Nursing & Midwifery Future – Ruth May

Nursing & Midwifery
The Future
Presented by Ruth May
Regional Chief Nurse
NHS England (Midlands & East)
October 2013
Wider Policy
The Keogh Review
Main findings:
a limited understanding of and failure to genuinely listen to patients and staff
the poor use of data to drive quality
the complexity of using and interpreting aggregate measures of mortality, including HSMR
and SHMI
some hospital trusts are operating in geographical, professional or academic isolation
the lack of value and support being given to frontline clinicians, particularly junior nurses
and doctors
the imbalance that exists around the use of transparency for the purpose of accountability
and blame rather than support and improvement…some boards use data for reassurance
rather than, the sometimes uncomfortable, pursuit of improvement.
The Keogh Review
Dissonance between nursing establishments, staff in post and staff
available on each shift
Inadequate staffing levels on night shifts and weekends
Poor skill mix
Assistant Practitioners counted in Registered Nursing numbers in some
Links to Compassion in Practice Workstream
Berwick Recommendations
Government, Health Education England and NHS England should assure that
sufficient staff are available to meet the NHS’s needs now and in the future.
Healthcare organisations should ensure that staff are present in appropriate
numbers to provide safe care at all times and are well-supported’.
‘Boards and leaders of provider organisations should take responsibility for
ensuring that clinical areas are adequately staffed in ways that take account of
varying levels of patient acuity and dependency, and that are in accord with
scientific evidence about adequate staffing’.
Reference to NICE work and to staffing ratios
Our Vision – developing the culture
of compassionate care
“The actions set out in this vision
and strategy will change the way we
work, transform the care of our
patients and ensure we deliver a
culture of compassionate care”
Jane Cummings, Chief Nursing Officer
for England
Our values and behaviours are at
the heart of the vision and all we do
Action at all levels…
1. National Actions – a range of initiatives that will be led by national
bodies and regulators such as CQC, NMC, NTDA and Monitor.
These will also be supported by key stakeholders such as Health
Education England, the RCN and the RCM.
2. Local Actions – a range of initiatives to be led by local
organisations and be supported by national bodies, creating the
environment, providing leadership and giving the highest priority to
achieving the culture of compassionate care. There are many
examples of excellent practice in the Midlands & East region.
3. Call to Action – the overarching focus for organisations and
individuals specific to each area of action.
Six Areas for Action
Helping people to stay
independent, maximising well-being
and improving health outcomes
Working with people to provide a
positive experience of care
Delivering high quality care and
measuring impact
Building and strengthening
Ensuring we have the right staff,
with the right skills in the right place
Supporting positive staff
Francis Recommendations
Evidence to the inquiry suggested that the Trust did not have
reliable nursing establishment figures
23 – NICE to develop evidence-based tools for establishing what
each service is likely to require as a minimum in terms of staff
numbers and skill mix
195 – Nurse ward managers should operate in supervisory
capacity, visible to patients and staff, role model and mentor
205 – Seek and record the advice of Nursing Director on quality
and safety on major change
Key Objectives of Action Area Five
Directors of Nursing to agree appropriate staffing levels through the
application of evidence based tools
All nursing and midwifery staffing levels and quality experience
metrics should be discussed at a public board meeting
Boards to sign off and publish evidence based staffing levels at
least every six months, providing assurance regarding the impact
on quality of care and patient experience
Monitoring of compliance (CQC, NTDA, Monitor, Contracts)
Workforce Planning Tools
Tools for Acute Care:
Safer Nursing Care Tool Guidance and Multipliers Updated
Work in progress to develop Safer Nursing Care tool for
AMUs / A&E / Children’s In-Patients
IPAD-APP development to record SNCT acuity and
dependency scores at the bedside and generate local
reports – proof of concept stage
Workforce Planning Tools
Tools for Maternity –
Birthrate Plus RCM publishing updated guidance in autumn
Tools for Community (by April 2014)Workshop session held in August
Workstream being led by the Workforce Project Board of the
Community Nursing Strategy
QNI undertaking review of existing tools
Workforce Planning Tools
Tools for Mental Health (by April 2014)Two workshop sessions held
Pilots of Keith Hurst and NHSScotland tools due to
commence in next few weeks
Literature Review
Learning Disabilities (by September 2014)Sub group met in September
Literature Review
Working with MH group for in-patient settings
Focus on tools for community settings
Good Practice Guidance
National Quality Board publication 19th November
Will include expectations and case studies
Working with CQC regarding the potential monitoring of
implementation of recommendations
Themes –
responsibility and accountability
evidence base
Future Work
Work with NICE to establish adequate and appropriate staffing
`levels for all care settings
NICE have joined Steering Group and are scoping out options
`for the work programme
Scoping work around supervisory status of senior sisters /
`charge nurse / team leaders
NNRU review of impact of 12 hour shift patterns due to