My news editor Steve Ford commented to me last week that basically I am always angry whenever I write anything about nursing. And he’s probably right – but I’ve a lot to be angry about.
Cuts to CPD funding, the removal of the bursary, the real terms pay cuts to nurses’ salaries, NHS budgets getting thinner, fewer people entering the profession, more people leaving the register, Brexit and a seeming total lack of a workforce strategy.
I mean this is hardly a time for me to get the mariachi band out and start celebrating our happy state of affairs using the medium of dance is it?
Anyway, I decided that this week I should try to be positive. Here goes.
Often, I have lamented lately at the lack of power in the profession. Some of nursing’s most senior leaders have been silent on issues that will change the profession forever, and that culture has infused the whole of the profession.
“The team of senior nurses are looking at any product a clinical team might use”
So many nurses feel so done to that they have given up raising their voices to complain. However, just recently I have seen one group of nurses who have taken control and are making sure their expertise is heeded.
It is the clinical evaluation team, run by the Department of Health as part of the NHS Supply Chain, to assess the products used by nurses and other clinicians.
This team was set up by the DH as a result of the work with Lord Carter and in line with his report on unwarranted variations, alongside the Royal College of Nursing’s Small Changes, Big Differences campaign that was designed to help hospital trusts choose the most effective and efficient products for the specific clinical need they have.
The work was initiated and is now led by Mandie Sunderland, chief nurse of Nottingham University Hospitals NHS Trust, who is chair of the Clinical Reference Board, and the clinical programme lead Dr Naomi Chapman, then at the RCN and now at the DH, leading this work full-time.
“This is not about choosing the cheapest product, but about choosing the right one for the right clinical circumstance”
The team of senior nurses reporting into Dr Chapman all have their own projects – looking at everything from wound dressings, catheters, electrodes, cannula and any other product that a clinical team might use.
This is not about choosing the cheapest product, but about choosing the right one for the right clinical circumstance. This team will look at how sticky a dressing is when left on for long periods and exposed to egg white – the viscosity of which most closely resembles sputum.
They will also check out how effective gloves are to use, how clear product labelling is and how easy products are to fill or use.
As one of the team, David Newton of Nottingham University Hospitals, explains: “We buy 300,000 items on the national catalogue, but no one has ever said what we want them to do. For example, we have never said what we want a syringe to do, and often they have different measurements and different increments. In being involved in telling manufacturers about that, we can add lots of value to products. Throughout this process, we have captured hundreds of nurse voices and fed those back into industry.”
“What’s interesting about the group is that they genuinely do not know the cost of a product until the report is published”
The team identifies products that would make the most difference to patients and nurses, gather intelligence on them from reports and literature, talk to clinicians about what they need a product to do, evaluate the product in a lab, tabletop testing or real life situations, and then give suppliers the chance to see – but not change or influence – the criteria they are using to assess the products.
Suppliers are given a matrix so they can see how well they have done, and the reports of the CET are publicised so that all nurses (and others involved in care or procurement) can benefit from this comprehensive evaluation programme.
Another member of the team, Karen Hudson, insists this work is “by the NHS, for the NHS” and says their work enables suppliers to understand the questions nurses want answered.
Dr Chapman agrees. “We are informing innovation and guiding it,” she says. “A lot of this is common sense, but because nurses have never been asked before, they have not been involved in making decisions that would make life easier and safer.
“In a world where I repeatedly hear nurses feeling ignored and pushed out, to see this team of nurses taking charge of a huge area of expenditure, and one that has a direct impact on patients, is both inspiring and impressive.”
“For example, there are some syringe packaging that you can open at both ends, but if you open it at the wrong end, the product is not sterile and you have to throw it away. So we suggested that the product can only be opened at the right end.
We also know you usually only need six to nine electrodes, but you open a huge strip and the rest dries out and gets thrown away, so we suggested making them in smaller strips or fully re-sealable bags,” she says.
What’s interesting about the group is that they genuinely do not know the cost of a product until the report is published. “We think this would influence our view of quality,” says Dr Chapman.
And while cost does not motivate their evaluation or their choices, they believe that using the right products at the right time can have a massive impact on cost savings.
Another member of the nine-strong team Simon Hall says he believes trusts can “optimise their staffing levels as a direct result of buying smarter”. If you’re not wasting time fiddling with packaging or double checking things that should be consistent in usage, you could save yourself time.
In a world where I repeatedly hear nurses feeling done to, ignored and pushed out, to see this team of nurses taking charge of a huge area of expenditure for the NHS, and one that has a direct impact on patients is both inspiring and impressive.
I hope everyone takes notice of this team and the great work they are doing – because for once the nurses are making waves and we should all applaud that. I’ll book the mariachi band.
This team will be incorporated into the NHS Procurement Future Operating Model to ensure that the focus on clinical quality and evaluation of products provided to the NHS is paramount in the selection process.