PATIENT SAFETY
Making the NHS the best place to work
Recent surveys show a growing discontent among staff with regard to conditions of work in the NHS. Some of this is due to the pressure of not having sufficient time to work with patients, as well as rising levels of bullying and harassment. BAME staff report some very poor experiences and stories following the Brexit vote of racially motivated remarks being made to previously trusted colleagues from EU countries, demonstrating a general deterioration across the working culture in the NHS. We have to improve the working lives of all staff and increase the tolerance we have to each other! The intention to address the nursing shortage within the plan, talks of an urgent ramping up of overseas recruitment for the short term and better retention actions. Agreed – although this action is a lot too late. Awareness of increasing NHS nursing vacancies has been in the news for months and months now. There is no accountability in government for the poor nursing vacancy rate.
The plan states that in order to improve, a new offer will be developed with an explicit statement of support that can be expected of the NHS as a modern employer. The statement will be framed around some broad themes of creating a healthy, inclusive and compassionate culture, enabling great development and fulfilling careers, ensuring everyone feels they have voice, control and influence.
Creating a healthy, inclusive and compassionate culture, including a focus on: Valuing and respecting all Promoting equality and inclusion and widening participation
Tackling bullying and harassment, violence and abuse.
Enabling great development and fulfilling careers, including a focus on: Education and training (including mandatory training) and career and professional development
Recognition of qualifications and training between and within NHS employers Line management and supervision.
Ensuring everyone feels they have voice, control and influence, including a focus on: Whistle blowing and freedom to speak up Physical and mental health and wellbeing and reducing sickness absence
Workload, work-life balance, clear and timely rotas, flexible working, and managing unpaid caring responsibilities Work environment.
Improving the leadership culture The culture within the NHS is very much shaped by the leaders in the Trusts and commissioning organisations. Everyone in those organisations needs to focus on providing a positive, inclusive and people- centred culture that engages people and ensures a clear vision of improvement and
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advancing equality of opportunity. The plan cites that where leaders focus on developing, engaging and supporting their people to improve services for patients and citizens, the quality, financial and performance metrics also improve.5
They are careful to
highlight that middle management culture is vital too, as they set the tone for how teams across the NHS work and behave. So, the connecting layer of middle management also needs to engage with the vision described. New competencies and standards will be written for management to assist them to develop the shared purpose for their organisations.
Delivering 21st century care.
The Long Term Plan sets out the road map for the potential changes to healthcare required to meet the challenges ahead. The new service model includes increasing care in the community; redesigning and reducing pressure on A&Es; more personalised medicine; digitally enabled primary and
outpatient care; and a focus on population health and reducing health inequalities. The Long Term Plan also suggests areas where earlier diagnosis, new and integrated models of care and better use of technology offer the potential to significantly improve patient care and population health.6 If all of the above is to be realised, care teams will need considerable changes to address skill mix, co-ordination with others and transformation in their flexible approach to care delivery. There will be new roles, changes to existing roles, a huge increase in data science and digital skills, as well as scientific innovation to transform care pathways and clinical practice. Multidisciplinary teams will enable more integrated, person-centred care.
Tackling the nursing challenge
When the immediate issue of nursing vacancies has been reviewed at government level and significant action proposed, the interim plan suggests that looking forward the strategy should be to drive towards a supply balance for nursing that meets demand, centred on a domestically grown workforce. This will need attention on: Increasing supply through undergraduate nursing degree courses, as the largest and most effective supply route, and reducing attrition from training
Providing clear pathways into the profession and further developing additional entry routes through the nursing associate qualification and apprenticeships
Improving retention of our existing nursing workforce
Supporting and encouraging more nurses to return to practice
Ensuring that any nurses wishing to increase their part-time working hours are able to do so
AUGUST 2019
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