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Review of the year: Nursing in the news during 2016

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Steve Ford takes a look back over a year of major developments in nursing, from bursary cuts and staffing concerns to nursing associates and apprenticeships.

January

Sign of the times – A group of nurse leaders expressed concerns over the government’s planned introduction of the new nursing associate role, claiming the proposals “fail to recognise the functions and value of registered nurses”. In a letter to the Times, they also suggested the creation of the new role – designed to bridge the gap between healthcare assistants and nurses – could lead to an increase in avoidable patient deaths. Plans for the role were revealed by Nursing Times at the end of 2015.

 

Carry on striking – On 12 January, junior doctors went on the first of a series of strikes after failing to reach agreement with the government over new contractual arrangements for unsocial hours and weekend working. The industrial action continued until September when it was suspended by the British Medical Association.

 

London calling – Newly-qualified nurses that have trained in the capital could in the future be guaranteed employment in London, under plans developed by chief nurses. The plans are part of a new programme, called Capital Nurse, designed to improve recruitment and retention and create a sustainable workforce in London.

London city hall

London city hall

 

Eileen Sills

Eileen Sills

Eileen Sills

Non-starter – A senior nurse was appointed as England’s first whistleblowing guardian. Dame Eileen Sills, chief nurse at Guy’s and St Thomas’ NHS Foundation Trust in London, was given the role created in response to the Francis report but resigned two months later and before her official start date due to the perceived difficulty of combining it with her other post.

 

Able if asked – The Nursing and Midwifery Council would be able to regulate the new nursing associate role if asked to, its chief executive told Nursing Times. Plans for the role were revealed by Nursing Times in November and confirmed by a government announcement just before Christmas.

 

NICE old leak – Suppressed safe staffing guidance for hospital emergency departments called for the NHS to implement minimum nurse ratios to ensure safe care, it was revealed. The National Institute for Health and Care Excellence’s unpublished final report on accident and emergency department safe staffing, kept secret for months, were leaked alongside a number of related reports to Nursing Times’ sister title Health Service Journal.

 

By association – A consultation on the new nursing associate role – aimed at bridging the gap between healthcare support workers and registered nurses – was launched by Health Education England.

 

Tipping point reached – Mental health provision has returned to the crisis point it was in more 30 years ago, with nursing staff facing “intolerable pressures”, a leading mental health nursing expert warned. Cuts in funding and qualified staff – and the merging of some services – had contributed to strains on services at levels of severity not seen since the 1980s, according to Alan Simpson, professor of collaborative mental health nursing at City University London.

 

CNO for Scotland

Professor Fiona McQueen appointed CNO for Scotland

Professor Fiona McQueen

CNO courts controversy – Scotland’s chief nursing officer told Nursing Times she stood by a controversial blog post in which she highlighted instances of unprofessional behaviour by nurses. In the New Year blog, Fiona McQueen set out her wishes for 2016, including calling on the profession to “put patients first at all times”. The article entitled “No more Mrs Pishy Pants” prompted outrage among some nurses, who complained it painted a poor picture of the profession as a whole.

 

February

Taking a stand – A placement walkout on 10 February by student nurses over the planned removal of bursaries helped show the true contribution they make to patient care and how they “fill in the gaps” and “hold the NHS together”, according to its organisers. They told Nursing Times it would also serve as a warning to the government about the strain NHS organisations would feel under the funding reforms, which they claimed would deter student nurse applicants because of the prospect of debt.

anthony johnson student affairs

anthony johnson student affairs

 

New measures to measure – Lord Carter’s review of NHS productivity recommended that a new metric – “care hours per patient day” – should become the principal measure of hospitals’ use of nurses and healthcare assistants from April. The new metric was set out in Lord Carter’s final report on how the NHS could save £2bn through better management of its workforce, which formed part of an overall plan to achieve £5bn in efficiency savings.

 

South Tees Hospitals NHS Foundation Trust

National maternity review chair visits midwife-led unit

Baroness Julia Cumberlege meets staff and patients at the Friarage Hospital

Here to maternity – Findings from a national review of maternity services were published. The review, by Baroness Julia Cumberlege, was sparked by the Morecambe Bay scandal. Among its recommendations it called for a “more radical” approach to staffing models, in which small groups of midwives took responsibility for a caseload between them to ensure women were looked after by professionals they know.

 

March

Busted flush – Acute trusts in England overrode government-enforced caps on hourly rates of pay for agency nurses more than 60,000 times since they were introduced at the end of last year, an investigation by Nursing Times revealed. Experts warned that the number of breaches was higher than expected and looked set to get worse as the phased tightening of the caps on spending kicked in, noting that the national nursing shortage was the root cause of the problem.

 

Leading legislation – A landmark bill to ensure minimum nurse staffing levels in hospitals in Wales received royal assent, the final stage of the law-making process. Under the Nurse Staffing Levels (Wales) Act 2016, health boards and NHS trusts in Wales must in future calculate staffing levels they need for their adult acute inpatient wards and surgical wards, and must take steps to ensure those levels are maintained.

Welsh Assembly

Safe staffing pioneers: Welsh law focuses on appropriate nursing levels

What new Welsh legislation means for frontline nurses

 

Nurse numbers not the answer – The NHS must move away from a “knee jerk” approach to staffing and stop focusing solely on increasing nurse numbers as the only way improve patient safety, according to the health secretary. In an exclusive interview with Nursing Times, Jeremy Hunt said resources were “finite” and the NHS should look at how it can make better use of nurses’ time rather than just upping staffing levels.

 

NT annual survey 2015

Nurses blame fall in staff for rise in workplace pressures

Last-minute qualms – Obtaining feedback and writing reflective accounts on practice were the areas of revalidation worrying nurses and midwives the most, according to a snap shot survey ahead of the system’s introduction. With just weeks to go before revalidation comes into force on 1 April, Nursing Times surveyed registrants on their views and preparation for the new system that is replacing post-registration education and practice (PREP).

 

Strong appetite – There was a “strong appetite” for the introduction of nursing associates, according to those leading consultation on the new role. Health Education England’s director of nursing Lisa Bayliss-Pratt told Nursing Times the early indications from its consultation were that there was support and enthusiasm for the concept.

 

Education for Health

Exclusive: UK nurse in Brussels praises emergency response

Monica Fletcher was in a hotel near Maelbeek metro station

On the scene – A leading UK nurse who was metres away from one of the bomb blasts in Brussels praised the “amazing” work of emergency services that swung into action in the wake of the explosion. Monica Fletcher, chief executive of charity Education for Health, told Nursing Times how she was in a hotel about 150 metres away from the metro station where a bomb exploded killing about 20 people.

 

April

Pay reviewed – Nurses and midwives on Agenda for Change pay bands in England received a 1% pay rise in April, after the government accepted recommendations for the salary increase made by the NHS pay review body, the independent group that advises on NHS pay awards in the UK.

 

New system – A major new system to ensure nurses and midwives demonstrate their practice is up-to-date every three years was introduced from 1 April. Revalidation, brought in by the Nursing and Midwifery Council, replaced the old PREP system. Around 16,000 nurses and midwives were due to revalidate during its first month of operation.

 

Richmond House 182

Richmond House 182

Department of Health

Loss of advice – Leading nurses raised serious concerns about a loss of vital nursing expertise and influence over policy at the highest level after the Department of Health outlined proposals to cut up to 700 jobs. The confidential plan seen by Nursing Times revealed that the department was planning to axe its nursing, midwifery and allied health professions policy unit. The move sparked a petition that was signed by over 10,000 people and action from the government (see October).

 

Top student – Deborah Huyton from the University of Central Lancashire was named “most inspirational student nurse of the year” at a glittering awards ceremony in London. The judges described Ms Huyton as “quietly inspirational with a high impact factor” and said her ability to reflect, learn and influence her own practice and that of others was “remarkable”. The winners of the 2016 Student Nursing Times Awards were announced on 28 April at the London Hilton, Park Lane.

Student Nursing Times Awards

Student nurses and educators celebrated by Nursing Times

Source: Tom Hall

Most Inspirational Student Nurse of the Year – Deborah Huyton, University of Central Lancashire (second from right)

 

Change of approach – Nurse staffing decisions should be based on a “measure and improve” approach to raise care quality rather than the current “guide and comply” method, the most senior nurse at the health service’s newest regulator told Nursing Times. In her first interview since starting her new role, NHS Improvement executive director of nursing Ruth May discussed ideas across a range of workforce issues, including safe staffing guidance, curbs on the use of agency workers and efforts to retain nursing staff in the NHS.

NHS Improvement

Nurse staffing shortage is ‘top priority’ for regulator

Source: Kate Stanworth

Ruth May addresses the 2016 QNI annual conference

 

Bursary talk – A much anticipated consultation on planned changes to the student funding system for nursing and midwifery in England, which would see bursaries replaced by loans, was launched. It followed an announcement in the chancellor’s autumn spending review that the government was planning to reform nurse education funding.

 

Deputy directors – Successful strategies by employers to retain nurses are only found in “pockets” across the country and more work must be done to tackle sometimes “shocking” turnover rates, senior nurses warned. Redeploying staff between wards, unfixed rotas that are published last-minute and a perception of an increasing focus on targets over quality of care are among the problems of greatest concern. Senior nurses and advisors pointed to poor roster management as one of the main issues when they spoke at Nursing Times’ Deputies Congress event.

 

May

NHS England

Nurses able to ‘measure impact’ of new framework

Jane Cummings launches Leading Change, Adding Value on 18 May 2016

New strategy – The chief nursing officer for England unveiled a new four-year plan for nurses, midwives and care workers focused on how the profession can drive changes to services and help reduce unwarranted variation in health and care provision. The new framework – called Leading Change, Adding Value – was the successor to the 2012 Compassion in Practice strategy.

 

Tough targets – Trusts found it increasingly difficult to comply with caps on the hourly rates paid to agency nurses, as the government-enforced rules were ratcheted down, revealed official data shared with Nursing Times. While many trusts in England were initially able to stay within the rules, they were struggling to do so after 12 weeks, according to data from NHS Improvement, the regulator enforcing the new caps.

 

Public health risk – Council cuts to budgets for health visiting and school nursing services threatened to “unravel” recent national efforts to boost the workforce, it was warned. Nursing Times learnt of several regions where authorities were cutting or reviewing the budgets for health visiting and school nursing, which are paid for out of the public health grant that the Department of Health reduced in 2015-16 and announced would be cut further by £77m in 2016-17.

 

No place like home – Workload pressures were increasingly forcing a change in dynamic between the traditional roles of community and practice nurses, suggested a report that painted a picture of a system in “crisis”. GP surgeries were increasingly using their own practice nurses for home visits, instead of district nurses, according to the report by the King’s Fund.

District community elderly blood home patient dressing wound care

District community elderly blood home patient dressing wound care

 

Director support – The head of nursing at the new NHS regulator told Directors’ Congress that she was committed to supporting current and future nurse leadership around the country. Ruth May, executive director of nursing at NHS Improvement, set out a raft of initiatives at the Nursing Times event that she planned to implement that reflected the regulator’s intention of being more supportive in approach than its predecessors.

 

June

Poll predictions – Unlike any other indicative poll, ours closely mirrored the national result of the European Union referendum. The margin between nurses who planned to vote to leave or remain was extremely narrow, but “Brexit” just edged ahead. In our survey of more than 500 nurses 43% said they would vote to leave the EU, 41% said they were intending to vote to remain and a further 15% told Nursing Times they were yet to make up their minds.

Exclusive: Nurse views on EU referendum revealed

Exclusive: Nurse views on EU referendum revealed

Source: Jennifer Van-Schoor

Exclusive: Nurse views on EU referendum revealed

 

Up at last – A statue honouring nursing pioneer and Crimean War heroine Mary Seacole was unveiled outside St Thomas’ Hospital. The bronze statue – the first in the UK dedicated to a named black woman – was the result of 12 years of fundraising. More than £500,000 was raised through donations and the remaining £240,000 was provided by the government from LIBOR banking fines. Over 300 guests saw the statue, created by sculptor Martin Jennings, unveiled by Baroness Floella Benjamin.

Mary Seacole

Long-awaited Mary Seacole statue is unveiled

The statue of Mary Seacole unveiled on 30 June at St Thomas’ Hospital

 

College celebrates – In its centenary year, the Royal College of Nursing held its annual congress in Glasgow. RCN chief executive and general secretary Janet Davies took to the stage for her first speech since taking on the top job 11 months ago. Speaking on current government policies affecting nursing and the NHS workforce, she repeatedly said: “You couldn’t make it up”. The event also featured a keynote speech from Scotland’s first minister Nicola Sturgeon in which she announced Scotland would make it a legal requirement for the use of nursing and midwifery safe staffing tools.

Royal College of Nursing

RCN Congress 2016

Nicola Sturgeon

 

Nurse CPD at risk – Cuts to funding for continuing professional development that will see budgets halved this year nationally sparked warnings that ongoing training for nurses could be under threat. In March, Health Education England agreed to reduce funding for “workforce development” by around 50% for each of its 13 local education and training boards across the country. This money – which will be reduced from a total of £205m in 2015-16 to £104.3m in 2016-17 – is allocated locally and is largely used for CPD for nurses, midwives and allied health professionals.

 

July

Bursary to go – The government confirmed that plans to remove bursaries and introduce a loans system for pre-registration student nurses, midwives and allied health professionals in England from next year were to go ahead.

 

Staff Nursing

Nurse uses Swift song to teach handwash technique

Source: GabboT

Taylor Swift performing in Detroit in 2015

Shake it off – A dynamic dance routine devised by a nurse trainer in Northern Ireland helped hospital and care home staff remember the key stages of hand-washing. Ross Mawhinney was looking for a way to ingrain the correct hand washing technique in people’s memory and came up with a dance to chart-topping song Shake It Off by US star Taylor Swift. A short video clip of him performing the routine on Facebook proved a hit, reaching more than one million users and garnering nearly 600,000 views.

 

Brexit chill – Overseas nurses were already starting to feel anxious about their immigration status and whether they remained welcome in the UK, while rumours of bullying were also emerging. Nursing Times was warned that fewer nurses and midwives from abroad could come to work following the country’s historic vote to leave the European Union on 23 June. Trainee nurses from the EU told Nursing Times that these concerns, as well as the fact the country could suffer economically as a result of a “Brexit”, meant there was a risk the UK was becoming a less attractive place to work.

 

Going Dutch – A community nurse-led care model that sees management functions shared between staff and ensures at least 60% of time spent is with patients is being tested in the UK, following success in the Netherlands, Nursing Times learnt. The Buurtzorg – or “neighbourhood care” – model uses teams that have a maximum of 12 district nurses to deliver care in people’s homes.

NHS Borders

Exclusive: Scotland to trial Dutch district nursing model

Source: East of England LGA

Madelon Van Tilburg, a Buurtzorg nurse based in The Hague, recently visited West Suffolk

 

Mental health model – A rift among the mental health nursing community emerged over education reforms that could see a move towards more generic nursing degrees, an investigation by Nursing Times revealed. Last year a major review of nurse education recommended a new model that would see students spending more time on general training before specialising in their final year. But experts warned the proposals could lead to a dilution of mental health as a specialty.

 

August

No return – A Nursing Times investigation indicated that around a third of government-funded course places for nurses wanting to return to practice failed to deliver additional nursing staff for the health and care service in the first 18 months since a national campaign launched. The Come Back campaign was set up in autumn 2014 by Health Education England to tempt former nurses back into the profession and help fill staffing shortages by paying their course fees.

 

Stepping Hill

Victorino Chua

Source: Rex_Shutterstock

Victorino Chua photographed in March 2014

Still guilty – The nurse found guilty of murdering and poisoning patients at Stepping Hill Hospital in Greater Manchester failed in a bid to appeal against his conviction. Victorino Chua, who pleaded not guilty, was given a life sentence in 2015 for murdering two people and harming 19 others by poisoning them with insulin over a six-month period.

 

Children’s nursing warning – Plans to move towards more generic nursing degrees “would be the death knell for the children’s nursing qualification”, children’s nursing educators told Nursing Times. The warning came from a new UK-wide group of children’s nursing academics set up to give a stronger voice to the specialism in policy-making. Members of Children and Young People Nurse Academics UK fear a move to more generic nursing education risks the children’s speciality becoming no more than an “add-on”.

 

September

Expansion plansNursing Times revealed that the number of nursing associates trained in the first phase of the new role’s introduction was set to be doubled under plans being drawn up by Health Education England. When the new role was first announced at the end of last year, the government said it expected 1,000 people to be selected for training by the end of 2016. But Nursing Times learnt that the programme would be expanded to allow 2,000 people to be trained as part of its initial pilot phase from 2017.

 

Breaking point – Pressure on district nursing services was leaving staff “broken”, “exhausted” and “on their knees”, and was compromising the quality of care they are able to provide to patients, according to an influential think-tank. The problems are being driven by an increase in the number of patients and the complexity of care they require, in addition to a reduction in the number of community nurses in recent years, said the King’s Fund in a report investigating district nursing for older people.

 

Nursing and Midwifery Council

Ebola nurse Pauline Cafferkey speaks of anguish over NMC case

Pauline Cafferkey

Ebola nurse cleared – Pauline Cafferkey, the nurse who survived ebola, was found not guilty of professional misconduct following the conclusion of a fitness to practise hearing. The virus had affected Ms Cafferkey’s ability to alert health officials to her symptom of a high temperature when she returned to the UK in 2014 and so her actions did not amount to misconduct, the hearing panel said.

 

October

Doing drugs – Nursing associates were to be expected to calculate drug doses and independently administer controlled medications, leaked documents revealed. Health Education England internal papers described how the new nursing role would also be allowed to carry out invasive procedures on patients without the direct supervision of a qualified nurse. However, in an apparent U-turn, HEE subsequently said in November that nursing associates would be trained to administer drugs “within the confines of local employer policies” but made no mention within the final version of the curriculum that they would administer controlled drugs.

 

Domestic violence – Shocking survey results indicated that nurses were three times more likely to have experienced domestic abuse in the last year than the average person. Research for nursing charity the Cavell Nurses’ Trust found that 14% of nurses had experienced domestic abuse in the past year, compared with 4.4% of people nationally. The report also revealed that 2.2% of nurses had been injured as a result of domestic violence in the last year.

 

Gail Adams

Gail Adams

Gail Adams

Exiting the stage – Gail Adams, the well-known and outspoken head of nursing at Unison announced she was leaving her role after 14 years. Ms Adams, a theatre nurse by background, described her time in the role as an “honour and privilege”. She now “heads up” the union’s professional service’s unit, which represents Unison members in fitness to practise cases.

 

Status woe – Concerns were raised that a new post at the Department of Health created in the wake of the disbanding of its entire nursing and midwifery policy unit would not be able to provide the high-level advice required for future government decisions. The government said it would introduce a new post “specifically on nursing and allied health professional policy issues, including parliamentary business, in the new structure”. But stakeholders questioned the proposed seniority of the new role and whether it would be held by a registrant.

 

Testing times – The universities and employers selected to test the forthcoming nursing associate role were revealed in an announcement that confirms double the number of people will be trained for the new position than was originally planned. Eleven sites across England have been chosen to deliver the first wave of training for 1,000 nursing associates, beginning in December. An additional 1,000 people will also be trained in the role, as revealed by Nursing Times (see September).

 

Nurse of the year – A primary care nurse from Sussex was revealed as the 2016 Nursing Times “nurse of the year” at an awards ceremony in London. Erin Docherty, a mental health nurse who works at the Saxonbrook Medical Practice in Crawley has founded and run a “wellbeing clinic” that gives patients access to a mental health specialist at their local GP practice.

Nursing Times Awards

Practice nurse named Nursing Times ‘nurse of the year’

Source: Steve Ford

Jenni Middleton on stage at the Nursing Times Awards 2016

 

November

Remember nurses – An Army nurse was among current service personnel to feature in a Royal British Legion campaign urging the public to “rethink remembrance”. Corporal Ben Poku was one of the faces of the campaign designed to challenge perceptions that Remembrance Day and the annual poppy appeal are just about the First and Second World Wars.

Royal British Legion

Army nurse among faces of this year’s poppy appeal

Corporal Ben Poku

 

Health secretary

Hunt outlines latest moves on safe staffing guidelines

Jeremy Hunt

Goodwill hunting – Health secretary Jeremy Hunt used his speech at the NHS Providers annual conference to unveil a raft of nursing policy. Most notably he unveiled plans for 1,000 apprentice nurses to join the NHS each year in future and announced he had asked the Nursing and Midwifery Council to regulate the new nursing associate role. Other measures targeted at advanced nurse practitioners, e-rostering and managers from clinical backgrounds were also covered in his speech.

 

cphva 2016

cphva 2016

Stop the cuts – Health visitors and school nurses urged politicians to realise the “serious” risk to nurse jobs posed by cuts to public health budgets in England, and underlined the need for national minimum staffing standards in the community. They also pointed to an ongoing threat of redundancies as services were reconfigured by local authority commissioners, and the potential for nurses to be replaced with support workers. The concerns were raised at the Community Practitioners and Health Visitor’s Association annual conference.

 

New danger – fears began to grow that the sustainability and transformation plans being drawn up locally across England by healthcare leaders might lead to a reduction in nurse posts. The revelations about the regional reform plans sparked reassurances from the government and regulators to the contrary, but concerns about STPs persist for many.

 

Staffing worries – Only 27% of NHS trust leaders were confident they have the right staff numbers, quality and skill mix to deliver high quality healthcare for patients and service users. Fewer still, 22%, were confident about having the right staffing levels in six months’ time, revealed the largest ever survey of trust chairs and chief executives. The findings show that, for many trust leaders, worries over staffing were becoming even greater and more urgent than those over funding.

 

donna wood

donna wood

Donna Wood

Temperature rises – A nurse who was found to have deliberately concealed Pauline Cafferkey’s high temperature after the pair returned from volunteering to help fight ebola in Sierra Leone was temporarily removed from the Nursing and Midwifery Council register. Following the conclusion of a fitness to practise hearing, Donna Wood was suspended from working as a nurse for two months.

 

December

Clinician’s apprentice – In the aftermath of Jeremy Hunt’s announcements on apprentices and nursing associates, the NMC chief executive Jackie Smith spoke exclusively to Nursing Times. Apprentice nurses must be counted as supernumerary throughout their training, she said, adding that a “full debate” was needed on whether the NMC could regulate the new nursing associate role.

NT Deputies 2016

Revalidation will ‘go further’ in future to up standards

Source: Andy Paraskos

Jackie Smith

 

Contrasting forecast – The forthcoming removal of student bursaries in England has prompted an increase in the number of applications from universities to run nursing and midwifery courses, the professional regulator said. However, the Nursing and Midwifery Council also noted there were ongoing problems this year with student placement capacity, which could worsen if increasing numbers of courses were set up.

 

Welsh commitment – Ministers in Wales committed to continue giving student nurses and midwives a bursary in 2017-18, but with the condition they work for at least two years in the county after qualifying. However, it noted that long term funding arrangements for student nurses were yet to be decided.

 

HiRes iStock 645864

Money worries – There has been a 60% rise in the number of nurses contacting the Cavell Nurses’ Trust asking for financial help since the summer. The charity, which gives money and support to nursing professionals when they are experiencing financial hardship, said it had received 231 enquiries in November, compared to 143 in August. “We’ll be very close to 2,000 for 2016 by the end of December,” a spokesman told Nursing Times.

 

Public confidence – Nurses are the most trusted profession, suggested an Ipsos Mori poll. The poll found 93% of participants would “generally trust” a nurse, compared to 91% for doctors and 88% for teachers – the three professions making up the top three. Journalists, government ministers and politicians generally made up the three professions deemed least trustworthy.

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  • And the comments sections dominated and monopolised by one lay individual!

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