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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)

  • Nurses never have and never will stick together. I have nursed since 1973 and not once in all this time has the profession stuck together.

    No one made a greater mistake than the person who did nothing because they could only do a little.

    Tell a lie, make it simple, keep telling it, eventually they will believe it. Adolf Hitler

    In an atmosphere of universal deceit telling the truth is a
    revolutionary act. George Orwell

    The state is nothing but an instrument of oppression of one class by another--no less so in a democratic republic than in a monarchy.
    Friedrich Engels, preface to Kark Marx, The Civil War in France, 1891

    May the fleas of a thousand camels infest the arse of the person who screws up your day and may their arms be too short to scratch.

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  • Martin Gray

    Funny that when the fire service and ambulance service went on strike they called in the armed forces. The police are not allowed to strike ( I believe it's in their contract) and when the prison officers threatened to strike it was deemed illegal.

    All this draws me to the conclusion that there are some jobs nobody else can do and so it is made unlawful to take industrial action. This being the case I'm sure we would find it difficult to strike, and it may even be made illegal to work to rule as the powers that be would condemn us for putting other peoples lives at risk.

    Only things left are to emmigrate, find a totally different job, or retire.

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  • How on earth do you nurses in the NHS survive? I've worked independently (for myself) for many years now. If I need to save money I can do so without affecting the quality of care I give my patients. I have no wasteful, expensive management to pay and I often stay on at the end of the day simply because I want to. I feel so sorry for you all. Working conditions when I left the NHS in 1995 were bad then, but they seem to be intolerable now. I wish you all well and remember: Don't let the bar stewards grind you down. Stand up for yourselves and what you believe in.

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  • Martin, I am of the firm belief that the powers that be make it illegal for us to strike because they know exactly how deep in the shit they would be if we did! It is self preservation plain and simple.

    If they hadn't brought in the RGJ's and the green goddesses when the Fire Service went on strike, then they would have been exactly up that same street. It is interesting to note that the Fire Service still got exactly what they wanted out of it (especially after the army told the government we aren't doing this forever so get it sorted!) The fact is the Fire Service is ESSENTIAL to this country, as are the Police, Military, Nursing, etc. And the government knew then, as it would now, that to say no to demands, would mean essentially losing the service.

    The same thing would happen with Nurses, the difference is they do not have the military to step in for us.

    Yes they would try to use emotional blackmail, yes they would try to make it illegal. But when (if) all that failed, they would cave in, because they would know that they were in an impossible situation. Without Nurses, the NHS crumbles. Without the NHS, the country suffers, and then they lose power. So they will give us what we want.

    It is that knowledge which is making them try everything they can now not to make us strike. The emotional blackmail, the grey area of illegality, the fostering of the apathetic status quo and infighting in Nursing. It is all to their advantage.

    Furthermore there is no way any court in the land would be able to say working to rule was illegal (although I do not doubt they will probably try if we all did). Any worker of ANY field, can only be required to work within the remit of their contract, within the given working hours of that job. If we did the same, what would they call illegal exactly?

    Furthermore, even if they did say striking was illegal for Nurses, what exactly would they do if we all did strike? Would they arrest every single one of us? There would still be noone on the wards. I don't think they would, or could do anything. The reality is, WE have THEM over a barrel, we just do not see it!

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  • Mike "We have them over a barrell...But we just dont see it" EXACTLY!
    Working to Rule is NOT illegal...How can it be?Nurses are just continuing to do what is well above what is just their job, meaning doing ontop that of many others jobs. When that stops it will have a huge impact.Working to rule ALSO means getting your breaks back into shape! Im sure from what I remember in UK its the same as here, and that you are on an UNPAID lunchbreak and your morning /afternoon breaks are paid for. Anyway at the end of the day you are continuing to work the breaks that you should be paid for, and the ones you dont get paid for you are giving free worktime back. Still happens here but to a lesser amount.
    At the end of the day its millions of Sterling of your wages going back into Government funds yearly because you work it and dont claim.But thats only a grain of sand to what a work to rule would do.
    You all know what you want and need, but you need to get the band rolling.
    As far as being illegal to strike....probably wouldnt happen if Work to Rule happens, as you havent given the Government that delight yet.
    Seems to be so many wanting change for nurses and patient benefit that you just need to band together.
    Easier said thatn done.
    How do you get a new union for nurses over there?

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  • While endorsing all previous comments I would like to point out that in some trusts it is those at the uppermost end that waste the most. The Director who bought handcrafted paper for discharge letters, paper so thick that GP's couldn't fit it in their notes, the specially commissioned china for managment meetings,I could go on.
    Be careful what you ask for.
    There are going to be more and more nursing entrepreneurs in the future. Skilled people who want to offer a caring service, but cannot acheive a proper utillisation of their time and skills, and appropriate recompense for their expertise, will vote with their feet. The NHS will be poorer but those who value the service will find a way to pay for a private and more respectful service.

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  • Anonymous | 4-Jul-2010 11:39 am, that is a really good point about Nursing entrepeneurs in the future, and I really do see a time when Nurses will start up their own private buisnesses seperate from the NHS, and perhaps even taking contracts from it.

    Imagine a simialar set up to a walk in centre for example, staffed solely by Nurses of different bands. Where patients would come to get minor injuries treated by the band 5 Nurse, or be offered a similar service they get from their GP from a more experience band 7 for example. The Nurse led service could be seperate from the NHS, gaining it's money either from private patients or from government/NHS contracts in a similar way a GP surgery does now.

    Nurses would be able to demand the status and recompense their skills and expertise require, much in the same way Doctors do now.

    I really do see things like this becoming increasingly feasable.

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  • And to add to my last point, things like this would put Nurses in charge of their own profession, not subject to the whims of the government or idiot management or people like Beasley. It will happen.

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  • But your argument is self defeating - you say that if nurses where in control they would award themselves better conditions and bigger pay packets. Well I think we already see that in the growth of the NHS 'management' sector, the one which you claim is the enemy of all that is good - after all who wants to wipe arse for 40 years.

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  • Martin Gray

    Mike is this the possible entrepreneur coming out in you?

    My only concern in working to rule, although I totally agree with such a move, is that patients would end up being 'left' because the doctors were too busy trying to keep up with the increased workload.

    You are correct, we do have them over a barrel but we lack the guts to do anything about trying to put any action to the test. And don't forget taht much of the armed forces medical personnel are not regulars, they are terretorials and thus are being taken out of their civilian posts to fulfill their military obligations. That means we lose them from the wards and departments, thus increasing the problem of under staffing.

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