Chief Nursing Officer Bulletin

Nurses, midwives and health visitors have been sent detailed guidance about what to do if they suspect child abuse.

It says child protection is the responsibility of all staff who come into contact either directly with children or indirectly by working with adults who are parents and/or carers.

All nurses, midwives and health visitors have been urged to study the new What To Do If You’re Worried A Child Is Being Abused booklet. Chief nursing officer Sarah Mullally and chief medical officer Sir Liam Donaldson have also jointly written to nurses, midwives and health visitors to highlight the guidelines.

It follows Lord Laming’s report into the death of eight-year-old Victoria Climbie, which highlighted serious failures in professional practice.

Department of Health nursing officer for children’s services Katrina McNamara-Goodger said: "Staff should be familiar with and follow their organisation's procedures and protocols for promoting and safeguarding children’s welfare in their area, and know who they should contact in their organisation if they are concerned about a child’s welfare.

"All nursing practitioners should also communicate with the child in a way that is appropriate to their age, understanding and preference. This is especially important for disabled children and for children whose preferred language is not English."

This case study - based on actual events - highlights how nurses, midwives and health visitors can use the child abuse guidance issued to them

Wini (not her real name) was a nurse working in a hospital outpatients department. A patient arrived with her two children – a boy toddler who was running around the department and a small girl crying in a pushchair.

The patient was short-tempered with the girl, threatening to smack her, constantly shouting at her and occasionally pulling her roughly out of the pushchair, shaking her and telling her to shut up. Other patients were concerned and asked Wini to intervene.

Wini was uncertain what to do, as the child was not the patient. However, the young woman continued to be aggressive to the little girl and ignored the chaos the boy was causing as he climbed over chairs and tables. The mother also turned down Wini's offer of toys for the children to play with.

Wini phoned the children's ward to ask the play specialist for help. She brought some toys down and offered to wait with the children while their mother went in for her appointment.

Remembering the guidance contained in the booklet, Wini then sought advice from the named nurse in child protection, who later advised referral to social services.

Nurses will be the first to develop their skills and knowledge under the NHSU (the proposed NHS university).

Starting in the summer, 10 primary care trusts will pilot the First Contact Care Education Programme.

Developed by NHSU and the Department of Health, the initiative is designed to support those already delivering first contact care - seeing, treating and referring patients with undiagnosed conditions - and for others who want to develop skills to do this.

The programme is accredited by Sheffield Hallam University and based on five modules. Students graduate with either a postgraduate diploma and/or an MSc in first contact care.

Vince Ion, NHSU project manager for first contact care, said: "Improving first contact care is a key element to modernising the NHS.

"We want to provide a better service for patients in a friendly environment and we feel that nurses and other health professionals are the best placed people to do this because they are the frontline."

The programme will offer flexible learning in the workplace, which will include:

Although most of the professionals taking part will be nurses initially, the programme will also be open to paramedics, pharmacists, allied health professionals and others.

This month the chief nursing officer Sarah Mullally talks about the way the international nursing and midwifery community is being strengthened

Highly skilled and highly motivated nurses and midwives are the very backbone of health services across the world.

At the World Health Assembly, which I attended last month, there was a clear international consensus that we must work together across global and professional divides to strengthen nursing and midwifery.

Shortages of staff, an ageing workforce, funding issues, out-of-date or a lack of family-friendly working conditions and heavy workloads have been common problems in some countries.

So it is important for us to work with the World Health Organisation (WHO), its partners and other member states to pursue a range of initiatives to tackle these issues.

The Commonwealth Steering Committee for Nursing and Midwifery has been particularly active in driving forward programmes to shape international recruitment and retention strategies, promote nursing as a career among young people, develop flexible working policies, improve working conditions and introduce action plans for attracting nurses and midwives back into the workplace.

The NHS is starting to reap the benefits of adopting family-friendly working practices and a modern career framework for nurses and midwives.

We are attracting nurses and midwives back in to the NHS – 13,000 over the past four years. And we are providing new professional development opportunities to enable nurses to build on their skills. We now have more than 800 consultant nurses and midwives combining half of their time in expert clinical practice and the rest, in education, service development and research.

And we have many more who are ordering diagnostic investigations, making and receiving referrals, running clinics, prescribing medicines and performing minor surgery. We have much that we can share with colleagues around the world but we can also learn much from them.

WHO recognises there are still many challenges for member states, including the UK – the need to recruit more staff, the need to retain existing expertise and the need to continue the development of modern nursing and midwifery.

We must continue to achieve progress in these areas while pursuing our ethical policy for international recruitment, which tries to avoid exacerbating the staffing problems of developing countries.

Quality patient care - as WHO clearly acknowledges - depends on strong nursing and midwifery services. So we will continue to work with international colleagues to address these global issues – for the good of nurses and midwives – and for the good of patients worldwide.

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.

Subscribe to The CNO Bulletin

E-mail is the fastest and most cost-effective way for us to send the CNO Bulletin to you. Anyone with access to an e-mail address can subscribe and we want to encourage more readers.

How to subscribe

nurse directors should send an email request to dh-test-emails@doh.gsi.gov.uk
all other nurses, midwives and health visitors should send an e-mail request to doh_cno_subscription@talkingnumbers.com

Please provide the e-mail address you would like to use, your name, job title, full name of organisation, full postal address with postcode, plus telephone and fax numbers.

These details will be stored on a database held by the Department of Health database for future mailings of this bulletin.

If you are a nurse director and your contact details change, e-mail us at dh-test-emails@doh.gsi.gov.uk For all other nurses, midwives and health visitors, tell us about changes to your contact details by e-mailing us at doh_cno_amendments@talkingnumbers.com

The chief nursing officer’s conference, for directors of nursing, primary care trust lead nurses and lead nurses from higher education institutions, will be held on 12-14 November at the Grand Hotel in Brighton.

The three days will be stimulating, challenging and provide broad scope for interaction and involvement on the key topics that face senior nurses today.

Look out in next month's bulletin for information on how to register and further details of this event.

A better information service for mothers and a £1 million boost to recruit more midwives were announced at the Royal College of Midwives annual conference last month.

Centrally-funded local maternity guides will be produced which give full information to mothers-to-be on maternity services available locally.

Midwife Sandra Walsh has been appointed as national champion to lead the recruitment, retention and return to practice campaign with effect from June.

A total of £750,000 has been allocated to fund 500 return-to-practice places for midwives during the year 2003-2004.

A report highlighting examples of innovative practice in midwifery is now available online. Delivering the Best also covers issues for midwives to consider as part of the day-to-day activity in maternity services.

The website also contains information on how midwives can contribute to The NHS Plan, learn from colleagues, working in new ways and find sources of help and support.

An extra 35,000 nurses will be working in the NHS by 2008, under local plans to expand workforce capacity.

Local Delivery Plans (LDPs) have been produced for the first time by England’s 28 strategic health authorities, setting out how NHS services will be developed and improved.

With NHS investment set to rise by about 7.5 per cent annually by 2008, local organisations have been able to plan further ahead, even though the LDPs run from 2003 to 2006.

The 2008 recruitment figure also accounts for the time needed to translate training posts into full time positions.

The LDPs also include plans for 285,000 non-urgent NHS operations to be performed in GP surgeries and outpatient clinics by 2006, along with details of improved cancer, heart disease and mental health services.

NHS organisations wishing to set up new nurse, midwife and health visitor consultant posts will now be permitted to do so with the agreement of their strategic health authority.

Posts agreed in April 2003 were the last to be approved under the existing centralised process.

Chief nursing officer Sarah Mullally has written to lead nurses in strategic health authorities about the change.

The document, entitled PL CNO (2003)5 Approval of nurse, midwife and health visitor consultant posts, which contains full details of the changes, can be read by going to www.doh.gov.uk/publications/index.html and then clicking on the COIN link.

Amendments have been made to the directions for PCTs and strategic health authorities on the employment of an independent nurse prescriber or a supplementary prescriber under a new or existing PMS pilot scheme.

The amendment also permits these PCTs to include repeatable prescribing within existing or new PMS pilots.

StHAs and PCTs Implementation of Pilot Schemes (Personal Medical Services) (Amendment) (no. 2) Directions came into force on 5 June.

Contact: Mike.Garley@doh.gsi.gov.uk for questions on supplementary prescribing and nurse prescribing only

NHS Direct Online has won an award for empowering citizens in the management of health and well-being.

The website won the accolade at the European Commission where the 2003 e-Europe e-Health Awards were announced.

NHS Direct Online director Bob Gann said: "We are delighted that NHS Direct Online has been recognised as Europe’s leading online service for patients and the public."

The panel judged entries against economic benefit, access to services, quality assurance and technical standards.

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.

A consultation to help drive forward initiatives to tackle social exclusion of people with mental health problems is underway.

The consultation is the next step in the Office of the Deputy Prime Minister’s social exclusion unit’s project on mental health and ends on 5 September 2003.

Grants worth a total of £50 million have been allocated to councils across England to help them cut the number of delayed transfers from hospitals.

More than 4,000 patients, mainly older people, currently occupy hospital beds even though they are ready to be discharged.

From next January, councils will be obliged to reimburse NHS trusts if social care assessments and necessary social care services are the reasons transfers are delayed.

Comments are still invited from nurses and midwives on the neonatal intensive care review, details of which were published in April. The consultation period still has a month to run.

The review recommends a more structured, collaborative approach to caring for newborn babies by hospitals working closely together in managed networks.

It also suggests definitions of categories of care and the designation of units that would provide the various levels of care. The review makes proposals about staffing skills, information and support to parents.

Updated guidance for healthcare and laboratory workers on safe working with transmissible spongiform encephalopathies (TSEs) such as Creutzfeldt-Jacob Disease (CJD) and bovine spongiform encephalopathy (BSE) has been published at www.doh.gov.uk/cjd/tseguidance

Staff working in these areas, and those responsible for infection control and the reprocessing of medical devices, should be alerted to the guidance.

The Department of Health recommends that infants should be exclusively breastfed for the first six months (26 weeks) of their lives, as it provides all the nutrients a baby needs.

Breastfeeding (and/or breast milk substitutes, if used) should continue beyond the first six months, along with the appropriate types and amounts of solid foods.

An extra £3.6 million is being invested in the Government’s community engagement programme to tackle drugs abuse.

This follows a report which found the programme had successfully identified the needs of black and minority ethnic communities in treating substance misuse effectively.

Following GP concerns over a proposed new allocation formula the GPC and the NHS Confederation have held discussions to clarify a number of issues and agreed some technical changes to the formula.

A ballot of the profession was opened by the GPC on 2 June 2003. GPs are being asked: Do you wish to see the proposed new contract implemented? The ballot closes on 20 June and the results are expected to be made public on 23 June.

If GPs vote to accept the new contract, phased implementation will begin this year ahead of full implementation from April 2004.

Expert advice recommends that the drug Seroxat (paroxetine) is not used to treat children and teenagers under 18 for depressive illness.

The advice comes from the Medicines and Healthcare Products Regulatory Agency (MHRA) which recently launched an inquiry into the safety of antidepressant drugs.

Evidence examined by a group of experts shows there is an increase in the rate of self harm and potentially suicidal behaviour in this age group when Seroxat is used for depressive illness.

A high quality systematic retinal screening programme has been set as an early priority for PCTs. This is in line with the targets in Improvement, Expansion and Reform: the next three years - the planning and priorities framework for 2003–2006.

Local delivery is being supported by a UK National Screening Committee (NSC) programme, developed with professional organisations and Diabetes UK, to set:

The programme, detailing the national work to support local implementation, is at www.nscretinopathy.org.uk

The Department of Health is distributing £750,000 to PCTs in 2003-2004 to facilitate, in collaboration with social services departments, the hepatitis B immunisation of short-term foster carers.

It follows a recommendation made in the consultation document Children in Need and Blood-borne Viruses: HIV and Hepatitis which can be seen at www.doh.gov.uk/childrenbbvs

Janet Howard, a health protection nurse in Shrewsbury, has been seconded to work within the agency part-time for six months to develop the nursing function in the new organisation, established in April. Ms Howard is also chair of the Community Infection Control Nurses’ Network.

The agency is dedicated to protecting peoples’ health and reducing the impact of infectious diseases, chemical hazards, poisons and radiation hazards. The HPA workforce includes community infection control nurses and communicable disease control nurses previously employed by health authorities. There are also nurses working in the Chemical Division and Communicable Disease Surveillance Centre.

Contact: Carole Fry, Department of Health nursing officer, communicable diseases, at carole.fry@doh.gsi.gov.uk

The Foundation of Nursing Studies is inviting applications to its small grants programme, offering funding of up to £1,500 to support projects over a year.

All nurses, midwives and health visitors working in the UK can apply at any time.

The Queen’s Nursing Institute is inviting community nurse applications to its 2004 Innovation and Creative Practice Awards.

Winning projects will be awarded £6,000 as well as a year-long programme of professional development workshops. Deadline for applications is 25 July.

This year, the institute will be focusing particularly on projects which support the objectives laid down in the primary care nursing guide Liberating the Talents but will consider any community nurse-led project which has made a real difference to patients’ lives.

An integral part of the Innovation and Creative Practice Award scheme is the QNI/Alzheimer’s Disease Award for Excellence in Dementia Care Nursing.

The institute has also launched a new phase of its Developing Practice Award scheme. It wants to hear from community nurses who require £2,000 to take a project forward. The deadline for applications is 3 November.

For further information and application forms contact Wendy Holman on 0207 490 4227 or e-mail wendy.holman@qni.org.uk

The A3-sized posters, which are suitable for 11-16 year olds, are entitled If you are looking for the right career and can be ordered from Prolog, Department of Health, PO Box 777, London, SE1 6XH or e-mail doh@prolog.uk.com

Three projects aimed at integrating the support for workforce planning have been launched by the National Workforce Information and Planning Programme

Consultation on the draft regulations began on 21 May. The consultation document and accompanying draft regulations are at www.doh.gov.uk/involvingpatients/

To establish communication channels, NHS trusts currently running pilot PPI forums are asked to make initial contact with the Commission for Patient and Public Involvement in Health by e-mailing communications@cppih.nhs.uk

Plans to create a modern IT infrastructure for the NHS are making good progress.

Ultimately, all strategic health authorities will have to work through a local provider to replace or provide new IT equipment and systems for the NHS.

A list of individual companies and consortia has now been compiled and will be invited to negotiate for IT contracts for each region.

A statement has been issued following the recent court case between the Department of Health and the company, Operations Abroad, regarding the treatment of NHS patients overseas. The full statement is available at www.doh.gov.uk/international/overseastreatment.htm

New guidance for PCTs emphasises the need to act collaboratively when commissioning specialised services.

Strategic health authorities should oversee and performance manage these arrangements.

In particular, this guidance gives advice regarding the continuing role of the Regional Specialised Commissioning Group (or equivalent collaborative commissioning group) and also provides some examples of good practice.

PGDs for the stockpiled antibiotics, chemical countermeasures and potassium iodate are now available at www.doh.gov.uk/epcu/pgd.htm

Other PGDs will be published as they are developed. The Department of Health is in the process of developing a training strategy. In the meantime, NHS trusts may find the PGDs useful for emergency planning.

An extra £165 million is to be spent on modern equipment to speed up the diagnosis and treatment of cancer patients.

The effect of this consent order, concerning same sex partners and nearest relative under the Mental Health Act 1983, has caused some confusion over the relevance of the consent order to the wider field.

The Royal Marsden NHS Trust has published a consensus document together with competencies for advanced nursing practice. Nurse directors can obtain a copy by contacting Ruby Rambaran at ruby.rambaran@rmh.nthames.nhs.uk

A new prison health development network has been established to examine new models of commissioning health services in prison.

It also provides opportunities for early testing and purchase of learning around the development of the NHS and prison service partnership.

It is aimed at managers and clinicians in north-east London and covers roles including senior nurses and consultants.

The National Patient Safety Agency (NPSA) is joining forces with the World Health Organisation (WHO) to improve patient safety.

They will work together to promote a culture of reporting and learning from mistakes and ‘near misses’, through to the development of national reporting systems.

A drugs campaign offering advice and information to young people and parents has been launched by the Government.

‘Frank’ is a helpline and website providing information about Class A drugs such as heroin and cocaine.

Skilled hospital staff who combine the roles of doctor, nurse and therapist are being introduced in Kingston Hospital NHS Trust accident and emergency (A&E) department to speed up patient care.

They will treat patients with asthma, chronic obstructive pulmonary disease, acute coronary syndrome, acute gastro-intestinal bleed, urinary tract infections, strokes or pneumonia.

The joint chairs of the Strategic Learning and Research Advisory Group for Health and Social Care (StLaR) have issued a letter, on behalf of all StLaR members, to the health, social care and education sectors recommending the establishment of local Health and Education Partnerships (HESPs).

The June editions of the department’s NHS Magazine and Primary Care magazine, include articles on:

MDA/2003/009 – hospital bed: Hill-Rom Evolution 150 BO. Failure of the bed to flatten to achieve the cardiopulmonary resuscitation (CPR) position.

MDA/2003/010 – infra-red ear thermometers – home use. Infra-red ear thermometers may give low temperature readings when not correctly placed in the ear canal. This may give false re-assurance and delay medical treatment.

MDA/2003/011 – blood glucose meter test strips: Roche Accu-Chek Advantage II. Risk of overestimation of blood glucose results if these strips are used when patients are receiving IV infusions containing maltose or peritoneal dialysis with solutions containing maltose (e.g. icodextrin).

MDA /2003/012 – all biphasic defibrillators (all manufacturers), potential for confusion between biphasic and monophasic defibrillators.

MDA/2003/013 – "Infinity" pressure relieving wheelchair seat cushions, manufactured by Invacare Limited. Persons using these cushions may be at risk because the cushion may not self extinguish when exposed to an open flame.

MDA/2003/014 – static MRI scanners with quench vent pipes. Failure to meet MRI scanner manufacturer’s specifications for the quench pipe may lead to the discharge of helium gas into the scan room during a quench.

MDA/2003/015 – all medical electrical equipment. Connecting medical equipment to electrical equipment or to the supply main by an extension lead may create risks that have not been taken into account in the design of the individual item of equipment.

MDA/2003/016 – medical gas regulators and flowmeters. Risk of rupture, ignition or inadequate therapy.

Please remember to report any adverse incidents concerning medical devices via the Adverse Incident Centre on 020 7972 8080 or on our website.

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