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Jane Cummings: 'Publishing ward staffing data helps to promote an open culture'

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Publishing accessible data will lead to greater public scrutiny, which will drive improvement, says Jane Cummings

Last week I spoke at a press conference launching a new section on NHS Choices which, for the first time ever, saw the publication of nurse and midwife staffing data down to ward level. Joining me on the panel, talking about her role in a new government whistleblowing review, led by Sir Robert Francis QC, was Helene Donnelly, the nurse who courageously spoke out about her care concerns when at Mid Staffordshire Hospital.

Ms Donnelly mentioned one thing in particular that stuck in my mind, and that was how she wanted to get to a point where staff didn’t feel the need to whistleblow. The point being that whistleblowing is the product of a culture where staff don’t feel able to speak to managers and leaders in their organisation - where staff concerns aren’t listened to or acted upon.

And by the nature of what nurses and midwives do and the amount of time they spend with patients, they have a lot to offer that can identify concerns early and genuinely improve services for patients.

“This will put a spotlight on any unacceptable variation. Trusts will need to explain any variation”

Only by having a strong leadership culture - where staff feel supported and can approach their manager or an organisational leader with an idea to improve care or raise a concern - will we have the open culture that we are striving for. This is a culture where we never stand still and continue to improve.

This open culture must be within and outside the NHS. And there is an increasingly open culture of publishing information about our health services.

Although true openness and transparency needs to be more than just publishing data on a website. The information has to be accessible, understandable and meaningful for anyone reading it. It also needs to be used to drive improvement.

Last week was a watershed moment in this process. As well as ward staffing data it saw the publication of hospital performance on safety reporting, infection control, blood clots, pressure ulcers and patient and staff feedback.

Like any data, if used in isolation it doesn’t reflect the complexities of patient care. And what staffing data won’t do at the moment is tell us whether a ward is understaffed or unsafe. This is the first time this staffing data has been published and while it is an important step, it isn’t yet comparable. We are now working towards producing data where patients and the public can directly compare wards and hospitals using a rating system. As we refine the process and build up more historical data, it builds a more detailed picture of our local health services and at a more granular level. It becomes a barometer for local health services as well as a warning signal that will trigger questions about services.

We know that there is variation in the quality of care in hospitals, even in wards on the same corridor. We are starting to move from trust level data that can obscure this, to ward level information where we can see where this variation is. Every patient deserves great care wherever they are cared for. This will put a spotlight on any unacceptable variation. Trusts will need to explain any variation, publish their staffing plans and use the more granular information to put targeted improvements in place.

This is where the focus needs to be, not only for patients but also for staff, who need the support to provide high-quality patient care. Publishing more accessible and meaningful data will lead to greater public scrutiny, which will drive improvement and reduce the need for whistleblowing.

Ultimately, this is part of wider cultural change in the NHS, a journey that we must continue at pace. I look forward to the role that nurses will continue to play in this.

Jane Cummings is chief nursing officer for England

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