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Trusts must 'hold nerve' in safe staffing, say leading nurse executives

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NHS managers have no option other than to “hold their nerve” on maintaining the increase in staffing levels recruited in the wake of the Francis report, according to senior nurses.

It was the responsibility of directors of nursing and their deputies to ensure their boards understood the need to maintain safe staffing levels, despite the latest financial pressures facing the NHS, they said at a conference for deputy nursing directors.

“Do we really believe that the NHS will hold its nerve on the extra nursing places that have been created because of Francis”

Elaine Maxwell

As has been well-documented, there are 6,000 more nurses and midwives working in the NHS than this time last year, an increase dubbed the “Francis effect” by workforce experts. But this trend may have stalled recently, suggest the latest figures.

Meanwhile, figures published in September by the NHS regulator Monitor showed trusts had a deficit of £167m in the first quarter of 2014-15, against a forecasted deficit of £80m. A total of 86 out of 147 trusts were in deficit.

Last month at conference for deputy nursing directors, a panel of senior nurses was asked whether, during the current financial pressures facing trusts, they believed the NHS would “hold its nerve” on maintain the extra nursing posts created in response to the Francis report.

Elaine Maxwell, principal lecturer in leadership at London South Bank University and a former executive nurse, said: “It’s quite alarming to see that 80% of foundation trusts are in deficit at the end of the first quarter this year, compared with 20% last year, and a lot of that is due to investment in nursing.

“Do we really believe that the NHS will hold its nerve on the extra nursing… places that have been created because of Francis,” she asked.


Elaine Maxwell

In response, Janice Sigsworth, director of nursing at Imperial College Healthcare Trust, said she thought trusts had no option than to maintain the focus on improving nurse staffing levels in the wake of Francis.

Professor Sigsworth described the situation with staffing as “one of those very important moments in time, when I and my colleagues have to hold our nerve and make the right decision”. “I don’t think we’ve got any choice,” she said.

Elaine Inglesby-Burke, executive nurse director and deputy chief executive of the Salford Royal Foundation Trust, agreed that it was the responsibility of nurse leaders to “make sure that the investment that has gone in is used to deliver great care and also improve efficiency”.

Professor Sigsworth and Ms Inglesby-Burke were part of a panel that also included Naomi Holder, deputy associate director of nursing for medical and acute specialties at Wirral University Teaching Hospital NHS Foundation Trust.

The panel session – titled Managing and developing the nursing workforce post-Francis – took place at the Nursing Times Deputies’ Congress on 16 October.

The panel was asked what difference they felt the Francis report had done for them as nurse leaders in terms of the way they looked at staffing.

“What Francis can do for me now is hold a mirror up to the board to hold their nerve on what they’ve already committed to when the money gets tight”

Elaine Inglesby-Burke

Ms Holder said the report posed a “challenge”, in that it was viewed as a “nursing problem”.  

Ms Inglesby-Burke agreed nursing as a profession had “got left inappropriately” to deal with the fall-out from the report on the care failings at Mid Staffordshire Foundation Trust.

“Actually it was leadership at the very top of the shop and the systems that were operating in that organisation,” she told the audience.    

However, she added that the “biggest challenge” had been getting colleagues not to dismiss the report’s findings as being only relevant to Mid Staffs and “asking ourselves could Francis happen on my watch and the answer being absolutely”.

“That was the biggest challenge, getting people to start looking at themselves and not going that was Mid Staffs, it wasn’t here,” she said.


Janice Sigsworth

She added that as an executive nurse she had needed to “think the unthinkable” and look for variations in performance “to understand there are elements of Francis in my organisation”.

Meanwhile, Professor Sigsworth noted the “size and scale” of the three-volume report and its recommendations.

The “big challenge” for her, she said, had been how to interpret the report and pick out from it what was important for her trust and then how to present that to the “nurses at the coalface” and also “to help the board grapple with it”.

“That was a big one really, wanting to do it well and wanting to have a set of recommendations that would inspire our organisation [and] would get by-in,” she added.

She highlighted changing the focus to have quality as a “driving force in our organisation – not performance, not the A&E targets, not finance”.

The panel was also asked whether the Francis report had proved to be an “opportunity” in any way.

Ms Inglesby-Burke said it was the “generational opportunity to get things right”.

Elaine Inglesby-Burke

Elaine Inglesby-Burke

“We were already on the journey around safe staffing, so Francis just reinforced that,” she said. “What Francis can do for me now, and for the staff and patients at Salford, is to continue to hold a mirror up to the board to hold their nerve on what they’ve already committed to when the money gets tight.”

Professor Sigsworth said the Francis report had “helped galvanise everyone behind a common agenda”. “It’s accelerated some of the things I would have wanted to see us doing,” she added. “It’s been a really helpful tool in that regard.”

Conversely, Ms Holder said: “It has given us a bit of power in our box as nurses. But my experience is that the board don’t just want to hear me quote Francis at them time and again.

“While it’s provided opportunity, it’s not been a free for all if you like and our way to get what we want,” she said. “There has been challenge from the board.”

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