Significant gaps in nursing leadership have been exposed in assessments carried out by trusts in light of the Mid Staffordshire Foundation Trust scandal.
A year after the Francis Inquiry’s damning report into “appalling” care at the foundation trust, a Nursing Times investigation has revealed pervasive concerns over nurse leadership – a major factor behind the failings.
Nursing Times asked more than 100 trusts for information on the actions they have taken since the findings of the Francis Inquiry were published last February, of which 50 provided sufficiently detailed responses for analysis.
Of these 50 trusts, more than a third had identified a need for stronger management and leadership of nursing staff in the wake of Mid Staffs.
David Dawes, head of the Foundation of Nursing Leadership, said work arising from the Francis Inquiry had confirmed that leadership problems were widespread.
He said: “It’s sad that nursing leadership has been identified as an issue in almost every [NHS] inquiry in the last 20 years.
“The same issues seem to come up again and again, and don’t seem to get any better.”
A recurring problem in trust reports seen by Nursing Times was confusion over the roles of ward managers and matrons, an issue that the Francis report identified.
At Sussex Community Trust, for example, interviews with ward managers showed they “felt strongly that management activity was frequently put on hold to enable them to deliver nursing care”.
Matrons, meanwhile, felt “ward managers were not able to carry out all the management tasks associated with their wards, leaving the matrons to pick up this work”.
The internal reviews also reveal many trusts also identified a need to strengthen nursing leadership at board level.
As a result, Walsall Hospitals Trust has split its former chief operating post into two roles comprising a dedicated director of nursing and an associate director.
Royal Cornwall Hospitals Trust has ensured clinicians are in the majority on the board and is spending up to £500,000 on clinical managers’ training.
However, in several cases nurse leadership programmes or planned additional posts had been cancelled due to budget restrictions.
Funding for six extra matrons at Doncaster and Bassetlaw Hospitals Foundation Trust was due to end, a staffing review states.
Lewisham Healthcare Trust had written a business plan to free up ward managers for management tasks, but a report says “unfortunately this [money] was not available”.
Gloucestershire Hospitals Foundation Trust has been unable to carry out leadership courses due to “training restrictions”, which a spokesman said was due to winter pressures and financial constraints.
The investigation also suggested around a fifth of trusts have failed to carry out reviews into specific areas of concern affecting nurses that were raised by the Francis inquiry, such as staffing levels and training.
This is despite NHS chief executive Sir David Nicholson instructing all trusts boards to read the Francis report and review standards, governance and performance “as a matter of urgency”.
Of the 50 trusts, 10 admitted they had not reviewed staffing levels, staff training or management structures, while nine said they had not looked at nursing leadership or management.
Only 30 said their nurses worked to a published set of principles – another Francis Inquiry recommendation.