The chief nursing office for Wales has called on senior nurses to get more involved in the redesign of NHS services, warning that a “stronger nursing voice” needed to be heard in strategic decisions.
Professor Jean White said a strong “nurse leadership voice” was needed to balance the “desire” among other managers to get the health service’s struggling finances under control.
“I want to hear a stronger nursing voice coming through in a lot of these decisions”
Speaking yesterday at a conference in London, Professor White outlined current work on Welsh plans to reshape primary care and the workforce into new “clusters” based on population need.
She told an audience of senior community nurses that the “tipping point” had already been reached in Wales regarding the age of the population, which was now the oldest in the UK.
As a result, Professor White noted that ministers had put in place primary care delivery and workforce plans to tackle priority issues, including reducing avoidable deaths and encouraging patients to take more responsibility for managing their own illnesses.
“We’re organising ourselves into clusters… where we are trying to manage the services around the population,” she said.
“These clusters – there are 64 of them – are being given direct finance to get themselves sorted themselves out,” she told the Queen’s Nursing Institute annual conference on Monday.
“You have to have the right workforce with the right skills in the right place”
Professor White noted that the plans were not just centred on GPs, but were about matching services and the workforce in a cluster with “what that population actually needs”.
“It is also about getting strong leadership,” she said. “I’ve only got one senior nurse leading one of these cluster works in Wales.
“To be honest, that’s not enough,” she said. “I want to hear a stronger nursing voice coming through in a lot of these decisions about how we’re shaping services.”
She suggested getting the appropriate workforce in place was key, but noted staffing issues were “challenging all of us, not just in hospitals but in the whole of our health systems”.
“To be perfectly blunt, without us the health systems don’t work,” she said. “You have to have the right workforce with the right skills in the right place.
“You have to have strong leadership to make sure the things that are right for the patients remain front and centre, and it’s not driven by other motives, which sadly can be things like finance,” she said.
“For me, the strength of the nurse leadership voice needs to balance the desire to get the finances to come in a reasonable way,” she said. We can’t be niaive about it. Money is really important.
“I see it almost as an opportunity for us to say, okay, let’s think about using our money in a different way. Let’s try to be much more creative with our services – let’s look at new roles, new ways of doing things so this is an opportunity if we wish to embrace it,” said Professor White.
“It is not something to be fearful over. However, let’s not kid ourselves. It’s a big challenge at the moment to try to get this right within the financial envelope that we have,” she added.
Professor White also updated the conference on progress since the Nurse Staffing Levels Wales Act 2016 received royal assent in March.
- Guidance on Welsh nurse staffing law due in autumn
- Welsh nurse staffing levels bill receives royal assent
- Welsh Assembly passes ‘historic’ nurse staffing levels bill
“Wales has taken a very bold step to introduce a nurse staffing levels act,” she said. “To be honest, we don’t know quite what the impact of that will be. But it’s a very exciting opportunity for us.”
She stated that the first part would be “commenced next April”, with every health board and trust in Wales required to “work out” whether it had “enough nurses to treat its patients sensitively”.
In 2018, rules for establishing appropriate nurse staffing levels on medical and surgical wards would be introduced for trusts and boards, she said, adding that it could be extended to other services.
“We will certainly consider whether community is one of the areas where we extend this law,” she said, noting that the “general duty” coming in next April would apply to all settings.
“We need to ensure nurses are fit to work everywhere and particularly in community and primary care”
Professor White also challenged community nurses to improve the overall quality of services, noting that she had “seen real excellence in Wales this summer”.
“The difficulty I have is it’s in pockets, it’s not necessarily everywhere,” she said, highlighting examples of innovation such as Lindsay Leg Clubs and the country’s national lymphedema service.
“One of the things we need to debate is how do we make excellence everywhere, once you’ve been able to demonstrate it works really well in one place,” she said. “That’s the key challenge I want to throw to you.
Lastly, she said the revision of the Nursing and Midwifery’s education standards was an “opportunity” for the profession to ensure students were “ready to do the job when they come out”.
“We need to ensure nurses are fit to work everywhere and particularly in community and primary care, so we need to get into a debate about how we can influence [that],” she said.