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Words strong but action vague in PM plan

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In a high profile announcement earlier this month David Cameron set out plans to address poor nursing standards, the first time he has intervened on policy specifically on the profession.

The move can be seen as both a response to a raft of negative reports last year and a pre-emptive act ahead of recommendations from the Mid Staffordshire Foundation Trust public inquiry, due later this year.

However, the policies Mr Cameron announced have attracted a mixed reaction from nurses. A snap poll on last week found only 30% of readers welcomed the creation of a nursing quality forum – one of the centre pieces of Mr Cameron’s announcement.

The forum will comprise an as yet unspecified group of nurses who will be “charged with taking a national leadership role in promoting excellent care”. It will play a key role in pushing the adoption of Mr Cameron’s five priority initiatives.

However, the degree to which such measures will change anything at the frontline has already been called into question. Regular ward rounds, work to eliminate bureaucracy, and high profile nurse leadership are already commonplace in many teams.

In addition, despite the rhetoric used by the prime minister, it is unclear to what degree if any the policies will be enforced.   

For example, Nursing Times understands no trusts are being ordered to make changes or carry out the initiatives. A statement from Number 10 said the government would “focus targeted support [for care improvement] on 20 organisations that would most benefit from intensive support”.

It is understood trusts are being asked to volunteer. It is hoped those which need most support will come forward.

The government has asked the NHS Institute to work with the forum on introducing regular ward rounding and renew its push to roll out the Productive Ward: Releasing Time to Care programme. According to the institute, Productive Ward has already been used in around 67% of all hospitals wards since its launch in January 2008.

The programme’s national lead Lynn Callard told Nursing Times she welcomed Mr Cameron’s support to push Productive Ward further. She said the programme had shown that “taking out waste and non value-adding activities” could give time to focus on improving care standards.

However, others argue Mr Cameron’s initiatives are not enough to successfully improve care standards.

Yvonne Sawbridge was nursing and quality director at South Staffordshire Primary Care Trust when the Mid Staffordshire Foundation Trust scandal unfolded and is now a senior fellow at Birmingham University.

Last month she published research based on reviews of major nursing care failures as far back as the 1960s. Ms Sawbridge warned that Mr Cameron’s initiative was unlikely to lift the “red tape” from nursing.

She said: “Looking at bureaucracy and paperwork has been tried so many times before, I’ve got little confidence this is likely to be any more successful. Accountability means you have to produce lots of information. It would be good if we could reduce some of that, but we should recognise nursing is a complex task.”

In spite of the negative undertones from Mr Cameron’s announcement, a leading member of another one of the government’s current initiatives, the NHS Future Forum, was positive about the current standard of nursing, describing it as “bloody good”.  

Dame Julie Moore, a former nurse and chair of the forum’s education and training group, said: “I’ve seen some of the best examples of nursing in the last few years than ever before – people who couple such a high level of technical skill with a real level of understanding while dealing with increasingly frail and elderly people.”


The DH’s proposals

  • Patients to paperwork: The NHS Institute’s Productive Ward programme will be rolled out to all NHS Trusts, with the aim of full implementation by April 2013. The DH will focus on 20 organisations that “would most benefit from intensive support”. However, it is unclear whether foundation trusts will be included in the drive. A “red tape challenge” will be launched to ask frontline nurses to identify which pieces of bureaucracy get in the way of them performing their jobs properly.
  • Leadership on wards: A Nursing Quality Forum will be set up to identify good practice and advise on what is best to implement.  The forum will have two specific objectives: to ensure that the best nursing practice is widely diffused and adopted and to secure greater frontline nursing leadership in the future.
  • Regular nursing rounds: The Nursing Quality Forum will encourage the adoption of hourly nursing rounds by all hospitals by “raising its profile and demonstrating the benefits to frontline nurse leaders”. The DH said nurse rounds were a “systematic way of organising regular contact between nurses and checking on patients at the bedside”.
  • New patient-led inspections: A new patient-led inspection regime will replace Patient Environment Action Team inspections.  The inspections will cover cleanliness, food, privacy and dignity. The system will roll out nationwide from April 2013, with pilots beginning in 2012.
  • New friends and family test: Indicators will be added to all future national patient and staff surveys asking whether respondents  would want a friend or family needing care to be treated at that hospital.


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