Alastair Henderson on the need to anticipate change
As the Next Stage Review report A High Quality Workforce points out, nurses will always be at the heart of shaping patient experience and delivering care.
But what exactly does this mean for both nurses and for employers in the service envisaged by Lord Darzi? How much will nursing change in the future?
The NMC consultation response on pre-registration training in nursing - Standards for pre‑registration midwifery education 2009 - resulted in a welcome decision for employers with a move to an all-graduate profession.
With this in mind - and with the release of a range of research and reports to assist the profession in improving the quality of outcomes for patients - it is essential that the profession and employers start to debate and plan.
The discussion should be around what the move to an all-graduate profession will mean for the workforce, service delivery and quality of care from the patients’ perspective.
There are some who may see the move to an all-graduate profession as a shift that simply brings nursing in line with other healthcare professions and should not affect how nurses work.
Others see this as an opportunity to look at the overall shape and scope of the nursing workforce, and to develop it in line with future changes in requirements in the delivery of health care.
These two schools of thought need some reconciliation. Although there need not be a national prescription for the way the nursing workforce should appear, this is a prime opportunity for employers.
They should consider what opportunities can be gleaned from this change to the profession, while ensuring that there is flexibility for local delivery.
This debate must not just take place within the nursing community. It must engage patients and the public and it must also engage employers, both in and outside the NHS
There are a number of questions that employers and the nursing profession need to consider. But, in essence, we need to understand what will be different about having an all-graduate nursing profession and what implications this move will have both for service delivery and for the workforce.
Surely there must be some difference because, if there isn’t, why have we made the change?
Beneath the issue of moving to an all-graduate nursing workforce, specific questions will need to be addressed.
These will inevitably include:
- What roles should the various parts of the nursing workforce - such as healthcare assistants, registered nurses, advanced practitioners - be playing?
- What does an all-graduate profession mean for the composition and size of the workforce in the future?
- What will be the impact on the nursing support roles? Is there an increasing role here for assistant practitioners to provide
- one-to-one care for patients, while the registered nurse adopts a different role within the team managing the patient?
- What does all of this mean for workforce planning and for education commissioning?
- Will there be specific issues in relation
- to the community and primary care
- nursing workforce?
- What nursing services will PCTs want to commission in the future?
None of this, of course, even includes all the complex issues and questions around the actual mechanics of introducing an all-graduate profession. These matters will involve establishing curriculums, commissioning courses, attracting students, student funding and so on - as well as the transition itself.
The wider debate on the implications of this change needs to be happening up and down the country.
Hopefully, the recently announced Prime Minister’s Commission on the Future of Nursing and Midwifery, will prove key to this process.
Chaired by health minister Ann Keen, and the first full-scale review of nursing care for nearly 40 years, the commission
will be able to promote this discussion and address these issues.
However, this debate must not take place just within the nursing community. It must engage patients and the public and, crucially, it must also engage employers, both within and outside the NHS, who are responsible for the provision of services and for the nursing workforce.
In trusts, this issue is about how services are provided and how the largest part of the workforce is organised. It is, therefore,
an area of concern for boards, chief executives, human resource directors and the other clinical professions.
To support the process and encourage trusts to ask the right questions to formulate a broader plan and define what good nursing is or will look like in the future, NHS Employers is producing a discussion document.
This document will create the opportunity for employers to debate these issues, inform their vision of good nursing and support the delivery of the quality agenda.
The debate is crucial – let’s make sure we all take part.
Alastair Henderson is joint director of NHS Employers