Healthy debate – missing the point #NTsummit

It has been good following the debate on NT.net of our announcement of our move to the new all graduate nursing curriculum. Some get it and others don’t. We believe we have focussed on a curriculum designed to address fundamental issues relating to quality of care in the NHS and to express a passionate commitment to inculcating the values that are fundamental to putting right poor care.

It is good to see the issues discussed openly. I hold to my view – high calibre, well prepared nurses are pivotal to the quality of care in the NHS but, alone this will achieve little. Organisational culture and a leadership skilled in promoting high quality care centred around individuals, knowledge and skills and an organisation that promotes quality of care above all else remain key.

I have spent the last 2 days at the Nuffield Trust Health Summit #NTSummit with past and present leaders of the NHS system. Reform, redesign and performance management, at a fascinating time in the history of the NHS, were the predominant themes.

But I was struck by the preoccupation with the mechanisms of the NHS system by the assembled community. Debate around the extent to which it is in fact as ‘radical’ as the media suggests and the wisdom of taking the NHS through vast, costly, and poorly understood changes at a time of financial constraint – ‘It better be worth it’ was the main conclusion.

Absent for me was any real emphasis on core values, on the central and most important of issues – quality of care. On how quality is to be protected and nurtured in the new regime. Critical to this alternative agenda is not commissioning mechanisms or outcome measures but investment in a high calibre workforce and an organisational culture and reward systems that supports it.

Quality is a ‘cut-down’ concept referring to a deeply complex set of Pre-requisites that produce excellent support, productive care and health outcomes, valued by the individual who receives it. It is a pity that so little air time is given to fundamentals of quality, while so much emphasis is focused on a system, its hierarchies and the machinery of production.

I fear that caring, compassion and it’s corollaries succumb yet again to structures and careers.

A better week for nursing

This has been a historic week for nursing in England as higher education institutions have put forward plans to meet the requirement for all nurses to graduate from training with a degree by 2013. I am proud to say that the Faculty of Health Sciences at the University of Southampton was the first in the country to have our degree Programmes approved by the Nursing and Midwifery Council. Our nursing programme in Southampton will become all graduate from September, 2 years ahead of the deadline.

We have called for this change to happen over decades. Even though we are the birthplace of modern, evidence based and data informed nursing, England has lagged behind Scotland, Wales and many other countries despite there being strong evidence to indicate that nurses prepared to degree level enhance the quality of care and are associated with better outcomes. All other professions in health including doctors, physiotherapists, occupational therapists etc have been expected to study to degree level as of right, but with nurses there has been deep ambivalence over accepting that to manage care and provide treatment in modern health systems requires extensive knowledge and skill. Nurses these days do many of the tasks that doctors performed 25 years ago when I was training to be a nurse.

Our new degree programme in Southampton is based around a curriculum designed to inculcate clear values from the first day. Compassion supported by a deep understanding of evidence based knowledge and confidence to recognise and speak out against situations where care falls below acceptable quality. Our students will benefit from studying with our world class researchers. They will learn alongside other professions – trainee doctors physiotherapists and occupational therapists and others as we believe this is how teams in health care increasingly work. They will have opportunities to study a second language and to study abroad.

We believe the training we have developed will produce unique nurses well prepared for the ever increasing demands of contemporary health care. As part of the process of assessing the quality of our new degree members of the scrutiny panel met a group of students from our nursing degree programme. One member of the panel, a patient, told me that having met the students she was so impressed by them, that for the first time in many years she felt the NHS, and vulnerable and sick people in need of care are safe in their hands. After the events of last week when we saw the publication of the Ombudsman’s report it feels like we might have produced a genuine response to the problems quality of care – a much better week for nursing.

http://www.nursingtimes.net/nursing-practice/clinical-specialisms/educators/university-to-train-all-nurses-to-degree-level/5026261.article

Care and Compassion – the report this week by the Health Service Ombudsman is an indictment of NHS care for older people and we are all culpable. But let’s not jump to hasty conclusions about it

I started my training as a nurse in 1979. I was one of the early entrants to a new programme in London University preparing nurses to degree level, during the 4 years of my training I worked in hospitals across London, it was a great preparation for my career as a nurse.  But, I don’t look back on those days or those experiences as being exemplary.  There were problems in the quality of care then, much was excellent, but I was also witness to poor care and there were things that shocked me and could easily have made the headlines on the Today programme.  So the Ombudsman’s report, though shocking, sadly doesn’t surprise me.  http://www.ombudsman.org.uk/care-and-compassion/downloads 

Over the last days since the report was published we have heard a whole range of inputs into why is this happening, what has gone wrong and what we should do about it.  My main thought is to warn against jumping to hasty conclusions we have heard a lot about whether we should train nurses differently, concentrate on the basiscs of care or stop nursing becoming ‘too academic’. This seems precisely the wrong approach.

What we need are high calibre and highly trained nurses who are supported and well prepared to uphold strong values around compassionate and person centred care, attending to the basics of what people need when they are ill and especially for those who are vulnerable such as frail older people.  These are expert tasks not just every day actions.  We need to detail the science behind what creates the circumstances to get this right.  The evidence is developing on what is required and is pretty clear – leadership, organisational climate and context, a skill mix that includes high calibre and expert clinical leaders and teams, adequate staffing levels and interventions into the health system that provide a framework for high quality care. Critical is organisation culture that upholds and supports the delivery of such care. I’d like to see the debate on this focus on what really needs to happen, especially as health care organisations – hospitals, care homes and community care teams will be forced over the coming months to cut back on the very resources, that is expert nurses who are best able to provide expert care, for the most vulnerable people in our health care system.

it’s been great to welcome our two new Professors

Peter Griffiths has joined us from King’s College as Professor of Health Services Research. Peter is an expert on nursing workforce issues and the measurement of nursing and patient outcomes and the organisational factors that contribute to high quality outcomes of care. Peter is editor of the International Journal of Nursing Studies.

 Dan Bader has joined us from Queen Mary College, London as Professor of bioengineering and tissue health.  Dan is a medical engineer who is an expert in the science behind how pressure sores develop and in tissue damage, he will be establishing a new research programme working with nursing and allied health professional colleagues to tackle some of the most pressing and costly problems for the NHS – pressure sores and skin breakdown. He is currently establishing laboratory facilities at our academic centre at Southampton General Hospital and is looking forward to teaching nursing allied health professional and health science students at the University.

talking about the National Cancer Survivorship Vision at the NCRI conference in Liverpool

http://www.ecancermedicalscience.com/tv/video-by-category.asp?play=749&cid=2&scid=92&q=

first ever data to show the quality of care for patients with cancer in hospital trusts in England

 

These results from the national cancer patient experience survey for 158 hospital trusts in England show the quality of care reported by 67,000 patients treated for cancer in England last year and was published last week by the Department of Health.  The red, green and amber traffic light colour code shows Trust performance in the top and bottom 20% of performace.  This is a very powerful tool for judging the quality of care provided to cancer patients across England. 

http://www.dh.gov.uk/en/Healthcare/Cancer/Patientexperience/index.htm

 

Just published with my colleague Lucy Brindle

 We have set out our thoughts on the social factors and processes that seem to lie behind why people are diagnosed  with cancer much later than they should.  It is time that we invest in research to understand why this is the case and to think about how we might change an all too comon problem.

http://jech.bmj.com/content/early/2010/12/06/jech.2008.084285.full.pdf