Chief Nursing Officer Bulletin

Job shops and local recruitment drives have been hailed as a major factor in the record number of nurses now working in the NHS.

There are 367,520 nurses, midwives and health visitors working in the service, up 17,100 in the last year, according to the latest Department of Health figures.

Chief nursing officer Sarah Mullally said: "This reflects the hard work of nurses who have been involved in job shops and other local recruitment initiatives.

"This work is clearly paying off and it is important that these local events carry on to build on the achievements so far".

"I have also seen local examples of how boosting the workforce can both ease the pressure on staff already working in the NHS and further enhance patient-centred care," she added.

The Government has already achieved The NHS Plan target to recruit an extra 20,000 nurses two years early. An extra 50,000 NHS nurses have now been recruited since 1997.

The total number of people working within the NHS has increased by 57,808 (nearly five per cent) in the last year, taking the total to 1.2 million.

Scores of nursing staff who have pioneered new and innovative services for patients have been honoured with national awards.

Consultant nurse/midwife Faye Macrory won the Outstanding Achiever Award (nurse) at the Health and Social Care Awards 2003 this month.

Faye, who works at Central Manchester and Manchester Children's Hospitals University NHS Trust, has transformed services for drug-dependent women in the city.

Babies of substance-misusing mothers are no longer automatically transferred to a special care baby unit, they are looked after by their mothers on the ward.

Social services referral is no longer automatic but based on individual assessment.

Faye, who was awarded an MBE in 1997 for services to health care, manages and develops the service, which is now a model of care in many maternity services across the NHS.

In the Queen's Birthday honours 10 nursing staff from England were honoured.
CBEs went to Gary Jones, of Essex, for services to emergency nursing; Jennifer Lee Leggott, of Nottingham, for services to nursing and midwifery; and Robert John Pratt, of London, for services to nurse education.

OBEs went to Catherine Baraniak, of Derby, for services to primary care nursing; Robert Crouch, of Hampshire, for services to nursing; and Margaret Pauline Quinn, of Lancashire, for services to the NHS.

And MBEs were given to Stacey Atkinson, of Leeds, for services to children with learning disabilities; Christine Bentley, of Kent, for services to the NHS; Dianne Crowe, of Northumberland, for services to women's health; and Caroline James, of Bristol, for services to nursing.

Nurses can have a significant influence in making sure a hospital patient's recovery is aided by the environment they are treated in, a study has found.

Architectural healthcare environment and its effects on patient health outcomes focused on healthcare buildings in the acute and mental health hospital sector.

The NHS Estates-funded project found evidence that the architectural environment, such as the modern accommodation provided, did play a significant role in assisting recovery.

The study, which also involved Professor Bryan Lawson from the University of Sheffield, examined the clinical and economic effects on people being cared for by two trusts - Poole Hospital NHS Trust (acute) and South Downs Health NHS Trust (mental health).

Key findings were that patients are sensitive about their healthcare environment, have preferences for the wards they stay on and place great importance on cleanliness. Newer buildings were also found to have a better overall atmosphere.

Nurses are encouraged to look at the findings as they are best placed to raise issues relating to improving the patient environment and can also make many simple changes to directly improve the patient experience.

NHS Estates has also commissioned the King's Fund to extend a similar scheme - the nurse-led Enhancing the Healing Environment programme - which has been running in London hospitals since 2001.

The programme evaluation has so far mirrored many of Professor Lawson's findings, as well as showing the therapeutic value of improved patient environments.

The King's Fund has been asked to extend the programme to a further 23 trusts in England. Details will be sent to strategic health authorities in August.

The Government's new £50 million NHS genetics strategy set out in the White Paper Our inheritance, our future - realising the potential of genetics in the NHS will bring new opportunities for nurses.

As advancements in genetic research progress, and as people become more aware of how genes affect their health, healthcare professionals - including nurses - will want to keep abreast of how genetics can improve patient care.

There is much scope for new nursing roles from specialist nurses working with patients who have familial types of cancer, to practice nurses getting to grips with how different diseases run in families and when genetic testing can help.

There will also be opportunities to participate in pilot projects and other service developments being set up to introduce genetics-based healthcare into wider clinical areas. Of the £50m being invested over the next three years, about £5m is for pilot projects in primary care and in specific disease areas including cancer and familial hypercholesterolaemia. The Department of Health will be inviting bids shortly.

The nurse-led NHS Direct service will also need to keep abreast of genetic developments so that patients and the public will always be able to access up-to-date information. Midwives already play a vital role in antenatal screening for Down's syndrome.

Penny Guilbert, a senior genetic nurse counsellor who advised the Government on the White Paper, said: "Genetic research has traditionally been the province of specialist centres but this takes it more into the mainstream.

"There will be increased opportunities for nurses but, equally, it will also raise a lot of difficult ethical areas for those working in the service."

In a separate initiative, the Department of Health is funding a genetics-based education and training project for nursing at the University of Glamorgan.

Fit for practice in the genetics era: defining what nurses, midwives and health visitors should know and be able to do in relation to genetics maps out the competencies that nurses should achieve, working in different healthcare settings and at different levels of practice. Details will be available soon.

New guidelines from the National Institute for Clinical Excellence (NICE) focus on the triage, assessment, investigation and early management of head injuries.

Triage nurses will be required to immediately assess patients presenting with impaired consciousness before deciding whether the patient should be admitted.

The guidance also details procedures for NHS Direct nurses on carrying out prompt assessments, based on both a caller's current symptoms and any history of head injury. Nurses working in minor injury clinics will also assess a patient's suitability for referral to A&E.

Local emergency care networks will need to ensure that nurses involved in the rapid assessment of head injury patients have the appropriate knowledge, skills and competencies to carry out the assessment effectively.

Gabby Lomas, a senior A&E sister at Hope Hospital in Salford who helped develop the guidelines, said: "The most significant aspect is that CT scans will be carried out earlier.

"The guidance will also help deliver a consistent level of care across the country as it varies at the moment.

"For nursing, there are specific benefits, such as giving those working in NHS Direct, minor injury units and walk-in centres their own guidance on assessing whether someone needs to be referred to hospital.

"At Hope Hospital, we see about 65,000 patients each year and we are very fortunate that a lot of the procedures outlined by NICE, such as rapid assessment, are already in place here."

Ms Lomas said the guidelines raised training issues, with nurses requiring teaching in various new practices.

"Overall, ensuring the guidelines are implemented fully will mean a lot of multi-disciplinary working with other teams such as radiography departments," she added.

Approval of the new general medical services (GMS) contract for GPs will have a knock-on effect for nurses in primary care.

The contract is expected to lead to improved quality of care, a wider range of services and better rewards for primary care staff for the outcomes and quality of service.

Nurses will have the chance to extend their roles in areas such as chronic disease management, first contact care and preventative care.

The contract will also promote better access to continuing professional development, clinical supervision, appraisal and better employment conditions for all.

Nurses will be eligible for improved maternity and paternity leave and access to childcare, in line with their PCT-employed colleagues.

It may also be possible for nurses to become practice partners and to get more involved in decision-making.

They may also be able to get more involved in services that GPs opt out of such as out-of-hours care.

PCT lead nurses will have a vital role in implementing the contract. They will need to monitor and review contracts, ensuring clinical governance systems are in place for new roles.

They will also need to engage nurses in PCT decision-making and supporting nurses to work together across the PCT and practices.

Primary care nursing officer Maureen Morgan said: "The new GMS contract offers nurses and other health professionals a powerful mechanism for working in partnership with GPs to make a real difference for their patients.

"As a practice-based contract, there is recognition that primary care is best delivered by a team of professionals working together towards common goals.

"At the same time, modernisation of pay and terms and conditions, as outlined in Agenda for Change, means that nurses can be rewarded for the greater contribution they will make to patient care."

NHS pay reforms, recruitment and retention and training will continue to be the main responsibilities of John Hutton who was reappointed as health minister following the Prime Minister's reshuffle.

Mr Hutton will also be responsible for nursing issues as well as changing professional roles, regulation and improving working lives.

His portfolio also includes primary care, including nurse-led walk-in centres.

New health minister Rosie Winterton will cover the nurse-led NHS Direct service, emergency care, adult mental health services, clinical negligence, patient and public involvement, diabetes services, transplants and organ donation, dentistry and pharmacy issues.

Melanie Johnson becomes public health minister with responsibility for cancer, heart disease, tobacco policy, communicable diseases, immunisation, health inequalities, drug and alcohol misuse and sexual health matters.

Dr Stephen Ladyman will be the minister for community care, covering adult social services, older people's services, policy on carers, children's health services, services for disabled people and long-term medical conditions.

Norman Warner will be the Government health spokesman in the Lords but will also cover performance and quality issues.

Health secretary John Reid will have overall strategic responsibility for NHS improvement, delivery and reform, finance and resources.

This month the chief nursing officer Sarah Mullally praises the innovation, dedication and achievements of nurses over the past year.

Nurses, midwives and health visitors often make an extraordinary difference to patients and services.

As frontline staff you are at the cutting edge of this modernising health service and you achieve real results. Sometimes we may not see it ourselves or it may go unrecognised by others, but the difference you make is evident in many ways, for instance, in the way we relate to other colleagues and the way we build relationships with patients. This close interaction is vital for shaping and improving the patient experience.

The difference you make, whether it is on a large organisational scale or with an individual patient, their carer or family, still needs to be recognised, celebrated and rewarded.

Events such as the Health and Social Care Awards, the Queen's Birthday Honours and HR in the NHS Plan best practice awards, as well as a range of local events, have in recent months celebrated the contribution made by nurses, midwives and health visitors across the NHS.

I am delighted that this year 10 nurses and midwives from England were recognised in the Birthday Honours. Nurses also took a strong lead at the third annual Health and Social Care Awards and the HR in the NHS Awards.

Highlighting achievements in this way can only serve to spread good practice to other areas and organisations, which will lead to continual development of services and improved patient care. What we all need to do as nurses is to transform this excellence into the norm across the NHS.

These achievements are also changing perceptions of the profession. Such accolades should be viewed as a showcase for nursing as a progressive career, full of opportunities and rewards. This will boost morale and help our efforts to recruit and retain more nurses.

Numbers are rising as the latest figures reveal, and that is thanks, not least, to local recruitment drives but to national events which put nursing in the spotlight.

Nurses Day was another opportunity for us to promote nursing as a career and educate a new generation of youngsters about the vital contribution nurses make.

The Verse for a Nurse national poetry competition also helped to raise awareness of nursing.

I am extremely moved by and proud of the outstanding work this profession produces day in and day out and it is crucial that this is recognised if we are to continue making progress in modernising the health service.

Congratulations to all those nurses and midwives who have picked up awards and honours and all those nominated by peers and colleagues who have recognised how your contributions are changing the NHS - and changing it for thousands of grateful patients. Well done.

Have your say

The CNO Bulletin is tailor-made for nurses, midwives and health visitors across the NHS. It aims to cover the main topics of interest every month. Let us know about the information that you want to see included.

We also want to hear your views on the subjects covered in the bulletin. You can e-mail chief nursing officer Sarah Mullally direct at CNO-Bulletin@doh.gsi.gov.uk

We'll use your feedback to develop and shape future bulletins. It will also contribute to understanding better the views of NHS employees on current issues.

Please be assured that all feedback is confidential and that any opinions quoted will be featured anonymously.

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Guidance has been sent out to the NHS on further measures to tackle the problems of healthcare-associated infections (HCAI).

Chief nursing officer (CNO) Sarah Mullally and chief medical officer (CMO) Sir Liam Donaldson have written jointly to all trusts to extend the monitoring of these infections.

The mandatory surveillance programme will be extended to include serious bloodstream infections caused by glycopeptide-resistant enterococci and reporting serious infection-related incidents, such as hospital outbreaks of gastroenteritis.

From this month (July), surveillance information on methicillin-resistant staphylococcus aureus (MRSA) will be used as a basis for a performance management indicator. This will form part of the balanced score card which will contribute to the star ratings for acute hospital trusts.

Last month, the CMO also announced a further initiative to promote the prudent use of antibiotics in hospitals.

Nurses, midwives and health visitors are among NHS staff being urged to give feedback on the effectiveness of Practice Plus, the third and final stage of the Improving Working Lives (IWL) initiative.

IWL sets a standard of good working practice by which NHS employers and staff can measure an organisation's human resources management.

Organisations were required to achieve stage two accreditation by April 2003 by demonstrating they were improving the working lives of staff. They are now expected to complete the third and final stage of IWL accreditation by next April.

Practice Plus provides training to selected assessors but only targets those who have participated in at least one assessment during the past 18 months.
IWL accreditation will be awarded to NHS organisations that have
successfully completed Practice Plus.

The Department of Health says nurse involvement has been, and continues to be, a fundamental principle of improving the working lives of staff and crucial to the implementation of IWL.

NHS organisations can also use the National Audit Instrument (NAI), a practical tool enabling them to detail evidence of how they are implementing IWL.

Further details about the consultation process and NAI will be available shortly at www.doh.gov.uk/iwl/

In 2001, a community budget of £3 million was set up to provide grants for teams of frontline community practitioners and health visitors.

The intention was for primary care organisations to match that funding so that each locality team would have a budget worth at least £5,000 per year.

The budget has funded a range of public health schemes including community equipment for older people, breast-feeding support networks and mental health self-support groups.

The budget has also helped frontline practitioners to reach marginalised groups, such as asylum seekers and travellers.

Some practitioners are unsure whether this budget is still available. This is a recurring budget. The allocation for 2003-2004 was included in baseline allocations for all PCTs.

Lead nurses are urged to ensure that these budgets are made easily available to frontline teams to help tackle inequality.

A central budget for improving services for people with multiple sclerosis is available for 2003-2006.

This will support implementation of the MS Risk Sharing Scheme, which involves doctors and specialist nurses carrying out detailed monitoring of patients on disease-modifying treatments to assess their cost-effectiveness.

The specialist nurses' job descriptions should allow and encourage them to support all patients, not just those eligible for drug treatment.

The money will pay for additional MS specialist nurses and other nursing support in areas that might need extra resources to effectively implement the scheme. PCTs and their designated prescribing centres are invited to bid for funding.

During the war in Iraq, RAF reserve nurses from the NHS were mobilised to provide essential medical cover for the armed forces in support of aero-medical evacuation and surgical facilities. The RAF's director of nursing has paid tribute to those NHS nurses, saying they played a key role and their experience and training were second to none. The RAF added it could not have mounted such a medical operation without their contribution.

Heart boost

A new network of specialist heart failure nurses will be created after an injection of £10 million from the New Opportunities Fund.

The network will cater for patients with heart failure, helping them retain independence in their own homes.

The nurse networks will provide information for patients and their carers, linking in with primary and palliative care services.

The British Heart Foundation (BHF) will manage the network. BHF head of cardiac care Jackie Lodge said: "Research shows that our nurses have provided a lifeline for many people.

"The fact we're now able to fund at least 75 more posts means we can make a real difference to the quality of life of thousands of heart failure patients."

A new website to help nurses and health visitors reduce patient falls has been launched by the Foundation of Nursing Studies.

The site provides progress reports on various falls prevention schemes supported by the foundation.

It is also encouraging teams involved in similar work to share their examples of best practice.

A new report detailing the progress of the Government's diagnosis and treatment centre (DTC) programme has been published.

Diagnosis and Treatment Centres - A New Service Model has been published by the NHS Modernisation Agency.

It details the work being done by the various DTCs already established across the country and includes case studies.

The report also has a map showing where centres are situated and what stage of development they are at.

A hard copy can be ordered by e-mailing steven.ball@prolog.uk.com quoting reference MA/SIT/DTC/001 and including a postal address.

A Home Office review says nurses should be able to certify deaths. Currently, doctors usually complete the certificate stating the medical cause of death.

Following a two-year review of the national death certification and investigation process, nurses may soon take on this responsibility in certain circumstances.

The review was commissioned in response to the conviction of Harold Shipman, the GP who managed to kill at least 215 patients. His actions were repeatedly undetected because he signed his victims' death certificates.

The home secretary will consider the review later this year before deciding which recommendations to adopt.

A new NHS Recruitment Handbook has been published by the Department of Health to provide information, resources and good practice on the recruitment of all NHS staff.

The handbook sets out the national and international recruitment and return strategies. It demonstrates how these initiatives, in partnership with local innovation, have been applied successfully with a series of case studies, to make good practice the norm.

The Department of Health is fully committed to ethical overseas recruitment. International recruitment has made a key contribution to the delivery of services in the NHS. However, it is essential that international recruitment fills its proper place in staffing the NHS and is not done to the detriment of countries experiencing staffing difficulties. The NHS does not recruit from countries that cannot afford to lose staff. The department is working with developing countries to support their own human resources policies and with the independent sector to ensure they recruit ethically.

The website also provides a list of developing countries that the NHS does not recruit from. A list of agencies that abide by the ethical code of practice is also available.
[Follow the link on the website to Code of Practice in the left-hand column then scroll down the page to the Developing Countries List pdf]

Mary Coffey and Talib Yaseen have been seconded to the Department of Health as professional officers for development.

They will help develop the link between the department and the strategic health authority (SHA) lead nurses. Before taking up their new posts they were working in the Directorates of Health and Social Care, London and the North respectively.

A key part of their role will be to ensure the development needs of SHA lead nurses are met and that effective communication channels are in place between the chief nursing officer's office and the NHS. They will be supporting the professional networks established by SHA lead nurses.

The national poetry competition for primary school children as part of Nurses Day on 12 May was open to children aged seven to 14

Entries were received from all over England, including some from those in hospital and from special schools.

The overall winner in the seven to nine-year-old category was George Andrew, nine, from Scargill Church of England School, Derbyshire.

Emma Crook, 11, from Manor House School, Surrey, won the older age category with a poem written for the nurse who has looked after Emma all her life.

They both won a set of Puffin Classics books for their school and visits to their schools by favourite children's illustrators, Ken Wilson-Max and Chris Riddell, who will illustrate each of their winning poems for them.

ITV's SM:TV presenter Tess Daly helped the campaign this year by writing her own special poem for Verse for a Nurse and Blue Peter featured nursing on two of their programmes in May.

The website www.learnaboutnursing.org has been set up to support the activity, aimed at both primary school teachers and pupils.

The Nurses Day team are still looking for volunteer nurses to carry out some primary school visits. A list of those schools who are interested in arranging a visit is available at www.doh.gov.uk/cno/whatsnew.htm

If you would like to take part and can arrange a visit either this term or after the school summer holiday contact Vicky Wayland at victoria.wayland@brewerblackler.co.uk
or on 0208 875 3824.

Did you see the news about? If you missed an announcement or new development of interest to you, the chances are that it could be listed in The Digest. Each month in The Digest we feature subjects of note including where to obtain more information.

On the State of the Public Health highlights five areas of concern � the health risks from passive smoking; West Nile virus; obesity; poor clinical performance; and safe injections.

He also reviews progress made in tackling health inequalities, high blood pressure, E.coli 0157, epilepsy and alcohol and liver cirrhosis.

A comprehensive action plan to tackle inequalities in health across England has been published.

Health Inequalities � A Programme for Action sets out detailed ways in which the Government�s strategy to cut inequalities in health can be put into practice.

It provides a toolkit to help organisations restructure services to address specific local health problems.

A new system for handling cases of clinical negligence in the NHS has been proposed by the chief medical officer.

Views are now invited on Making Amends from nurses on the proposals. A consultation period will run until October after which a definitive policy statement will be issued.

A new NHS Redress Scheme is proposed to speed up the clinical negligence process when NHS care and treatment goes wrong.

The Department of Health has launched a new website section focusing on waiting, booking and choice.

It sets out the vision and strategy for delivering the reforms needed to ensure NHS patients obtain faster and more convenient access to health care, including within primary care.

The new section highlights tools available to managers and gives examples of primary care trusts or practices which are giving their patients better access to NHS services.

Waiting times for NHS treatment continue to fall as the latest figures reveal a massive decline in the number of patients waiting 12 months or more.

At the end of March last year, 21,900 people were waiting over a year for hospital treatment.

But by the end of May this year that number had dropped to an all-time low of just 159 people, concentrated in just 11 hospital trusts in England.

The number of outpatients waiting to see a hospital specialist at the end of May was 1,003,000 � 52,500 lower than at the same time the year before.

The 136-page guide works alongside the NHS Direct helpline service and contains advice on the most common symptoms about which people call the service.

While the guide is available to everyone, limited stock means we have to be more targeted with its distribution. As such NHS Direct is currently concentrating on socially-disadvantaged groups and older people.

However, this should not affect the already established strong distribution links through GP surgeries and pharmacies.

If you can help with this targeted distribution, copies are free and can be obtained by calling the NHS Responseline on 08701 555 455.

Details and application forms for the Nursing and AHP Researcher Development Awards and Post Doctoral Awards are available from www.doh.gov.uk/research/rd1/nahp.htm

The new health watchdog is inviting NHS managers to help shape the way it carries out inspections.

The Commission for Healthcare Audit and Inspection (CHAI) will be responsible for assessing the quality of health services from next April.

In April, the Department of Health published Emerging Findings � a document setting out some of the early thinking on the development of the National Service Framework (NSF) for Children, Young People and Maternity Services.

The NSF will set standards across health and social care services. It has three key objectives: to put children and families at the centre of care; to develop effective partnership working so that the needs of the child are always considered and to deliver needs-led services.

The Children�s NSF team would welcome your views on this paper by 10 August � now extended from 10 July. The Emerging Findings document is available at www.doh.gov.uk/nsf/children.htm

You can send your comments in writing to: Claire Phillips, Children�s National Service Framework, Room 526, Wellington House, 133-155 Waterloo Road London SE1 8UG, or by e-mail to
MB-Childrens-NSF@doh.gsi.gov.uk

Saving Lives, Valuing Donors � the new national framework for transplants � has been launched by the Department of Health.

It sets out key aims for organ and tissue transplantation over the next 10 years and identifies national and international good practice to maximise organ and tissue transplantation.

Building on the success of the conferences for middle managers, a new series of leadership development events are planned focusing on individual professions, including nursing.

Clinical guidelines on routine pre-operative tests for elective surgery have been issued by the National Institute of Clinical Excellence.

The number and type of these tests varies widely across the NHS and can lead to unnecessary delays or cancellation of operations as well as inconvenience and discomfort to patients.

Residential choices for older people will be increased following an investment of �87 million into �extra care� housing.

The money will be used to back schemes in the public and private sector which offer more choice to older people, providing them with an alternative to existing residential care facilities or to staying at home with the help of flexible home care support.

It is expected that some extra care housing will provide facilities such as GP surgeries and exercise/alternative therapy centres for the wider community.

Senior cardiac nurse Jonathan Carver of University Hospitals of Leicester NHS Trust recently led an independent review of thrombolysis targets.

The review confirms the importance of early thrombolysis; outlines the NHS� success in delivering faster treatment; provides a checklist of good practice; and emphasises the need for NHS ambulance services and acute hospitals to work even more closely to secure better and faster care for heart attack patients.

Registered deaths from cervical cancer have fallen below 1,000 in a year for the first time.

NHS Cancer Screening Programmes� director Julietta Patnick said: "This figure will help reassure the 4.4 million women who are invited for screening in England that the NHS Cervical Screening Programme is effective in reducing the number of cases of cervical cancer and the death toll from the disease."

The Government�s Care to Learn scheme gives financial support to teenage parents who wish to continue with their education. From 1 August 2003 a young parent aged between 16-18 starting a course can have childcare costs paid up to �5,000 per year.

A new initiative has been launched to facilitate the transfer of health care in prisons to primary care trusts.

The Prison Health Development Network will provide support to prisons and primary care trusts (PCTs) during the transitional period.

A practical guide for involving the public in health and social care services has been produced by Leicester City Health Action Zone and Leicestershire, Northamptonshire and Rutland Workforce Development Confederation.

A primary care trust has introduced an electronic �LookOut� call service to protect nurses against violent and abusive patients.

A centralised computer at Hounslow PCT keeps track of community and night nurses when they are called away from the surgery.

For more information contact Hounslow Night Nursing Service clinical manager Liz Lewis on 020 8321 2211.

More on the Government�s zero tolerance scheme to reduce violence against NHS staff is at www.doh.gov.uk/zero.htm

Management Matters � a brochure about how NHS managers are making a difference to services � has been published by the NHS Confederation. It discusses why management matters, who today�s managers are, how they are making a difference and managers of the future. To receive a copy e-mail chris.Atkinson@nhsconfed.org

The magazines aim to spread good practice, stimulate debate and keep health professionals working in the NHS up to date with the latest developments.

New addition to Diary: Conference for healthcare assistants, Tuesday 16 September 2003

The chief nursing officer�s annual conference is being held in Brighton from 12-14 November 2003.

Delivering the Difference Together will focus on challenging traditional boundaries and promoting multi-disciplinary and inter-agency collaborative ways of working to help deliver better services for patients and staff.

The programme will celebrate success, address challenges for the future and provide useful tools to help deliver results. An exciting line up of speakers will stimulate and inspire, encouraging lively debate.

Full details on how to register for the event at The Grand Hotel, Brighton, will appear in the September CNO Bulletin.

The event is a must-attend for all nursing directors from NHS trusts, primary care trusts, strategic health authorities and heads of university faculties. Personal invitations will be sent out next month.

The newly-formed Nurse Advisory and Development Group (NADG) is meeting in Bristol on 25 June, Birmingham on 17 September and Manchester on 3 December. Each meeting will start with an open forum where local mental health nursing issues can be raised. Further information at www.nimhe.org.uk or contact carol.bavington@doh.gsi.gov.uk or the department�s director of mental health nursing Rachel.munton@doh.gsi.gov.uk

The Royal College of Nursing and the Royal Berkshire and Battle Hospitals NHS Trust present a major one-day national conference on 17 October 2003 at the Renaissance Hotel, Reading.

This important national conference will bring together senior nurses from across the UK to share experience and learn from experts in the leadership field.

Further information and a booking form are available from Matt Beard at the RCN on 020 7647 3583 or e-mail matthew.beard@rcn.org.uk