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No opt-out: nurses told of 'moral duty' to save money


Nurses have been told how to fulfil their “professional and moral responsibility” to help the NHS cut waste and save money, in comprehensive guidance shared exclusively with Nursing Times.

The 260-page document has been published to show nurses how they can implement and measure the eight “high impact actions” aimed at saving more than £9bn.

Produced by the NHS Institute for Innovation and Improvement, High Impact Action for Nursing and Midwifery – The Essential Collection draws on lessons learnt from trial sites.

It states: “A few nurses and midwives may still think that money is someone else’s business, but those that think this are, quite frankly, out of touch with reality - opting out isn’t an option.

“Addressing financial inefficiencies is a key personal, professional and moral responsibility.”

The “high impact actions” were announced last November and include areas such as improving patient nutrition, reducing pressure sores and falls and cutting staff absence.

A major theme in the document is the importance of good communication methods. At one trust, infection control teams carried out trolley dashes through the wards, handing out themed “goodies” to get people talking about catheter care.

Another trust designed a giant floor game to disseminate important information.

The guide also sets out how cost benefits can be calculated. For example, by using the Department of Health’s estimate that the daily cost of care for a patient awaiting hospital discharge is £100, nurses can identify savings from reducing delays.

Chief nursing officer Dame Christine Beasley urged nurses to read the document, saying  senior nurses such as matrons and ward sisters would be “absolutely pivotal” in achieving the drive.

She said: “We have seen that’s the case from productive ward work, where ward sisters and ward leaders at that level have really taken it on and made it their own.”

She told Nursing Times that successful pilots had often addressed two or three areas together such as pressure ulcers, falls and nutrition.

But work to date had also shown that nursing leaders also needed the backing from their organisations to ensure change actually happened, she stressed.

NHS South Central chief nurse and director of clinical standards and workforce Katherine Fenton said it was vital nurses took action now to avoid “slash and burn policies.”

She said: “Nurses have got to get involved otherwise we will suffer.” Unless senior nurses were engaged, “others haven’t got a chance.”

Some might be worried about schemes appearing to pit ward against ward, but Ms Fenton said the work had shown nurses could be “energised” by an element of competition.

However some improvements, such as nurse led discharge and nutrition, had proved particularly tough to crack, she said.

NHS County Durham and Darlington took action on nutrition, involving enforcing protected meal times, gathering patient feedback on menus and ensuring hot, fresh meals were available 24 hours a day.

Modern matron Karen Dyson said patients were happier and catering costs had fallen.

Another case study in the guide is East Kent Hospitals University NHS Foundation Trust, which used routine falls risk assessments, sensor alarms and falls “champions”. One ward reduced its falls rate by 85 per cent in a year.


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Readers' comments (72)

  • We work for free often, do the jobs of ten people because of the trust's desire to hire more expensive "facilitators" rather than front line staff. We stay over hours unpaid at the end of our shifts. We skip lunch breaks yet still get deducted pay for that time.

    We make do without necessary resources or equipment. We do the jobs of pharmacy, the domestics, physio, and ward clerks as they are short staff too. But no one helps the nurses. We are getting a pay freeze and we are already on much less than nurse's in other countries anyway. The RCN and Unison knows all of the above.

    We were horrid tatty uniforms which chip away at our self esteem. The trust won't allow new ones or allow us to buy our own.

    Senior nurse's are already on their knees barely getting through a shift.

    We cannot reduce discharge delays because the problems that cause the delays are external to the hospital.

    How much money are we already saving the NHS as a result of working in these abusive conditions?

    The NHS institute for innovation is completely and utterly warped.

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  • well voiced, and so utterly true across every trust in the country.

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  • How true, I have worked in the NHS for the past 25 years, In my trust to save money there has been e-mails saying there will be ward closed, reduduances,( I quote from e-mail don't expect any high redudancy pay outs) if you can't find yourself another job
    cutting beds, no money for angency staff to cover sickness or Annual leave,
    I work though my lunch breaks most every other day and stay over at least twice a week. I always said when I lose the compassion for nursing, would leave, I haven't lost that I love nursing, but I don't like the way the NHS is going, so I am now looking around for another job not nursing. Other nurses are doing the same, I do agree we should all be aware of cutting costs: but at what cost??

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  • If nurses were treated with respect then they might feel obliged help save money. It is time that those in high places listened to what nurses were saying and acted to make their lives and those of their patients better. This would be more beneficial than a 260 page document that probably cost a fortune to produce. It is hardly an effective communciation tool as no-one is likely to have the time to read it!

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  • I agree that there is a lot of wastage on the wards, the highest is probably the amount of paper that gets binned, for example printing blood results for ward rounds, that can't be filed in medical notes and just get put into confidential waste and the reams and reams of leaflets that we have to give to patients in pre-assessment or anytime they move in!
    I am a Specialist Practitioner, I already do the job of at least 4 people, I also back fill for the House Officers when they are on leave or busy, I prescribe, write discharge letters, pre-assess and have more scope and clinical skills than you could shake a stick at. I don't mind all the hard work I put in to maintain my skills, but sometimes I feel that they are trying to wring every last ounce of expertise out of me. With every new degree module I gain or scope I maintain I get more and more pressure and with no extra remuneration for the effort put in. I have just completed my nurse prescribing, probably one of the hardest things I have ever done. I will not get any extra money for this, yet I will be expected to take on the responsibility of this role along with the pressure from House Officers who see me as a leaning post already in their busy schedule.
    Along with paying to keep my registration, car parking, milk for my tea (perk that has gone) and now my prescriber status, I wonder when we shall be expected to start paying in part for our uniforms!
    I love this job and could not think of anything else I would rather be doing, but if Trusts want to save money, they need to start looking at the Management systems and the amount of site managers, bed capacity, discharge leaders, agitators - yes thats a new one, they have wandering around the ward, pressuring the nurses with a clip board, many doing the same job as the other so called managers.
    I have no doubt that we have a genuine need for good nurse managers, but our hospital is fast becoming 'top heavy' and we badly need to see some balance on the wards in the shape of nurses.
    The other cost effective way of saving money is to offer staff proper remuneration for working extra shifts, staff would gladly do extra shifts if they were being paid better than bank rates, why would anyone want to work on a bank holiday alongside an agency nurse they know is getting double the pay. If they were offered overtime, it would be less than the agency charges but still more than what they currently are offered.
    I think a lot of the problems lie in the fact that when decisions are made, no-one asks the important people and that is the staff who work on the front line for their opinion, half the decisions made are bad because they are unworkable, unrealistic and unpopular. We need to get common sense back into nursing.

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  • if we shed some of the increasing layers of management and lots of those in commissioning which quite frankly seems to be a job creation industy for band 7 and above posts who appear dto do little. we might acheive some cost savings tha tcan be ploughed back int front line care. If the public only knew half of the crap taht goes on they would be scandalised

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  • Savings are always possible, but it is hard not to make savings at the expensive of quality. Power needs to go back to ward level and away from non nursing project leaders who seem to think patient care is a tick box exercise.

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  • Some excellent points raised. Can NT pass these on to Christine Beasley and Nick Clegg/D Cameron - think it addresses the issue comprehensively.

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  • i think giving the staff option to work overtime with a pay lesser than the agency but much better than the regular rate is another way of saving nhs money,people behind the idea of saving nhs lots money should look everywhere and every angle not only in the nurses.

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  • Absolute cheeky bastards!! I'm sorry I know my language is strong but it is deserved here! This is yet another example of the management using emotional blackmail to wring that final drop of blood out of us!

    How dare they!

    I totally agree with Anna lincoln and others.

    Nurses already do this by working free overtime, doing the jobs of other disciplines who should be on shift 24/7, we work through breaks, etc and yet we STILL do not earn anywhere near as much as we should be doing because of pay freezes.

    And they expect more?

    Just where the hell do these people think they can get off asking more out of us, and using emotional blackmail by saying it is our moral duty to do so? Who the hell do they think they are?

    I think every single Nurse should work to rule, watch the NHS and these moronic idiots crumble under the pressure as they FINALLY realise exactly how much money Nurses working practices ALREADY save the NHS!!!

    Be very, very careful Christine Beasley, you are treading on thin ice already with the amount of pressure you are piling on Nurses. Before long, something has to snap. Lets see how much an all out strike costs the NHS eh?

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