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Chief Nursing Officer's Bulletin July 2010

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All the latest new from the current CNO’s bulletin.


What the White Paper means for nurses and midwives

The proposals contained in the White Paper – Equity and excellence: Liberating the NHS – will give more freedom to nurses and midwives so they can spend more time caring for their patients and communities.

The White Paper outlines the plans for achieving this.

  • As the people who have the most day-to-day contact with patients, nurses can ensure the NHS’s care is guided by a simple mantra – ‘no decisions about me, without me’.
  • Nurses in the community will play an important role in the ambition to improve services for people with long-term conditions and improve services for older people.
  • Midwives are central to providing the kind of care women want. Health visitors and school nurses will be essential in improving the health of our families and young people.
  • Nurses will need to build on their strong working relationships across hospitals, primary and community health services and social care teams to support patients inside and outside the hospital ward.
  • Nurses will need to work in partnership with GP consortia to ensure the best services are commissioned for patients.

The White Paper works hand in hand with the drive for efficiency by proposing to remove unnecessary bureaucracy and cut waste in the NHS. A new independent NHS Commissioning Board will allocate and account for NHS resources and lead on quality improvement. Frontline professionals will be given more freedom to innovate and make decisions based on their clinical judgement.

A variety of engagement and consultation documents have been launched to seek views on more detailed aspects of some of the proposals. Comments by 11 October are welcome on the following:

  • Commissioning for patients sets out proposals for putting local consortia of GP practices in charge of commissioning services to best meet the needs of local people, supported by an independent NHS Commissioning Board. (View the consultation.)
  • Transparency in outcomes: a framework for the NHS seeks views on the proposed NHS Outcomes Framework, which will support the delivery of better health outcomes, for which the NHS Commissioning Board will be accountable.
  • Increasing democratic legitimacy in health seeks views on how we can increase local democratic participation in health and how the NHS can work more closely with local government to make sure local services are joined up.
  • Regulating healthcare providers will set out proposals for more autonomous healthcare providers and for the role of the proposed economic regulator.

Draft legislation on the White Paper will enter Parliament in the autumn. Subject to parliamentary approval, the Bill could receive Royal Assent by summer 2011.


A varied career – profile of a midwife

Professor Gwendolen Bradshaw is Head of the Division of Midwifery and Reproductive Health at the University of Bradford’s School of Health Studies. She was co-chair of the England Midwifery 2020 Steering Group and also the chair of one of Midwifery 2020’s subgroups.

Can you give an overview of your career so far?It has been an interesting mixture of clinical and academic experience. I trained as a nurse at Guys Hospital, London then completed midwifery at Queen Charlotte’s. I decided on midwifery as a career because I think that, at that time, it was more autonomous than nursing. My husband’s change of job took us to Yorkshire where I returned to a clinical role for five years, as Clinical Midwifery Adviser at Leeds General Infirmary. During this time, I also completed an MA in Health Service Management and started a Doctorate in Education, both on a part-time basis. I moved to the University of Bradford where I had eight years as Dean of the School of Health Studies. During this time, I co-authored a book on health policy and became a Nursing and Midwifery Council (NMC) Visitor and Quality Assurance Agency (QAA) Auditor. In September 2009, I took up my current post as Head of Midwifery.

What do you like most about this role? I can combine leading an excellent team of lecturers and researchers in Bradford and continue as a Supervisor of Midwives, knowing in detail the experiences of our women in Bradford and the high quality care we provide for them. I can also write and research, and maintain

my external activities – such as the Midwifery 2020 initiative and the NMC Review of the Midwives Rules Advisory Group QAA Auditing activity – from which I learn so much.

What has your role in Midwifery 2020 involved?I was Chair of the Midwifery 2020 Education and Career Progression Workstream and Co-chair of the Midwifery 2020 England Steering Group. It has been a fantastic opportunity to meet with and learn from leaders in midwifery in all four countries, who are responsible for everything from professional regulation and policy making, to clinical practice, education and research. Rosemary Kennedy and Noreen Kent did an excellent job of steering the whole programme, and Rona McCandlish and Carmel Bagness provided incredible support for our workstream. I have never been involved in something so dynamic.

How can midwives prepare for leadership positions?

Midwifery leaders need to be excellent role models, people we look up to and wish to emulate. They also need to be visionaries, provide direction, act as catalysts for change, be politically astute, have the capacity to operate at a strategic level and be able to spot talent and nurture it so that individual midwives reach their potential.

Midwives do need to provide evidence of demonstrable expertise, so traditional academic routes are as important as practical experience. And now, more than ever before, leaders need financial acuity and skills in critical areas like workforce planning.

What do you think are the biggest challenges for midwives in the current climate? Sustaining clinical, educational and managerial excellence in midwifery in a time of serious austerity is a major challenge. At the same time, we need to transform midwifery practice and improve health outcomes for women and their families – at a local, regional and national level. And midwives need to be involved in service evaluation and research to ensure clinically effective practice.

Can you name a career highlight? There have been several, spanning my clinical, management and academic careers, including becoming a supervisor of midwives, a professor and a QAA Institutional Auditor. Another highlight was overseeing the introduction of a patient and public involvement strategy in our school to inform all the activities associated with the education of healthcare practitioners in Bradford. Midwifery 2020 was an opportunity to help shape the future, which few others have had, and I consider it a privilege to have been involved in the programme.


Final report published in September

The Midwifery 2020 programme was commissioned by the four chief nursing officers to develop an informed vision of the contribution midwives will make to achieving quality, cost-effective maternity services for women, babies and families across the United Kingdom.

The programme’s final report will be published in September and the key messages will cover:

  • the core role of the midwife
  • workforce and workload
  • education and career progression
  • measuring quality
  • public health.

Hundreds of midwives, service managers, maternity team members, educators, commissioners and women who use maternity services contributed to the report, which is also supported by five in-depth workstream group reports.

These messages reinforce and restate the core values of the profession, celebrate achievements and show how midwives can continue to strengthen their unique contribution to ensure that women, their partners and their babies have safe, and life enhancing experiences.

Links and info


Improving quality, increasing cost efficiency

The eight High Impact Actions (HIAs) for Nursing and Midwifery resulted from a call to action for all nurses and midwives to tell us about the improvements they had made within their organisations that had improved quality of care for patients and reduced costs.

More than 600 examples were submitted within three weeks, and these submissions were rigorously reviewed and assessed by a panel of nurses and midwives representing a variety of specialities and roles. From this process, the eight key themes emerged.

A collection of stories from 31 site visits plus supporting reference material has been published as a printed and web-based resource aimed at frontline staff, called High Impact Actions for Nursing and Midwifery: The Essential Collection. An ‘opportunity estimator’ allows teams or organisations to calculate potential cost savings they could make by working on the HIA areas.

More than 1,000 nurses and midwives have already pledged their intention to support implementation of the HIAs and to participate in the webexes where they can hear directly from the case study sites and have interactive discussions with the speakers and colleagues (see the diary for more on these).

Eight high impact actions

  • Your skin matters
  • Staying safe – preventing falls
  • Keeping nourished – getting better
  • Promoting normal birth
  • Important choices – where to die when the time comes
  • Fit and well to care
  • Ready to go – no delays
  • Protection from infection

Links and info

Please note, you will be required to log into the website before you can access this resource.


A message from Anne Milton

Anne Milton is no stranger to healthcare. She qualified as a nurse at St Bartholomew’s Hospital in London and spent 25 years in the NHS. Her political career has also been dominated by health, first by serving on the Health Select Committee and then being appointed shadow health minister. In addition, she has been the shadow minister for licensing, gambling and tourism. All this was a prelude to her ministerial appointment as Parliamentary Under-Secretary of State for Public Health.

Anne has taken on this role with an enthusiasm fired by her nursing background combined with a political will to do the best for patients and communities. She has a very broad portfolio of responsibilities, but here she explains her priorities for nursing and midwifery.

‘First, I must say how thrilled I am to take up this appointment and influence healthcare for the future and improve public health particularly.

‘A big priority for me will be to help create the culture where the quality of nursing and midwifery care is as high possible. After all, high standards of care cost nothing and when it comes to the individual practice of nurses and midwives those standards are central to the patient experience.

‘Of course, the White Paper will drive other priorities. We are making sure doctors, nurses, midwives, therapists and others are empowered to use their professional judgment about what is right for patients and communities. So this is an excellent time to become involved in commissioning – GPs may have been the focus of media attention, but it will be a whole team approach that will get commissioning right.

‘I don’t underestimate the challenges that are ahead. I have met some hugely talented people in the NHS who will lead significant change and help address the issues of productivity and cutting out waste and duplication. I am also sure that there will be fantastic opportunities for nurses and midwives to grasp, particularly when it comes to being innovative, designing services that are patient centred and taking early steps to prevent deterioration in health and well-being.

‘There is no doubt that every penny counts, but it’s not just about the money, it’s the people. We need to recruit the best and retain the valuable the staff we have. We have put a particular emphasis on recruiting more health visitors, but I am clear we need to make sure nursing and midwifery are attractive and accessible careers for the widest possible range of people.

‘I am keen to work with everyone necessary on these priorities so we can genuinely put patients and communities first, improve health outcomes, empower staff and cut out waste. I am confident that with nurses and midwives leading the way we can improve care and transform services.’


Introducing Paul Burstow

The new Care Services Minister, Paul Burstow, was elected as Member of Parliament for Sutton and Cheam at the 1997 election. Since then he has held several front bench positions, including Shadow Spokesman for Health, Shadow Minister for London and most recently Shadow Chief Whip.

Before being elected to Parliament, Paul headed the Liberal Democrat’s Local Government Unit and served on Sutton Council for 16 years from 1986. Here, he explains his plans for social care.

‘I want to start by paying tribute to the hard work you do, and the difference you make to the individuals and families you support.

‘We are very lucky to have so many talented and dedicated people working in social care. Yet, while job satisfaction levels are high, I know there is more we can do to attract and keep the best people in the job – and that’s a major priority for me.

‘It is, of course, a challenging time to be Care Services Minister. We know the current care system faces significant challenges. We need a lasting settlement to tackle the unfairness and secure the future for social care, and I am determined to move quickly on this front.

‘That’s why we are establishing a new Commission to report within a year on different funding options. We will legislate soon after this.

‘But improving care for people of all ages isn’t just a question of money. We also have to do things differently and more effectively in future. For me, the answer lies in better integration.

‘As my responsibilities straddle health and social care, I view myself as the “Minister for Integration”, the person responsible for making the right services available in the right place at the right time for everyone.

‘This is how we meet three big priorities: greater personalisation to build support around the individual and put them in control of their lives; greater preventative action to support people before they reach the point of crisis; and greater productivity to make every penny count.

‘I am clear we can’t do any of this without you. I want to make your job less bureaucratic and more attractive as a career. Above all, I want to put you and the people you support in the driving seat.

‘By learning from your experiences, responding to your concerns and seeing you as genuine partners in change, I am confident we can transform social care and improve many more lives in the years ahead.’


The programme picks up pace

At the QIPP Mobilisation Summit on 2 July, those responsible for implementing the agenda at regional and national level, and representatives from the third sector, local government, industry associations and professional bodies heard a series of programme updates and explored the practical issues of mobilisation.

Crucial times for QIPP

National Director for Improvement and Efficiency Jim Easton gave a programme update under five categories. He started with engagement, highlighting the hundreds of engagement events that have embedded QIPP thinking and the massive, autonomous peer network that is being built.

He also outlined the new support system – which includes hard benchmarking data and programming tools, such as those surrounding long-term conditions – and confirmed that the QIPP programme remained perfectly aligned with Government policy; in fact ‘driving the White Paper and driving QIPP would be the same’.

Jim warned that the next few months would be crucial, and leaders across the service will need to learn from one another to overcome disagreements without watering down ambition, and to empower front line professionals and patients to drive change.

‘We are going to be the generation of leaders whose decisions were fundamental in whether we could secure the basic principals of the NHS that are so important to the population,’ he said.

Creating a more vibrant NHS

In his speech, Parliamentary Under-Secretary of State – Quality Earl Howe reasserted the Government’s commitment to the NHS’s underlying principles and acknowledging the dramatic improvements made under the previous administration. However, he highlighted that increased funding had not delivered proportionately better services or health outcomes, and driving the QIPP agenda would be central to policy.

Earl Howe then set out the five planks of Coalition policy:

  • full patient involvement in care decisions
  • a focus on clinical outcomes rather than process
  • empowering professionals to make decisions, free of government targets and bureaucracy
  • a new emphasis on public health
  • integrating health and social care around individual needs.

The Government was, he said, ‘committed to creating a vibrant NHS, fizzing with ideas about quality and productivity’; and one that could justify the privilege of ring-fenced funding by exceeding the public’s expectations.

‘I am convinced the NHS has the resources, knowledge and ability to give the people of this country a truly first class NHS and to deliver it within our means,’ he said.


Guide to improve the quality of end of life care in acute hospitals

The National End of Life Care Programme has published The route to success in end of life care – achieving quality in acute hospitals for clinicians, managers and board members. It emphasises the importance of early recognition that the end of life is approaching, advance care planning, coordination of care and regular assessment of need. It calls on trusts to work closely with partners in primary care, district nursing and social care to ensure a higher percentage of people are able to be cared for and die in the setting they choose. The guide also supports the QIPP agenda by tying quality improvement to effective use of resources.

New code on ethical recruitment of international personnel

The World Health Organisation (WHO) is starting a campaign to publicise the adoption of a global code of practice, which encourages countries to behave ethically in international recruitment and discourages policies that would disadvantage, developing countries, particularly those facing critical staff shortages. Recommendations include developing mutually beneficial bilateral arrangements between countries. The campaign aims to inform all stakeholders – including employers and staff – at national and sub-national levels about the existence of the code. All healthcare professionals are encouraged to familiarise themselves with its principles.

MMR vaccine for travellers to France

French authorities have reported an increased number of measles cases in France this year. Nurses – especially those in public health and GP practices – are asked to provide parents who are planning a holiday in France with advice on ensuring their children have the Measles, Mumps and Rubella (MMR) vaccine. Nurses can also direct parents to more information on the NHS Choices and Foreign and Commonwealth Office (FCO) websites.

The Health in Pregnancy Grant (HiPG)

The HiPG officially ends on 1 January 2011. Women who reach their 25th week of pregnancy by 31 December 2010 are still eligible to make a claim. This includes women who have reached their 25th week by the end of December, but do not have an appointment to see their healthcare professional until after 1 January. All eligible women will have 31 days, from the date the claim was signed by their midwife to send their completed HiPG claim form to Her Majesty’s Revenue and Customs (HMRC). Midwives are asked to continue to provide advice to these women, as well as issue and sign forms. A calendar has been created as an easy-to-use, printable guide to the key dates ahead.

Mixed-sex accommodation

The Secretary of State has signalled his commitment to eliminate mixed-sex accommodation, with an emphasis on more single rooms, sound information for patients and effective sanctions for poor performance. Managers will wish to ensure their plans to eliminate mixed-sex accommodation are robust and their mechanisms for sanctioning poor performance are effective.

Improvements in chlamydia screening

The Health Protection Agency has reported that, in 2009/10, over 1.5 million chlamydia tests were undertaken outside of genito-urinary clinics in England, with 14 per cent of them done in general practice. The national cumulative coverage was 22.1 percent of the population aged 15-24, which is a 43 per cent increase on the previous year. However, the Parliamentary Public Accounts Committee (PAC) is encouraging GPs and PCTs to further improve the uptake of screening because embedding it in core health services has shown to be sustainable and provides the opportunity for GPs to give patients wider sexual health advice.

Drive for a more active NHS

The NHS Challenge, supported by Sir David Nicholson, launched on 13 July with the aim of involving 300,000 NHS staff in physical activity by the 2012 Olympic Games. The challenge is a response to Dr Boorman’s review of NHS staff health and well-being and aims to reduce sickness absence, improve staff morale and provide better care for patients. The DH and SHAs have been working with sports governing bodies, including the London Organising Committee of the Olympic Games and Olympian Jonathan Edwards, to develop a package of resources.

Call for Olympic and Paralympic Games volunteers

At the end of July, the London Organising Committee (LOCOG) launched its volunteering campaign for the Olympic and Paralympic Games in 2012. A number of volunteers are expected to come from the NHS, some of whom will be needed to help deliver medical services to Games family members in the Olympic Park.

Maintaining the supply of Group O RhD negative red cells

A repeat of the 2008 audit examining the use of group O RhD negative red blood cells has been commissioned by the Chief Medical Officer’s National Blood Transfusion Committee (NBTC). All trusts that receive blood directly from NHS Blood and Transplant (NHSBT) have been invited to participate in the audit, which is being conducted by NHSBT and the Royal College of Physicians. The aim is to determine whether the stockholding and use of group O RhD negative red cells meet with national recommendations to ensure availability of this limited resource. However, anecdotal evidence suggests that significant inappropriate use of O RhD negative red cells continues to occur. The results of this year’s national audit will be published in the autumn.

Tool to assist victims of forced marriage

The Government’s Forced Marriage Unit has launched a free online resource, Forced Marriage E-learning, to help health and social care professionals identify and provide appropriate support to potential victims of forced marriage, using scenarios based on real-life stories from the FMU’s work. The tool also encourages all organisations and individuals who come into contact with those affected by forced marriage to work together closely in order to protect victims. Practitioners handling forced marriage cases and victims can call the FMU’s public helpline on 020 7008 0151 between 9am-5pm Monday to Friday, or email

Support for local innovations: apply now

Patients First is the Foundation of Nursing Studies’ (FoNS) partnership programme with the Burdett Trust for Nursing. Over a 12-month period, the programme provides support to clinically based, nurse-led teams to help them develop, implement and evaluate innovative local projects that improve patient care in any healthcare setting across the UK. Funding of up to £3,000 is also available. The closing date for applications is Friday 10 September 2010.

New toolkit from the British Association for Parenteral and Enteral Nutrition (BAPEN)

The ‘Malnutrition Matters’ – Meeting Quality Standards in Nutritional Care Toolkit has been developed to help commissioners and providers deliver high quality nutritional care across all care settings and meet national nutritional quality standards including those of the Care Quality Commission.

Report on future standards for pre-registration nursing education

The consultation report on the future standards for pre-registration nursing education has been published by the Nursing and Midwifery Council (NMC). The final standards will be presented for approval to the governing trustees on 16 September in Belfast.

NHS Choices pregnancy planners available

The pregnancy planner is a popular feature on NHS Choices, signposting expectant mothers to information to help them plan their pregnancy. Marketing materials, including business cards and posters, are available to promote the planner to your patients.


UNISON Healthcare Assistants Conference

Date: 21 September 2010

Venue: Trade Union Congress, London.

The provisional programme includes discussions on healthcare assistants’ (HCA) roles and responsibilities, regulation, the future sustainability of the workforce and the role of HCAs in the future of patient care. Results of the 2010 HCA survey will also be published at the event. Registration for the conference closes on 1 September.

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