Nurses could save over £9bn a year if they implemented just eight ‘high impact actions’ which have been set out by the chief nursing officer Dame Christine Beasley.
The actions and potential savings are summarised in the report High Impact Actions on Nursing and Midwifery published by the NHS Institute. It shows changes to nursing could produce a substantial portion of the £15bn to £20bn in savings the NHS expects to have to find in the next five years.
The report estimates that up to £7.3bn could be saved a year if patients were properly nourished and hydrated when in hospital or care homes.
A further £1bn could be saved if the number of patients admitted into hospital due to pressure sores was cut in half.
The report says NHS Newham achieved this last year when it increased the number of home visits for elderly patients in the community and educated nursing home staff about preventing sores. The changes, which were led by a nurse, resulted in halving the number of admissions due to pressure ulcers, which saved the NHS £59,000 for each avoided admission.
Other NHS organisations whose suggestions have been included are Ipswich Hospital for falls reduction, and Milton Keynes foundation trust which uses a simple “red jug” to identify patients at risk of dehydration (news, page 3, 20 October).
Dame Christine told Nursing Times she wanted nurses to get on with implementing the eight actions now, as that would save money, but also because “it can’t be right that people are having all the pain and discomfort of ulcers”.
She said she and her team were looking at how nurses and NHS organisations could be held to account for that. This could include national targets, although she said it might be more useful to allow NHS commissioners to withhold payments from hospitals if changes were not made. That would allow commissioners to focus on particular problems for their region or hospital, Dame Christine said.
However, she added that there also needed to be individual-level accountability lessons – potentially learning from the success of the handwashing campaign. She said that with that campaign, organisations made sure all staff understood why it was a priority, “but if they didn’t do it, they got challenged”.
She added that there was a role here for performance related pay. Team-based bonuses for good performance were already being explored, she said, and the high impact actions could be an “ideal” way of it introducing it.
However Nurse leaders have also been candid that uptake of the actions – which could save the equivalent of almost 10 per cent of the entire NHS budget in a year, if fully implemented – could mean less demand for nurses. That is because many of the changes would either avoid hospital admissions altogether or result in lower bed days.
Lynne Maher, interim director for innovation at the NHS Institute, said: “It won’t mean job cuts. But it might mean we do not replace some people when they leave. Those nurses won’t be missed because we will be releasing time to care. We need to focus on the fact of natural attrition; people retiring and leaving the service for good reasons.”
NHS south central chief nurse Katherine Fenton agreed. She said the changes “possibly could” lead to a lower demand for nursing staff, but that would be met by reducing the number of training posts rather than making people redundant. “That’s much cleverer than we’ve been in the past,” she said.
She said the eight actions were only the start. Over 600 nurses had responded to the chief nursing officer’s call in September to come forward with the evidence on how they were improving care while simultaneously saving money. A “how to” guide and further evidence on the eight is due to be published in March, but more actions are also due to be detailed, once the evidence on their effectiveness has been collected.
Ms Fenton said nurses had been asking themselves “why haven’t we done this before?” and she said they really had to “challenge ourselves” about that as “some of it is about unacceptable care”.