Jane Cummings: I am delighted as the Chief Nursing Officer for England to be presenting this short film about how nurses, midwives and care staff
can make a huge difference by leading change and adding value.
Global recession and austerity has put public services under significant pressure. We do know, though,
that there is a way forward, as set out in the Five-Year Forward View. With the right
changes, the right partnerships and the right investments we can put our health and care
services onto a more sustainable footing. This understanding has led to the creation
of a new framework that positions all nursing, midwifery and care staff as leaders.
Firstly, it is about aligning our efforts, so we use our leadership to narrow the gaps
that exist in England. These are in relation to health and wellbeing, care and quality,
and funding and efficiency. Secondly, in order for us to close these gaps,
we need to focus on working with unwarranted variation. This helps us to understand the
differences in how services are delivered, and the outcomes that are achieved. Working
with information is key, as is measuring, monitoring with peers and working to secure
and demonstrate improvements. Thirdly, it is about measuring what matters.
Evidence tells us that measuring improved outcomes, better experiences and better use
of resources is the way that we can truly demonstrate the impact we have.
Finally, the new framework offers ten commitments. They can be applied at any level and by everyone,
irrespective of where you work or what you do.
Kirsten Ellmore: The unwarranted variation is that
there was a minimal amount of care around asthma in Shropshire schools. Most schools
did not have a policy. A lot of schools did not have an identified lead. A lot of schools
were using out-of-date inhalers or other children’s inhalers, and they did not have a clear, identified
training schedule. The care of asthma was not really where it should be in terms of
national evidence and national drivers. My role in identifying this as the lead for
asthma for the Shropshire nursing team was to work in partnership with our acute trust,
and part of that was to come up with an audit tool and to roll that out to the school nursing
team, to go into every single school in Shropshire to basically audit their care for asthma.
We decided to put together a guidance for schools with a few core principles. One was
that schools were to have an identified asthma lead, and then it would be the lead’s responsibility
to develop the training package, ensure children had a consent and a plan in place, and to
be the link, if you like, between the schools and the school nursing team.
The ability to demonstrate better outcomes following the roll out of the programme that
we implemented was really done in a re-audit, where we evidenced a huge increase in the
amount of children who had a written consent and an asthma care plan. Just those two things
alone will increase the care that young people get with asthma.
Part of that audit was also going back out to parents and having some qualitative information,
as well, and parents were saying that actually they were now sending their children to school.
Dr Kate Bell: The unwarranted variation in this
case was that we found that we had a really good group to support women during their pregnancy
with weight management issues, but unfortunately many of the women did not attend that group.
Kate Henton: One of the things that we did was actually ask ladies that did come to the group what
would engage them a little bit more within the group, and one of the things that always
came up – you know, everybody is always on their phones all the time – was actually Facebook.
Sally Walters: As midwives, we realised there were
these problems, and we could not get women to attend.
Kate Henton: Our Facebook group was the first Facebook group that was set up within the
unit, and there was quite a lot of negotiation that went on.
Sally Walters: Since the group has been set up, we have noticed there has been much better
attendance. Women are aware of what the groups are about. They interact more, they talk to
each other, they have got more confidence, they feel more positive about their pregnancy
and the service that they are getting, and the extra pathway they have for their pregnancy care.
Dr Kate Bell: The project is very important in
adding value to patient experience. The benefit of the peer support that people get from the
weight management Facebook page means that they are able to build up relationships and
share experiences, which they have reported back to us they have found extremely helpful.
Dr Kate Bell: I would say to other midwives in other trusts that actually, this is something that is worth
trying. Within the service, and maternity service, our engagement with our local population
has significantly increased.
Phil Orton: The unwarranted variation that we identified was that we were not necessarily
always getting it right in relation to delivering the right resident outcomes.
Belinda Jones: We were noting that there was inconsistency in practices. People were becoming quite task-orientated,
rather than person-centred. Phil Orton: We put a lot of staff through training.
We put a lot into our training budget every year, and we felt that we were not always
getting the best outcomes from the staff that had gone through the training. So we were
receiving things like customer complaints. We were finding that people with very complex
needs were having to move into more specialised services.
Belinda Jones: We needed something that would be able to benchmark where people are now, where
their knowledge and where their confidence and their skills in the care practice was.
The impact that we noticed with the Cognisco dementia key skills was that people’s confidence
was rising. Robert Miller: Before the training, I was going
into the household pretty much blind. Even though we knew each other as individuals,
the way we worked, we did not know each other’s knowledge gaps.
Belinda Jones: What we have also developed is an hour training session, so what we can do is
tailor training to that team. Phil Orton: The staff themselves are feeling
that they are providing better outcomes for the residents. They feel more empowered to
make decisions, and to make leadership decisions. Where it has really had the most effect is
where leaderships happen on a very local level, and people have embraced it and they have
really wanted to carry it forward and make some changes.
Gerry Bolger: The problem or unwarranted variation
that we were addressing was the fact that, when a patient was at risk of deterioration,
the wider clinical body would not be able to see that information. By introducing a
single VitalsLink solution, we now have to bring one device and so they can act immediately.
Katie Pritchard: It has had a real impact on handovers. We can have a list of our patients up on the
screen, and we can go round and individually look at the new scores. So there is no miscommunication;
it is clear. Gerry Bolger: We have been able to show that, by
using bedside devices, we have been able to release 600 hours of nursing time from routine
documentation. That time can be used in direct patient care that supports the patient outcome,
but actually supports the nurse’s wellbeing as well.
Nefer Mercado: Usually, in the old system, it took me at least an hour and a half to take all
my patients’ vital signs, but with this system it just takes me 30 minutes.
Gerry Bolger: We are not seeing technology as something new. We are seeing it as a way to help us.
I would say to any organisation that wants to replicate what we have done here at Imperial:
think about the conditions of change that are needed to effect improved patient care,
better experience for nurses, better outcomes for patients. Think about the leadership,
think about what it is you are trying to achieve, and actually bring everyone together. What
you will really do is involve nurses using technology in something that they do day in, day out.
Kirsten Ellmore: We are committed to promoting a culture that improves population health.
Robert Miller: I am committed to giving individuals the best care that I can.
Gerry Bolger: I am committed to improving patient care, enabled by technology.
Kate Henton: As a midwife, I am committed to get better outcomes for mother and baby.
Jane Cummings: The leadership potential of the workforce to manage the challenges of
today and shape the future is phenomenal, and we all need to recognise our potential
to do this. Everyone can influence and lead, whether in the 3,500 care homes or where a
million patients are treated every 36 hours in the NHS. You all have such a role to play.
This framework encourages us all to reach further, both as individuals and as a collective,
but to do this we need to focus on what is really important, to connect with each other
and to ensure that everything we do is focused on improving care for patients, for the population
and, importantly, to demonstrate the value of our professions.
Thank you very much for everything that you do.