Director of patient safety at the NPSA Suzette Woodward on the abolition of the NPSA and what this means for nurses.
It has recently been announced that the NPSA, along with several other arm’s length bodies, are being abolished and that the functions of the patient safety division of the agency will be moved to the NHS Commissioning Board.
This announcement, made in the Report of the Arm’s Length Bodies Review, follows on from the NHS reforms made in the recent white paper Liberating the NHS.
What is clear is that the size and scale of the changes being made are going to impact greatly on how health services are provided. No one is untouched by this reform, from the Department of Health, to primary care trusts, strategic health authorities, foundation trusts, non-foundation trusts, general practice - all are affected.
There has been a steady stream of consultation papers since the white paper. In addition to the arm’s length body review there has also been a recent one on outcomes - Transparency in Outcomes: A Framework for the NHS. For those who want to influence the current agenda, this is the time to have your say. Studies undertaken in the US, Canada, England, Switzerland and New Zealand, all show that the adequacy of nurse staffing and the quality of the nurse working environment are associated with the quality of patient care.
‘What is clear is that the size and scale of the changes being made are going to impact greatly on how health services are provided. No one is untouched by this’
In those hospitals that have poor work environments for nurses, patients tend to be at an increased risk of adverse outcomes - including mortality. If the NHS wants to improve outcomes, we need to address the following essential ingredients: adequate nurse staffing; a high proportion of registered nurses; a well educated nurse workforce; positive nurse-doctor-manager relations; and responsiveness of leadership and management when it comes to addressing problems in patient care that are identified by nurses at the bedside.
In the past 10-15 years patient safety has come to the fore and been recognised as an important source of preventable patient morbidity and mortality. It is a core agenda that unites us all, whether we are clinicians, managers or policy makers. Now is the time to shine a light on the link between nursing and patient safety. Rather than simply focusing the attention on preventing errors, we need to work towards reducing those latent conditions that actually increase the risk of error. Latent conditions that include nurse understaffing, tiredness and fatigue, distractions and poor communication, stress and burnout, inadequate education and a poor practice environment - all are classic examples that predispose individuals to make mistakes, and make it difficult for others in the environment to identify a mistake before the consequences are serious.
To date, these latent conditions have received less attention than the factors directly connected to the errors themselves. Reducing nursing numbers is not the way forward. So much more can be achieved, in terms of reducing errors and poor patient outcomes, by investing resources in work environments. We can improve the productivity of nurses by improving the environment at the bedside, thus making it possible to achieve more with the resources in hand.
Reducing latent errors requires a change which is hard to capture in any policy document; we need to change the culture. Nurses need to stop blaming and start learning. Stop pointing fingers at each other or at other professions and start working together. Demand a commitment from leaders and managers alike for a different style of decision making with a greater devolution of authority to nurses at the bedside. This authority should be proportionate to these nurses’ high level of responsibility for the welfare and safety of their patients.
Nurses must be developed in their roles. They must also be listened to and supported in their decision making and in the management of nursing services. They have the ability to transform the way in which care is delivered, to improve safety and reliability in healthcare, and are an untapped resource. Over the next few years we need to see significant advances in the way nurses are involved in patient safety improvement.
The continued need for strong and committed nursing leadership at all levels of the NHS is apparent. Authority and resources must be invested in nursing leaders, both at the frontline of organisations and at the executive level. In addition, meaningful and positive interdisciplinary relations must be cultivated. Without such leadership, the patient safety movement cannot succeed.
Improving patient safety has to underpin all decisions that nurses make about their work. They need to be trained for the future, not for the past and they need to master a whole new set of skills that are crucial when it comes to patient safety - skills such as continual improvement, teamwork, measurement, change management and so on.
Over the next few years as the NHS puts into place the changes set out by Liberating the NHS, and the National Patient Safety Agency moves some of its functions to the NHS Commissioning Board, it is more important than ever to ensure that patient safety is firmly at the heart of a 21st century NHS. Nurses can be the first to step up and lead this new agenda.
Suzette Woodward is director of patient safety, National Patient Safety Agency