In order to ensure safe care in the NHS, we need to lift the veil of secrecy, says Peter Carter
Last week, the well-respected Sir Bruce Keogh published his review into 14 trusts in England with higher than expected rates of patient mortality. The review attracted nationwide media attention, with 11 of the 14 trusts being put into “special measures” in an attempt to turn things around.
The review is a seminal piece of work, one that should be examined by anyone who is responsible for how we deliver patient care. Sir Bruce sets out what he calls his “ambitions”, which are the recommendations for change that he wants to see “significant progress” on within two years. There are eight in total, ranging from the use of early warning systems to involving patients and families in reviewing and evaluating patient care.
“We need staffing levels that are both flexible enough to reflect what patients require, while at the same time providing a minimum number, which sets in stone what safe staffing looks like”
Two of Sir Bruce’s ambitions struck a real chord with me and I suspect the same will be true of many readers of Nursing Times. Ambition six demands that “nurse staffing levels and skill mix will appropriately reflect the caseload and the severity of illness of the patients they are caring for and be transparently reported by trust boards”.
Sir Bruce rightly identifies that not all patient requirements are the same, and similarly neither are their medical conditions. We need staffing levels that are both flexible enough to reflect what patients require, while at the same time providing a minimum number, which sets in stone what safe staffing looks like.
We must also, as Sir Bruce points out, be completely transparent about nurse staffing levels. Trust boards must be obliged to publish what staffing levels in their services should be, and what they actually are. Patients and their families are then entitled to examine any deficits and ask what has gone awry. One reason why the NHS is suffering from unsafe staffing levels is because trust bosses have been allowed to get away with freezing vacancies and cutting posts. In order to ensure safe care, we need to lift this veil of secrecy.
Secondly, in ambition eight, Sir Bruce demands that “all NHS organisations will understand the positive impact that happy and engaged staff have on patient outcomes, including mortality rates, and will be making this a key part of their quality improvement strategy”. There are few who can deny that happy, empowered and appropriately rewarded staff deliver better care to patients.
The same is true in any environment, not just in health; if you care for the people who deliver the service then everything else starts to fall into place. However, the NHS, and indeed those in government, have a questionable record on looking after the staff who deliver patient care. Nursing staff are being stretched in all directions. They are understaffed, overworked and, with a 1% pay cap until 2015, they are underpaid.
At congress this year, I was struck by just how bruised our members felt at the repeated attacks on their integrity and compassion. We also know that when staff are empowered to lead (and perhaps even change) the services they provide, the quality of care improves. Nurses should be at the heart of constantly challenging the status quo and suggesting new and innovative ways of delivering care to patients. The NHS needs to get better at recognising the vast talents of the staff who work for it, and we must do more to allow nurses to shape change and influence the way things are done.
Sir Bruce has delivered a superb review, one that rightly identifies the journey that the NHS needs to take now. The time has come for those at the top to start the engine and get things moving.
Peter Carter is chief executive and general secretary of the Royal College of Nursing