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Focus on nursing and care quality

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The establishment of a Nursing and Care Quality Forum (NCQF) was announced by prime minister David Cameron in January, with the broad remit of identifying and spreading best nursing practice.

Former nurse and long-term patient advocate Sally Brearley was chosen to lead the forum, which will focus its efforts on four areas: promoting nurse leadership; instilling the right culture and values; listening to patients; and ensuring nurses have time to care.

Ms Brearley will lead a team of 22 forum members with a range of nursing expertise and is confident that the breadth of experience they bring to the table will allow the forum to make effective recommendations. The group met for the first time last month.

'You could regard the forum as being the 22 people in the room with David Cameron and we do need those people to get together and look at what best practice is and devise how they are going to spread it and make it happen,' says Ms Brearley. 'But on the other hand, we cannot do that alone. We need buy-in, energy and enthusiasm from the nursing profession.'

The Nursing and Care Quality Forum

The Nursing and Care Quality Forum aims to help all those involved in providing nursing and care, in all care settings, to:

Deliver the fundamental elements of good care- compassion, dignity, respect and safety- first time, every time and to everyone.

Achieve their ambition of providing the very highest quality of care through supporting the adoption of best practice and promoting innovation.

Reignite and restore public confidence in the quality of nursing and care provided to the people of England or manage incontinence.

The forum will focus its work on four 'work streams':

Promoting and achieving nurse leadership across the system

Making sure that the right culture and the right values that put patients first prevail at all times.

Looking at how best to involve, listen to, hear and respond to feedback from patients.

Making sure that those providing care have the time to do so properly.

End of May deadline

Mr Cameron has challenged the forum to 'scour the country, find out what works, and share it across the NHS'. He has given a deadline of the end of May for the group to present some 'key ideas'.

However, with a 400,000-strong nursing workforce, a range of disciplines and different care settings, this sounds challenging.

'We can't do everything,' acknowledges Ms Brearley. 'That's why we are focusing on the four work streams.' She adds that the work of the forum will continue beyond the May deadline.

'We are constrained to some extent by the short timescale, but we are hoping to have the opportunity to go out and talk to people and meet people and we are asking our individual forum members to each identify an engagement opportunity for us. We are also open to people coming to see us to tell us what they're doing.

'We want to do more engagement events, and if we can't fit it into this first phase, we will make sure we do that in phase two. '

However, with falling nurse numbers, a controversial reorganisation of the NHS driven by the Health and Social Care Act, and a health service battling to make £50 billion of efficiency savings by 2015, Ms Brearley concedes that engaging the nursing workforce will be an uphill battle.

'Cynicism is completely understandable, but I've been tremendously encouraged already by people's willingness to contribute to this,' she says.

'Even those who have expressed cynicism have gone on to tell us the great things they are doing and the things they think should happen to make things better.

'I hope we can demonstrate in what we do that it is worth it and that it is worth putting cynicism aside and committing to it. This is fundamentally about trying to enable people to do what they want to do. People come into nursing and they want to do a great job for their patients and their service users.'

Critical reports

Part of the forum's remit is to address issues raised in a series of critical reports on the quality of nursing care, including an investigation by consumer watchdog Which? into care at home; this found that some patients had been left in soiled beds; were unable to reach food; or had not been given medication.

'I'm sure these reports prompted the start of the Nursing and Care Quality Forum and we need to address the concerns raised,' says Ms Brearley. 'I'm not suggesting the people we recruit at the moment aren't caring, but are we doing enough, based on the recommendations of the NHS Future Forum, to make sure we are recruiting as much on the ability to be caring and compassionate as we are on their technical abilities?'

This is not just a concern when nurses are starting out, Ms Brearley argues. She believes employers should ensure compassion is high on the agenda when appointing nurses at any level, across all settings.

'An element of the recruitment selection process should include not just that someone came into nursing willing and able to care, but that they are still willing and able to do it.'

Lack of compassion

A recent Independent Nurse survey of more than 100 primary care and community nurses found that 32 per cent of respondents believed levels of dignity and compassion were slipping in their organisation with 45 per cent saying levels were 'remaining the same'. In more than half of cases, respondents stated that their employer neither monitored nor promoted the importance of compassion in patient care.

'Perhaps employers are failing nurses, by not enabling them to maintain their caring and compassionate skills,' Ms Brearley says. 'It is something that relates to people who feel burned out. People want to care and be compassionate, but that is hard to do day-in, day-out.'

One issue that has divided opinion (among nurses, ministers and professional bodies) is that of regulation for healthcare assistants (HCAs) and for advanced nurses, including advanced nurse practitioners (ANPs). Currently, use of the ANP title is not regulated, and HCAs are only subject to voluntary regulation.

The government does not believe there is a strong enough case for expanding compulsory HCA regulation, despite nurses' leaders claiming it is a way of improving care quality. Ms Brearley can see both sides of the argument.

'I know there is a strong feeling that the answer is always regulation: that whenever there's a problem, we need more regulation,' she explains. 'As a patient, to some extent, that tends to be my reaction: more regulation or better regulation. I'm not saying that isn't part of the answer but there may be other things that we can do too.'

Ms Brearley is also sympathetic to the view that better care comes as a result of better staffing levels.

Last month, a survey of more than 1,500 members of health sector union Unison, found three quarters did not believe they had a sufficient time to spend with patients in order to deliver dignified, safe, compassionate care. Almost 90 per cent said they supported legislation to set minimum nurse-to-patient ratios.

'If you look at ensuring nurses have time to care and are being supported to care and have the right culture and values to be able to exercise leadership, obviously all of those things are predicated on you having the staff there able to do that,' says Ms Brearley.

'You will not have time to care if you do not have enough staff. Obviously you need enough people to deliver high quality care to every one, every time, in every setting,' she says.

'Considered opinions'

Rather than offering definitive solutions to specific issues such as staffing levels or regulation, Ms Brearley says the forum may proffer 'considered opinions'.

'The forum may say nurses need a tool to be able to say what their level of staffing is and what level of staffing they need, but I'm not sure how far down the line we go. Issues like regulation and staff-to-patient rations probably aren't topics for us to do pieces of work on,' says Ms Brearley.

How the Nursing and Care Quality Forum intends to disseminate recommendations is unclear. Speaking at the Florence Nightingale Foundation conference in March, health secretary Andrew Lansley said the body would not be producing a report when its work came to an end, begging the question: 'how will it ensure its findings have practical meaning for nurses working on the frontline?'

Practical role

Ms Brearley believes the forum has a practical role in spreading best practice. 'I'm not saying we're not going to write anything down, but I think we'll be going back to the prime minister with something much briefer than a report.

'It's about capturing what's going on at the moment, showing how it is being spread, looking at how we, as a nursing profession, can work together to spread it, rather than simply saying "here are some recommendations" and asking someone to pick them up in the future.'

Ms Brearley is confident that the forum's work will be acted upon by ministers and is not disheartened that the Report of the Prime Minister's Commission on the Future of Nursing and Midwifery, conducted under the previous Labour government, was shelved by the incoming administration.

'All I can say is we have the term of this government, until 2015, and we're only in the first half of 2012,' she says. 'We must make as much happen as we can and I think it is great the government is behind us - we must make the most and do the best we can.

'We need to make sure that we are evidence-based, and that we have established evidence for what we recommend,' she continues. 'It also needs to be do-able and we are very conscious of the constraints around money.

'But if we have the support of the profession and willingness from nurses to do it, I'm really encouraged that, as an independent forum, we have the political support to make it happen. However, it won't happen without the support of nurses on the ground doing their day job.'

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