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Nurses could save NHS £9bn by improving patient nutrition and taking other 'high impact' actions


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 were unveiled at the chief nursing officer’s summit in Newcastle last week following suggestions from over 600 nurses.

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”.


Readers' comments (7)


    i knew it would come performance related pay ,how on earth can you evaluate nurses for this agenda, Patients eating has always been an important part in recovery. when i was a nurse I gave out the patients food from a food wagon,i knew what each patient ate ,i allocated a person to feed those patients who were unable to feed them selves.

    thease days we have people who can not even speak the language passing out re heated food . these people were employed by the health service without consultation with nurses and low and behold who is accountable for the patients well nutrition

    youve got it the nurse.

    We need to go back to some of the old tried and tested ways of care giving

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  • kind of harks back to the debate of basic care done by the nurses again, if you have the luxury to be referred to in the plural at any point in a nursing day of course!

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  • I love Lynne Maher's statement: It won't mean job cuts ... Those nurses won’t be missed because we will be releasing time to care.

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  • I am a training manager in the private sector working for a large nursing hones group and constantly are informed by staff that many service users who are returned from hospital have pressure sores that were not there when they went into hospital. I have personally seen a number of these situations.

    The care in the private sector is heavily monitored by a number of inspection teams but there does not appear tpo be the same level of outside scrutiny in the NHS.

    I know all is not perfect in the Private sector but finance is an issue that must be addressed. If the funding is improved to the private sector then you will also get a reduction in the number of hospital admissions.

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  • Does anyone remember the days when you gave out breakfasts from a trolley with a big pot of porridge on it, so you could ladle out a nice hot bowl of porridge and then pour a good dollop of golden syrup on the top, from the generous jugful also provided on the trolley? These were of course "handmade" by the hospital kitchen. And as a student nurse, your job was to sit with the patients who needed help and feed them. You could also make toast for patients in the ward kitchen at any time of day, and there was a big block of butter so you could puts lots on the nice hot toast. And you could whizz up a nice frothy build-up drink with the addition of one of those icecream blocks they used to keep in the ward freezer in in the ward blender. Those were the days.....

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  • Yes anonymous 18.11.09 @9.47 ......
    Oh I too remember those days. We must go back to the same era.
    I am waiting for the wheel to go full circle, so that we can return to them. It was, as you state, easy to pop into the ward kitchen and rusle up some toast or scrambled egg, for those with no teeth or easy to slide down. We also sat down & fed patients.
    Patients' did not suffer from poor nutrition or hydration in our day. Our ward sisters would have wiped the floors with our
    Those certainly were the days.....

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  • Yes but the eggs were always hard-boiled because nobody could remember when the water started to boil!

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