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CNO calls on nursing for ideas to avoid NHS 'slash and burn'

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Chief nursing officer for England Dame Christine Beasley is to ask nurses to suggest ways they can save the NHS millions of pounds in a bid to avoid arbitrary “slash and burn” cuts from managers.

From Thursday this week nurses will be asked to submit their suggestions for Top Ten High Impact Actions for Nursing and Midwifery to Dame Christine.

They will be expected to provide the evidence on what they are doing now locally which could be implemented nationally to save money and improve quality and patient experience.

The proposals will be assessed by a team based at the NHS Institute for Innovation and Improvement and the best – likely to be around 10 – will be launched at the CNO’s conference in November.

Some of the measures could end up being made mandatory for trusts, or even linked to nurse pay incentives.

Ms Beasley told Nursing Times she was not looking for “new ideas” but rather things which were already being done with a firm evidence base on savings and quality improvement. She gave the example of pressure sore prevention which could save the NHS significant amounts of money in reduced bed days while vastly improve patient care and experience.

The Top Ten initiative was the brain child of strategic health authority chief nurses before being rapidly taken on by Dame Christine.

Chief nurse and director of clinical standards and workforce for NHS South Central Katherine Fenton said: “It’s about getting the ideas out there that already work and replicating them. It’s not about taking money out, but using the money we have better. It’s about stopping the waste and reducing the variation.”

Dame Christine added that swift action was needed by the nursing profession to react to the NHS funding squeeze before it was taken out of their hands. NHS chief executive David Nicholson has stated that the health service needs to save between £15 billion and £20 billion by 2014.

“We are on a pretty quick timeframe because after all we need to get on. It’s quick and it’s focused. I think that if we don’t get on we will get over taken with other things,” said Dame Christine.

 “Clearly we are facing a very challenging financial climate. It’s foolish to think we [nurses] won’t have to make a contribution. Nurses and midwives are a very big workforce,” she added.

She said that if nurses could play this role in developing firm guidelines on how the NHS could make efficiency savings they could avoid than having things “done to them” by managers.

“It’s about saying to nurses: ‘We can lead the way on this and we can do it early so there is less chance there will be a slash and burn’,” she said.

When asked if nurses might suspect their proposals would be used to cut funding to frontline nursing services rather than freeing up money to reinvest in better care, Ms Beasley said: “It’s a real problem because that’s been the history. I’m trying to say: ‘look, we are getting on this very early, rather than rushing to the precipice and cutting budgets and posts’.”

Nurses will have three weeks from Thursday to submit their proposals and evidence online via the NHS Institute’s website. Nurses will be able to view the proposals submitted and vote for the ones they think are best.

A team of nurses and academics will then assess the proposals and do site visits to see some in action. The best will be drawn up into case studies and “how to” guides, ready for a formal launch in November.

The NHS Institute’s economists will also work out how much each of the initiatives will potentially save the health service if implemented at all hospitals and NHS organisations. Detailed figures on savings will be available by April next year, in time for NHS managers and politicians to factor them into their budgets.

Asked if she would consider making some of the selected “high impact actions” mandatory, Dame Christine said she “wouldn’t rule it out”.  

She added too that, following recent Royal College of Nursing suggestions about tying efficiency targets to nurse pay, the Top Ten initiative could potentially be linked to incentive payments. “Exploring how we could incentivise people could be a good thing,” she said.

Unison head of nursing Gail Adams described the initiative as a “welcome opportunity” for nurses to say where savings could be made. But she said it was crucial the “driving force was quality” rather than cost cuts. She said Unison would oppose any attempt to introduce performance-related pay because experience showed that discriminated against lower grade nurses and female staff.

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