The government needs to build on its actions to ensure the system supports nurses to deliver high-quality care, says Peter Carter
At the end of March, health secretary Jeremy Hunt insisted the NHS must not crush “the innate sense of decency and compassion” that drives people to want to work for it.
His comments resonate with the concerns of nursing staff whom I meet every week. Nurses up and down the country are suffering from the demands and often the culture of their organisation, leaving them feeling utterly demoralised and unable to deliver the standard of care they came into the profession to provide.
This is often due to a cocktail of pressures: a lack of staff on wards; bureaucratic burdens on time; a lack of professional support and supervision; and a fear of being open when mistakes have been made. These are the things Robert Francis QC identified in his final report into Mid Staffordshire, and those that the government now has the chance to put right.
Mr Hunt recently announced positive action to tighten regulation and accountability in the NHS, including a new statutory duty of candour covering providers and trust board members, and a new chief inspector of hospitals. Encouragingly, the government has also committed to reducing the paperwork burden by a third.
Despite these positive measures, the government’s initial response to Francis has left a number of unaddressed issues and missed opportunities. It has left the Royal College of Nursing concerned about how nurses are to be supported in other vital areas to deliver patient care.
For many years the RCN has been calling for a system of mandatory training and regulation for healthcare assistants. It is positive that the government will be implementing the recommendation for a code of conduct and national standards of training for HCAs, but a system of mandatory regulation has regrettably been dismissed. This is hugely disappointing. A voluntary system will provide false reassurance; only mandatory regulation will give HCAs and patients the protection they deserve.
Last November, the Willis Commission on Nursing Education, established by the RCN, delivered its independent verdict. It found no evidence that the education system is failing, nor that it is associated with a decline in compassion. Despite this, the government is proposing that students wanting to enter nursing must spend up to a year working as an HCA before starting their degree. We have concerns with this proposal and it raises a number of questions: who will train, employ and monitor tens of thousands of HCAs, and how does the government expect to deliver this radical change to training on a cost-neutral basis?
Mr Hunt recently admitted that more nurses are likely to be needed on the frontline when staffing levels are reviewed by the chief inspector of hospitals. We welcome this commitment to look at staffing levels, but this simply does not go far enough. The RCN has consistently highlighted the real need for safe staffing levels. The reality is that nurses continue to work with up to 11 patients each in older people’s settings, and with even higher numbers in care homes. Simply leaving the setting of staffing levels to local discretion clearly isn’t working; the time has come for mandatory, legally enforceable safe staffing levels.
The Francis report is forcing professionals, organisations and the government to reflect on the changes needed to provide safe and high-quality care. We are facing a watershed moment in the NHS. It is a major opportunity to ensure the system supports, rather than obstructs, the desire of nurses to deliver high-quality care. I urge the government to build on the actions they have set out and work with the RCN to go even further. The time to be bold is now.
Peter Carter is general secretary and chief executive of the Royal College of Nursing