you’re talking about Mid Staffordshire or the BBC, people saw things that they were concerned about but didn’t say anything.

Ms Heffernan talked about the science of fatigue, and said that those of us who turn up to work when we are tired and think we are being heroic, we are not, we are dangerous. Ms Heffernan said a tired driver was more risky than a drunk driver.

If you want someone to do something unethical, find a time when they are tired, she said.

She also said that multitasking was another reason why people walked past things that weren’t right.

“Multitasking is another reason why people walk past things that aren’t right”

“We are profoundly social beings, we like being part of the gang. That is why people will do a lot to belong, including doing the wrong thing,” she says. This is why a good person will not raise concerns. We are social creatures, which means we turn a blind eye to people’s shortcomings.



We need people who will challenge, ask the hard questions and see things from a perspective wider than our own. She talked about institutions that appear harmonious and don’t have much conflict – that could be the problem. She says that everyone can be so keen to support each other, they didn’t challenge.

“At the end of the day, what you need is courage”

She said at the end of the day, what you need is courage. She said she had interviewed a lot of people who had done this and not one of them said it was easy. But sooner or later, they say it was the best thing they ever did. 

Ms Heffernan said she didn’t think we would ever eliminate willful blindness but we need to gather people around us that challenge us.

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