Andrew Lansley on how the Conservatives would empower nurses to improve care
Nursing roles today are broader than they’ve ever been. Clinical procedures, specialist care, commissioning, research - there is little that falls outside nurses’ area of expertise.
These developments are crucial to our plan for change in the NHS. We want to see a radical shift in the distribution of power: away from national and regional health authorities and into the hands of frontline clinicians and patients. We want nurses and doctors to take control of budgets and decision making processes so they can manage their patients’ whole care pathway.
We know that we can rely on nurses to take on these responsibilities. Time and again, where they’ve been given greater autonomy, the decision has been vindicated. Look at the success of nurse led health centres. A study found no discernible difference in patient outcomes in emergency care between nurse and GP consultations.
The NHS must adapt to allow nurses to demonstrate these leadership skills at every stage of their career. Nurses spend their days at the bedside or out in the community. Their constant contact with patients puts them in the best position to spot safety issues, recommend better ways of delivering services and come up with innovative ideas to increase productivity.
‘Conservatives would entrust NHS staff with patients’ safety by giving them a contractual right to raise concerns directly with the Care Quality Commission’
One important lesson of the recent report on failures at Mid Staffordshire Foundation Trust was that those nurses who saw the dreadful state of affairs had no power to communicate their concerns to the board.
This has got to change, which is why we are consulting on a proposal to allow a junior nurse representative to sit on the board of a trust on a rotational basis. If we are to make the NHS truly patient centred, we’ve got to put those who know patients best in the driving seat.
But where we give nurses leadership positions, we must make sure they have the time to lead. A recent RCN poll showed that nurses spend a million hours a week on bureaucracy. That doesn’t have to be the case. A Conservative government will make sure each hospital has high quality administrative staff to do the secretarial tasks that hold nurses back from tending to patients.
More fundamentally, we will slash the red tape that distorts priorities and stifles clinical initiative. We will scrap the targets that demoralise our nurses and doctors and divert time from the task of improving frontline care. No longer will our NHS be governed by tick boxes and targets. It will be led by clinicians exercising their professional judgement. They will be accountable to patients for results and measures of outcomes that look at the whole of their treatment, rather than one tick in a box marked ‘four hours’ or ‘18 weeks’.
Where we give nurses this autonomy, we must empower them to capitalise on it to deliver higher quality care. Part of this will involve giving them the space and authority to make their voices heard. Conservatives would entrust NHS staff with patients’ safety by giving them a contractual right to raise concerns about practices at their hospital directly with the NHS regulator, the Care Quality Commission. These concerns will be treated in confidence and have no impact on employment.
Where nurses feel able to speak out, the onus is on management, policymakers and politicians to respond. Empowerment comes through involvement. Why is it that only a quarter of NHS staff feel that management involves them in important decision making? Why do only a third of NHS staff feel that managers encourage them to suggest ideas? We will never have a patient centred service unless we listen to those who spend most time with patients - our nurses. I know that we will never get our policies right unless we have the insight of frontline nurses at every step of policy development.
That is why we are consulting on our plans for the future of nursing in the NHS. How can we capitalise on the freedom that flows from removing central process driven targets to deliver better care? What else can we do to help nurses have more influence and control over the patient environment? What other mechanisms should we consider to give nurses a strong voice and improve staff safety? We want to hear all your views, positive or negative, because we want our policy to be shaped by those who know patients best.
But we know that empowering nurses isn’t just about presenting an idea and asking for feedback. It’s about actually drawing on your expertise to get a better idea in the first place. The nursing profession has been pivotal in our policy development so far. The RCN brought us evidence about the lack of isolation facilities in hospitals. Nurses across the country told us tales of the indignity of mixed sex wards. We listened and learnt and committed to using the NHS capital budget to provide single rooms for all patients who need one on the grounds of medical safety or to maintain personal dignity within five years of a Conservative government.
I believe in the NHS. I believe in what nurses in the NHS can achieve. I believe that they will achieve even more in the future. But I know that nurses can only do so if we give them the time and freedom to deliver.
Andrew Lansley is shadow health secretary