Lord Darzi's plan for the NHS - What is missing?

Leeds Church Institute LS1 6DG

Wednesday 12th March 2008 10am - 4pm

Chair David Pickersgill

with Dr Ken Jarrold, former chief executive of County Durham and Tees Valley strategic health authority, will talk about Nursing and Team Leadership

Dr Hannah Cooke School of Nursing, Midwifery and Social Work University of Manchester. Hannah's presentation

Ruth Marsden Vice Chair National Association of Patient Forums

Rob Demaine UNISON Regional Officer for Health covering Sheffield: UNISON's written response to Lord Darzi’s NHS Next Stage Review

Socialist Health Association Response to the NHS Next Stage Review

Ken's presentation:

Lots of good things in today’s NHS – shorter waiting times, National Service Frameworks, improvements in services for Coronary Heart Disease, Cancer and Mental Illness, patient centred process, the work of the Healthcare Commission and NICE and resources.

Growing and worrying evidence of loss of focus on patient experience including;
Almost a third of the complaints about hospitals referred to the Healthcare Commission for independent review relate to dignity and respect, nutrition and other aspects of basic personal care including;

• Patients left in soiled bedding and clothing, no regular baths or showers or oral hygiene, inappropriate or inadequate clothing.
• Commission noted that care on general wards fell well below the care provided on specialist wards. Older patients were most at risk because they were often most dependent on good nursing care.
• Commission Report on older people. Of 23 Trusts only 5 complied with all the core standards for dignity in care. Formal warnings to 8 Trusts including Barts.

Darzi very clear on the issues – patients want to be treated as people, care to fit into their lives, the basics to be right, to be treated with dignity and respect, notes to be available and buildings to be clean.

Older people feeling neglected, treated as an object, privacy not respected, needing to eat with fingers, being rushed and not listened to, beds not being cleaned, not being helped to wash, mixed sex wards.

All four of Darzi’s themes are relevant to these issues – fair, personalised, effective and safe.

Darzi says that “nurses have a key role” but does not develop the theme.

The first thing that is missing from Darzi is an understanding about what is going to deliver personalised care.
Nursing is the most important process in healthcare. Nursing is the essence of care.

The danger of a former lay manager talking about nursing but 37 years of working in the NHS, career long interest in nursing started by involvement in Briggs committee, 14 years experience as a carer.

The danger of nostalgia – bring back Matron! But my support for nursing education within HE, advanced nursing practice, nurse prescribing and nurse consultants.

What we need is a crusade [an organised energetic campaign] to focus on nursing.
Nursing is the forgotten issue. Burdett Report [Who Cares Wins] – NHS Boards rarely discuss nursing. Targets and money dominate the agenda.
The crusade should include:

Leadership from the Chief Nursing Officers in the four home countries working with Nursing and Midwifery Council, Royal College of Nursing, Royal College of Midwives, Community Practitioners' and Health Visitors' Association, Queens Nursing Institute, Unison and Universities with the full support of Ministers and the Chief Executives of the NHS in the four home countries.

Nursing needs to be a priority at all levels in the NHS – Department of Health, Strategic Health Authorities, Trusts, and Primary Care Trusts.
Managers need to understand nursing – the most important process in their organisations.
Directors of Nursing need to be encouraged to talk about nursing!

We need to ask;

• The public, patients and carers about their experience of nursing, and what they would like to change.
• Applicants for nursing why they want to be nurses and what they expect to be doing.
• Schools of Nursing about the education and training process and about values and behaviour as well as knowledge and skills.
• Nurses at all levels about their work, they issues they face and what it means to be a nurse in the UK today.
• Other staff, including doctors, about their views on nursing.

Nursing needs to be at the heart of the NHS.
Only improved nursing can deliver care that is personalised.

Only improved nursing can deliver real attention to dignity, privacy, cleanliness and nutrition.
Nurses need to be valued and appreciated.
Nurses need to see real evidence that nursing is a priority at all levels.
Nurses need to be empowered to focus on the essence of care.

The second thing missing from Darzi is a focus on Team Managers.
The people of the NHS –the staff – work in Teams.
The managers with the most potential for effective change are the Team Managers because, as Beverly Alimo Metcalfe says, leadership is a contact sport!

It is the Team Managers who can deliver performance, productivity, and good quality patient experience.
Only Team Managers can manage, lead and motivate staff effectively.
Research suggests that Team Managers need to provide support, feedback, development, training and clear job content.

Darzi acknowledges that “ some staff are not listened to and trusted” and that “ staff often feel left out of the changes that are happening”.
Darzi set up David Nicholson’s group to consider how to put the business of care at the heart of what local NHS Boards do and to focus on leadership.

However there is no mention of a focus a on Team Managers.
The two things missing from Darzi are;
A focus on nursing – the essence of care and on Team Managers the real managers of the NHS.
There is a close connection between the two issues.

Most Team Managers are nurses.
Only Team Managers are close enough to patients, carers and front line staff to make a difference to patient and carer experience.

last updated 13/03/08