Last summer the government announced that its future health policy would be heavily focused on driving up the quality of NHS services. Graham Clews talks to the nurse charged with advising ministers on how to ensure this happens
Hilary Scholefield, chief nurse at Sheffield Teaching Hospitals Foundation NHS Trust and a pioneer in developing measures of nursing quality, has the task of representing the nursing profession on the new National Quality Board.
The membership of the board was announced by the Department of Health last month. Its remit is to take forward the new focus on quality in health care services set out by health minister Lord Darzi in his NHS Next Stage Review, published last June.
It comprises 21 expert and lay members, including senior figures at the Department of Health, and is intended to provide leadership on the quality agenda, particularly on the mechanics of assessment and benchmarking. It will therefore play a key role in the development of the quality indicators themselves – the so-called nursing metrics.
Lord Darzi has said the board will play a pivotal role in ‘aligning quality at all levels in the NHS’, from clinical teams using quality metrics right up to SHAs benchmarking their services at a regional level.
Chief nursing officer for England Dame Christine Beasley will also sit on the board, as will Sally Brearly, a former nurse, who now campaigns for patient and public involvement in NHS decision-making. She is currently chair of Health Link, a not-for-profit organisation that represents patient views, and was formerly chair of the Patients Forum.
However, Professor Scholefield is the only practising frontline nurse on the board. She has said it will be her job to ensure that something that nurses hold dear to their heart is a success.
She told Nursing Times that she believed nurses were ‘crying out’ for a system that would clarify what quality means and how it can be measured, and would give nurses greater confidence in the service in which they are working.
‘The concept of quality as the organising principle in the health service is inherent in every nurse,’ she said, following her appointment to the board – a post she will hold for the next four years.
‘Inherently, professionals want to know that they are doing a good job and this is one way of demonstrating that they are doing a good job. And at the heart of nursing is caring for the patient in a holistic manner and people want some measure of that, how they can assure themselves that they are caring for patients correctly, as the patient wants, not as the profession wants,’ she added.
Professor Scholefield suggested that the lack of senior nurses on the board itself would not necessarily be a problem. ‘The board’s membership comprises a mix of skills and expertise and hopefully this collaboration will result in making a real difference to patients,’ she said.
Recent revelations about consistently poor standards of care at Mid Staffordshire NHS Foundation Trust may have given the work of the board some unexpected urgency.
In his response to the Healthcare Commission’s report on the failings of the trust’s emergency care pathway, health secretary Alan Johnson said: ‘I have asked the National Quality Board to ensure that the early warning system for clinical underperformance is working effectively across the whole of the NHS.’
So far, members of the board have held two informal meetings, plus a first full board meeting at the end of March. Communication lines with nurses on the ground have yet to be established, but Professor Scholefield is confident that she and Dame Christine will be able to set these up.
‘I wouldn’t be so arrogant to say that the two of us can represent the whole profession, but I think both of us have very established networks that enable us to speak to nurses across the board,’ she said
‘We have national networks and networks across our regions, and then within my own trust I have access to 5,500 nurses who all have very strong opinions. And I go back to the wards once a month and work in uniform alongside nurses including support workers, nurse specialists, ward sisters and staff nurses,’ she added.
The long-term priority, as Professor Scholefield sees it, is to ensure there is a system in place that will ultimately enable patients to feel confident in the service the NHS provides and to help them choose where they access health care.
As far as the actual nursing indicators that will be used in this system are concerned, Professor Scholefield said the chief nursing officer’s department at the DH had already identified leading candidates based on the three key elements – as described in the next stage review – of patient experience, safety and effectiveness.
‘The work, led through the CNO’s office, has come out with a sort of top 10 metrics that are relatively easy to gather information against, but probably most importantly they are the things that are important to patients and nurses,’ she said. ‘Those metrics will be part of where we go with the National Quality Board, certainly.’
Although Professor Scholefield would not be drawn on the identity of the indicators, the likelihood is strong that they will be similar if not identical to the shortlist of ‘front-runners’ identified by the National Nursing Research Unit in its government-commissioned report State of the art metrics for nursing.
Additionally, the ward-based Clinical Assurance Toolkit – a metrics system in place at Professor Scholefield’s own trust in Sheffield – may offer some indication of how the metrics system could ultimately play out across the NHS.
Like other pioneering trusts around the country, including those in the North West and Birmingham previously reported in Nursing Times, Sheffield Teaching Hospitals Foundation NHS Trust has developed its own set of local measures for improving quality.
Using the DH’s Standards for Better Health – a framework document published in 2004 – as a starting point, the trust has developed a series of measures in consultation with nurses.
The indicator results from the system are presented to the board, although by that time any steps to rectify problems should have been taken.
In the 18 months or so since its introduction, the indicator results have improved, a clear sign that quality has risen, according to Professor Scholefield.
‘There is something about nurses wanting to do a good job for patients, but there is a slightly competitive element as well,’ she said. ‘We have over 100 wards in our hospital and they all want to do well.’
The trust reviews its system annually and assesses it constantly throughout the year to decide whether issues from the current indicators need adapting or other areas need to be included.
As a pioneer in measuring nursing quality, Professor Scolefield would seem well-placed to represent the profession on such a key issue.
‘I heard Lord Darzi say the other day that the search for quality is infinite,’ she said. ‘I completely subscribe to that view.’
Career – Professor Hilary Scholefield
Currently chief nurse at Sheffield Teaching Hospitals NHS Foundation Trust, she has spent her entire career to date in the NHS.
Professor Scolefield trained as a nurse in Sheffield, working initially in cardiac and critical care. She has post-registration qualifications in ICU nursing, teaching and research, and has previously held chief nurse posts in Kettering and Coventry.
She is also a member of the National Institute of Health Research Advisory Board, an associate fellow at the Institute of Health at the University of Warwick, and a visiting professor at Sheffield Hallam University