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| The
CNO Bulletin - May 2003 |
Top News
RCN Congress update - more opportunities for nurses
Further opportunities for nurses to expand their roles were announced
during the Royal College of Nursing (RCN) Congress at the end of April.
These include the introduction of nurse governors, an update on Agenda
for Change, more prescribing powers and quicker approval for consultant
posts.
Nurses will for the first time have the opportunity to become hospital
governors under plans for new NHS foundation trusts, announced health
minister John Hutton. He said foundation trusts will mean improvements
not only for patients but also better working conditions for nurses and
other staff.
NHS staff, including nurses and doctors, will be given the opportunity
to elect their own representatives to a hospital board of governors, once
the proposed Health and Social Care (Community Health and Standards)
Bill is passed. This will mean nurses influencing not just the quality
of nursing but the quality of the whole hospital.
The Agenda for Change pay formula will also leave many nurses significantly
better off, said Mr Hutton. Under the scheme, the maximum wage of the
most experienced and expert nurses could go up from the current £46,000
ceiling for nurse consultants to £65,000 as well as increase career opportunities
for nurses at all levels.
Mr Hutton said: "The decision by RCN members to back Agenda for Change
is a huge step forward for the NHS as well as a massive vote of confidence
in the future of nursing. Not only will nurses gain from Agenda for
Change, patients will benefit too from more flexible, nurse-led services,
allowing faster access to high quality care."
Nurse prescribing is also being extended to cover areas including midwifery
pain relief, emergency treatment of asthma and the treatment of chlamydia.
In the past year nearly 700 nurses have qualified as 'extended formulary'
nurse prescribers, with another 700 currently in training.
They can prescribe for more than 60 medical conditions, from a list of
more than 140 prescription-only medicines and all over-the-counter medicines.
Plans are now underway to allow nurses to prescribe some medicines for
'off label' use in palliative care, while Mr Hutton also announced the
start of a public consultation on proposals to add around 60 new medicines
to the Nurse Prescribers' Extended Formulary.
Mr Hutton has also asked the chief nursing officer to move towards giving
local organisations the power to approve new nurse, midwife and health
visitor consultant posts. This will help speed up the approval process
and recognises the considerable experience the NHS has acquired in establishing
these innovative new posts.
More information on
Leadership for staff nurses
About 50,000 NHS staff, including nurses, are being encouraged to develop
their leadership skills under a new programme.
Leadership at the Point of Care was announced at the Royal College of
Nursing (RCN) Congress. Already 40,000 staff have benefited from investment
in leadership development. And now that will be extended to cover frontline
staff including D and E grade nurses.
The programme is aimed at staff whose day-to-day work impacts directly on
patients' lives. Commissioned by the NHS Leadership Centre, it offers leadership
skills through a variety of work-based learning methods.
The programme, which starts this September, also involves the RCN Institute,
the University of Leeds and Creative Healthcare Management. Groups or individuals
interested in getting involved should contact Louise McCarthy at the NHS
Leadership Centre on 0207 592 1049 or e-mail louise.mccarthy@doh.gsi.gov.uk
More information at www.nursingleadership.co.uk
Nurses with a special interest
Nursing roles are being expanded as part of the drive to widen the range
of services provided in primary care.
A framework for establishing nurses with a special interest (NwSI) has
been published, outlining ways for nurses to further develop their skills
and experience to provide more specialized care closer to people's homes.
Over the next three years, the NHS plans to be offering a million more
procedures in GP surgeries and community health centres, rather than in
hospital.
This will save patients trips to their local hospital, cut waiting times
and free up consultants to focus on the more complex cases.
The new framework sets out guidance for nurses to develop in specialities
such as heart failure, diabetes, stroke care and falls prevention. NwSIs
will complement the growing number of GPs with a special interest.
Department of Health primary care nursing officer Maureen Morgan said:
"Nurses in specialist roles have been around for a long time. This guidance
suggests to PCTs how they can build on this success, expand capacity and
break down traditional boundaries between primary and secondary care."
Royal College of Nursing (RCN) primary care advisor Lynn Young said: "Many
generalist nurses working in primary care have developed expertise in
a particular area and have proved to be a superb resource to both colleagues
and patients. This framework makes these examples of enlightened and good
practice explicit and ensure it is further encouraged and developed across
the country."
The framework is available at
www.doh.gov.uk/pricare/gp-specialinterests/nurseswsi.pdf
A feature on the expansion of primary care services is available at www.nhs.uk/nhsmagazine/primarycare/perm/pcexpansion.asp
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Nurse specialists - case study
When diabetes patients in Essex have a problem they can turn to
specialist nurse Alexis Hodgkins.
She runs two clinics a month and a weekly drop-in clinic at a local
health centre, to help patients manage their care and medication
better.
Alexis is one of four nurses with a special interest (NwSI) in diabetes
employed by Castlepoint and Rochford PCT.
The clinics give patients fast, easy access to care and treatment
and, by providing follow-up care, frees up the time of consultants.
Her role also includes visiting housebound patients and educating
GPs, practice nurses and other health professionals about the condition.
"Our services are very patient-centred, clinics are local and easy
to access. We don't diagnose. Our role is to troubleshoot, advise,
support and educate. Patients are very happy to see a nurse because
we can take the time to get to know them and take a more holistic
approach to their condition," said Alexis.
The former district nurse has a degree in specialist practice and
an English National Board Certificate in diabetes management. She
is now completing a masters in inter-professional practice in primary
care.
Southend Hospital diabetes consultant James Ahlquist said: "The
clinics mean patients do not need to visit consultants as often
for follow-up care resulting in fewer over-booked clinics and late-running
appointments.
"I can't imagine running a diabetes service without specialist diabetes
nurses because they are so skilled in so many areas such as education
and training and monitoring and advising patients."
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News in Brief
CNO's school visit marks National Nurses' Day
Chief nursing officer Sarah Mullally (CNO) marked the launch of National
Nurses' Day by joining local nurses in a school visit.
Pupils at East Sheen Primary School in Richmond, London, had the opportunity
to monitor their heart rates before and after exercise, see examples of
healthy eating, name the bones on a miniature skeleton, learn about first
aid and learn how to take care of themselves in the sun.
School nurse Jenny Robinson and nurses from Richmond and Twickenham Primary
Care Trust planned the visit with Head Teacher David Ford who led a role
play session with the school children. It was one of a series of events
held during National Nurses' Day on 12 May.
More information on nurses' school visits is available at
www.learnaboutnursing.org
Midwifery at its best
Midwives working with the Department of Health are publishing an online
report highlighting examples of innovative practice.
The website, Delivering the Best, will also present issues for
midwives to consider as part of the day-to-day activity in maternity services.
It will include a section on midwifery’s five challenges:
- excellence in midwifery practice
- dynamic leadership
- partnerships with women
- improving public health
- working with others.
The website will also contain information on making change happen and
where you can go for help.
An executive summary of Delivering the Best is available now at www.doh.gov.uk/deliveringthebest/execsummdeliveringthebest.pdf
www.doh.gov.uk/deliveringthebest/index.htm will be live in June.
Action On pilots
New pilot schemes to improve access and quality of care for patients have
been launched.
These schemes - a total of 33 projects in NHS trusts - will form part
of the NHS Modernisation Agency's Action On programme which is
designed to trial new ways of working in certain specialties.
These new pilots will extend the programme to urology and plastic surgery
with each project receiving between £70,000 and £105,000 over the next
18 months to develop improved methods of treating patients.
Existing Action On areas include cataract surgery and ophthalmology,
dermatology, ear, nose and throat and orthopaedics. Those pilots have
already produced good practice guides for use throughout the NHS.
For urology, pilot projects include nurse-led assessment and management
at Colchester Primary Care Trust and urology in the community at the Royal
United Hospital Bath NHS Trust.
Plastic surgery projects include hospital at home nursing by University
Hospital Birmingham NHS Trust and digital imaging in plastic surgery by
Lancashire Teaching Hospitals NHS Trust.
More information on Action On programmes is available at www.modern.nhs.uk/action-on
Severe Acute Respiratory Syndrome (SARS) - advice to health care staff
The possibility of SARS should be considered in travellers who have high
fever (above 38ºC) and one or more respiratory symptoms including cough,
shortness of breath and/or difficulty in breathing, and:
- a history of close contact, in the 10 days before becoming unwell,
with a person who has been diagnosed with SARS. Close contact means
having cared for, having lived with, or having had direct contact with
respiratory secretions and body fluids of a person with SARS
- a history of travel to areas reporting cases of SARS.
Further information is available at www.phls.org.uk/topics_az/SARS/menu.htm
or www.doh.gov.uk/sars
Health and safety action pledge
NHS chief executive Sir Nigel Crisp has promised that further action will
be taken to improve the health and safety of NHS staff.
This follows a report from the National Audit Office (NAO), which found
that the management of health and safety risks for staff was patchy.
Sir Nigel said: "The health and safety of staff working in the NHS is
paramount. I welcome the publication of this report, which recognises
the progress made in managing health and safety since the NAO last reported
(in 1996).
"It rightly highlights where more needs to be done but does recognise
the wide range of initiatives undertaken by the Department of Health to
improve management and monitoring of health and safety risks.
"We are already taking action to address the main causes of sickness absence
in the NHS, which has been recognised by the NAO, and we will be stepping
up action in response to some of the recommendations they have made.
Overall, the proportion of slips, trips, falls and needlestick accidents
has fallen since the last report."
Raising standards
A new NHS improvement plan backed by £200 million will help all hospitals
and PCTs raise their standards.
Raising Standards - Improving Performance in the NHS features a
programme of support that includes:
- a clear assessment of the individual needs of each NHS trust to identify
relative strengths and weaknesses, leading to an agreed package of
- tailored support using the expertise of the NHS Modernisation Agency
and others to address particular weaknesses and, where necessary,
- targeted resources to help underperforming NHS and primary care trusts.
As part of this process acute and specialist trusts will agree with their
strategic health authority by the autumn a timetable for achieving NHS foundation
trust status.
A fund of £200 million will be available between 2004-2005 and 2007-2008
to help fund local improvement plans.
More information at
www.doh.gov.uk/raisingstandardsnhs/improving_performance.htm
NHS Direct expanded
The success of the 24-hour, nurse-led health advice service NHS Direct
has attracted an 80 per cent increase in funding to double its capacity
over the next three years.
With the capacity to deal with 16 million calls a year by 2006 the Government
intends the operation to reduce the burden on GPs and emergency services.
A strategy document Developing NHS Direct has been published outlining
future plans.
These include providing a single access point to NHS out-of-hours services,
handling all low priority 999 calls and offering the public a personal
health organiser on NHS Direct Online.
From next April, PCTs will be responsible for commissioning NHS Direct
services and a new national provider will be set up to manage the service.
All NHS Direct staff will continue to work for their current employer
until next April when they will transfer to the national provider.
They will all keep the same terms and conditions of employment and pensions
will be protected. There will be no redundancies as a result of the re-organisation
and nurses will continue to work at their current location.
The strategy points out the need to deliver a consistently high quality
clinical service which helps to meet national performance targets and
offers value for money. It must also continue to integrate with other
NHS services.
Delivering NHS Direct is available at www.doh.gov.uk/developingnhsdirect
Evercare pilot
The United Health Group from the United States is to pilot a new model
of enhanced care in 10 PCTs in partnership with the Department of Health.
The Evercare system of enhanced care management is designed for vulnerable,
at risk older people. Primary care teams comprising doctors, nurses and
care staff work together to improve outcomes for these patients.
A criteria of vulnerability is developed, based on actual patient information,
and used to include individuals in the scheme. In the US, nurse practitioners
act as care manager for the patient, coordinating services across all
settings. They provide clinical care, synchronise interventions, and link
with the family, teaching and supporting them in their caring role. The
nurses also prepare the family for the time when the older person is reaching
the end of their life.
The Evercare model incorporates the principles of the National Service
Framework for Older People: assuring standards of care, extending
access to services and promoting independence.
In the US, the nurses work at practitioner level. Their roles mirror the
10 key roles for English nurses as set out in The NHS Plan, with
the addition of physical examination and some limited diagnosis. The nurses
work collaboratively with medical colleagues and can readily obtain clinical
advice and support.
Under the contract, a team from Evercare will provide practical support
to the PCTs. They will help PCTs adapt the model to take account of local
circumstances and will provide training for the nurses.
Evercare report improved patient outcomes across a range of indicators
including reduced hospital admission.
Personalising care
Ward housekeepers are helping to provide hospital patients with more personalised
care.
Their contribution has been highlighted in Ward housekeepers: Improving
the Patient Experience.
A third of all hospitals have appointed housekeepers to look after the
patient's basic needs and comfort. The goal is to have housekeepers in
half of NHS hospitals by 2004.
Housekeepers make sure wards are clean and meals meet individual patient
needs. Often they bring skills from the hotel and leisure industry to
make the patient feel special while releasing nurses to nurse.
Housekeeping practices and service standards are included in the report.
More information at www.doh.gov.uk/wardhousekeepers/
International cooperation co-ordinator
A secondment opportunity has arisen in the international recruitment section
of the Department of Health for an international co-operation coordinator.
The co-ordinator will develop positive working relationships with countries,
particularly developing nations, to address those countries' issues and
concerns about the department's international recruitment policy.
Current projects, for example, involve discussions with the South African
Government over ways to control the exodus of nursing staff from that
country through managed exchange programmes.
Other aspects of the job will include assisting the head of international
recruitment with ethical recruitment issues raised by callers to the International
Nurses Advice Line.
The closing date for applications is 30 May.
If you would like more details about the post contact head of international
recruitment Liz Kidd on 0113 254 5844 or e-mail liz.kidd@doh.gsi.gov.uk
Voicepiece
This month chief nursing officer Sarah Mullally talks about the importance
of education in nursing and midwifery.
Day in, day out, frontline nurses are contributing to improvements taking
place across the NHS.
The scope of a nurse's role has been evolving for some time now to the
extent that they are benefiting patients in more ways than ever.
The NHS Plan set out 10 key roles for nurses and midwives, enabling
them to take on greater responsibility to improve services and provide
better care for patients.
Nursing roles are being extended, with many nurses across the country
now carrying out a wide range of activities to help provide faster, more
convenient and better care.
In addition to the 10 key roles that are being undertaken by many nurses
in the NHS, the development of more than 850 nurse, midwife and health
visitor consultant posts is testimony to the profession's appetite for
advanced learning and practice.
Now we can build on that success by giving NHS trusts more freedom and
support to establish consultant posts in the future. I am delighted that
health minister John Hutton has recognised this and asked me to transfer
responsibility for establishing posts to the NHS.
The fact many nurses want to develop their skills and knowledge demonstrates
the importance of education. You never stop learning - myself included.
At the RCN Congress I met with student nurses, accident and emergency
nurses and nurses leading in the vitally important area of child protection.
It was an ideal opportunity for them to raise issues of concern, yet it
was equally important for me to be able take their views on board so I
can help address them. Student nurses, for instance, still have worries
about financial hardship and the need to balance work against study time.
The additional support for students experiencing hardship and the new
tax credit system announced by John Hutton in his Congress speech will
help.
Accident and emergency nurses, meanwhile, work in a unique, yet highly
demanding environment. They told me of the pressures involved in trying
to deliver patient-friendly care, against the backdrop of meeting the
Government's four-hour waiting times targets.
And in child protection, issues of confidentiality, information sharing
across different organisations and police checks are all encountered by
nurses on a regular basis.
One particular issue the last group raised was the need for child protection
to be seen as everybody's business, not just dedicated child support staff.
Meeting these three groups again emphasised for me that working within
the NHS, particularly for nurses and midwives, is a continual learning
curve. Educating people about the role of a nurse is something I place
great importance in and I have also seen first hand how this is making
a difference away from the wards and the hospitals.
I recently accompanied a group of local community nurses during their
visit to a school where they took part in nurse role-play activities with
pupils.
These activities both raise awareness and dispel the outdated stereotypes
that persist among children about nursing, particularly in primary schools.
The most effective way of changing children's perceptions of modern nursing
is by letting them learn first hand from a real nurse just what they do
and the range of skills they have.
The role that education plays throughout nursing and midwifery is there
for all to see and one of my responsibilities is to ensure all nurses
are aware of the opportunities available to them.
Have your say …………….
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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 email 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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The Digest
Did you see the news about…?
If you missed an announcement or new development of interest to you the
chances are it could be listed in The Digest
Hospital food
The programme to improve hospital food in the NHS is moving up a gear.
More focus will be given to examining the need for patients to be able
to take their meals in a calm and peaceful environment and also to look
at ways in which patients can take their meals away from their bedside
or ward, eating with their family if they wish.
The next stage will also look at food and drinks services for children
and young adults as well as services in accident and emergency (A&E) units.
Further information is available at www.betterhospitalfood.com
Coronary heart disease report
Nearly 2,500 improvements to the care of heart disease patients have been
introduced in the NHS since the launch of a national collaborative programme
in October 2000.
The Coronary Heart Disease (CHD) Collaborative, now part of the NHS Modernisation
Agency, illustrates ways in which services have been redesigned in its
annual report A multidisciplinary challenge: Improving services for
people with Coronary Heart Disease.
The report is available at www.modern.nhs.uk/chd
NHS recruitment
An NHS recruitment drive has attracted more than 500,000 responses so
far during 2003, including enquiries about nursing and midwifery.
The campaign has played a vital role in increasing the number of staff
joining and returning to the NHS, as well as encouraging others to start
training for future careers within the service.
More information is available at www.nhs.uk/careers
Post-mortems guidance
Hospitals have been told they must get clear consent from families before
carrying out post-mortems on relatives.
A series of guidelines are now available. These are:
- codes of practice on families and post mortems and the import and
export of body parts
- model consent forms and information leaflets about post mortems
- interim statement on the use of organs and tissue
- a summary of consultation on Human Bodies, Human Choices (July
2002).
The documents are available at www.doh.gov.uk/tissue
or by calling 08701 555 455. A video helps to explain why post mortems may
be needed after a child's death. A video on adult post mortems is planned.
NHS Direct - drug side effects
Patients suffering from suspected side effects to drugs will be able to
report their conditions through NHS Direct.
The NHS Direct call centre in Beckenham, which covers south-east London,
is the first in the country to introduce patient reporting of suspected
adverse drug reactions.
And depending on how it goes, the intention is to extend the service to
all 22 NHS Direct call centres throughout England.
Diabetes eye tests
An extra £27 million is being invested in digital cameras for retinopathy.
These cameras give precise digital images of the eye that can be compared
over time to track changes due to diabetes and other conditions.
Clinicians can get an earlier warning of any deterioration in their patients'
sight as a result of this process. The investment will enable every primary
care trust to provide digital eye screening services by 2007.
More information at www.doh.gov.uk/nsf/diabetes/
NMC registrations
Record numbers of practitioners have signed up to the Nursing and Midwifery
Council (NMC) register, according to provisional figures.
In the year ending 31 March 2003 a total of 31,677 practitioners registered
for the first time, of which 12,825 were nurses and midwives from overseas.
This represents an overall increase of 11,500 nurses and 900 midwives. The
NMC now has 597,489 registered nurses, up from 586,047 in 2001-2002 and
34,063 practicing midwives.
More information at www.nmc-uk.org/cms/content/home/
Complementary research
A £1.3 million award scheme to fund research and development into complementary
therapy and alternative medicines has been launched.
The new National Complementary and Alternative Medicines (CAM) post- doctoral
award will fund studies into areas such as acupuncture and homeopathy.
The range of subjects covered by the first five awards includes the use
of CAM for asthma and homeopathic treatments for chronic fatigue syndrome.
More information at www.doh.gov.uk/public/altmed.htm
Tackling health issues
A report from the Health Development Agency (HDA) highlights innovative
ways in which local councils are tackling health issues.
Local government scrutiny of health: using the new power to tackle health
inequalities features case studies from 18 councils on campaigns targeting
sex education, teenage pregnancy, drug use and smoking in public places.
There are also wide-ranging reviews of issues such as homelessness, children's
diet and the provision of services of older people and children.
The publication is available free at www.hda.nhs.uk
Quality Assurance Agency request for reviewers
Nurses are invited to take part in the major review of the standards and
quality of NHS-funded higher education programmes while equipping themselves
with new skills and experience.
About 150 reviews are being carried out by the Quality Assurance Agency
over the next three years. About 500 reviewers will be required from a relevant
practice and/or academic background with experience of professional or occupational
practice and/or current teaching experience.
Reviewers will be expected to carry out up to three reviews per year - each
one requiring a commitment of seven days.
Reviews will involve meetings and observation in both campus and practice
placements.
Anyone interested in becoming a reviewer should contact Sam Wootten on s.wootten@qaa.ac.uk
Drugs: Guidance for schools
The consultation draft of Drugs: Guidance for schools is now available to
download from www.dfes.gov.uk/consultations2/08/
Hard copies can be obtained from the DfES publications line (0845 6022260)
quoting reference number DfES/0 205 /2003.
Send your comments by 18 July to: drugsguidance.consultation@dfes.gsi.gov.uk
or by post to: Consultation Unit, Level 1, Area B, Castle View House, East
Lane, Runcorn WA7 2GJ.
Electronic recruitment project
This is the first part of a three-stage programme to create an integrated
electronic recruitment service for the NHS, linked to the existing NHS Careers
service.
Workforce development confederations and human resource networks have been
invited to nominate key contacts to work with the project and a national
reference group is being formed which will develop local user groups.
Further information at www.doh.gov.uk/hrinthenhs/electronicrecruitment
Contact: sarah.clark@doh.gsi.gov.uk
or on 0113 2545316.
Incorrect use of infra-red ear thermometers
The Medicines and Healthcare Products Regulatory Agency (MHRA) has alerted
healthcare staff to the possible risk of incorrect temperature readings
when using infra-red ear thermometers.
Users are advised to follow the manufacturer's instructions, ensure the
probe tip is clean and undamaged and ensure the probe tip is properly positioned
in the ear.
An information sheet providing seven steps for accurate temperature measurement
has been sent by the MHRA to healthcare staff including paediatricians,
oncologists, GPs, practice nurses, district nurses and health visitors.
Further information is available at www.mhra.gov.uk
Diary
NADG meeting
The newly-formed Nursing 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
Celebrating Nursing and Midwifery Leadership - 17 October
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 email matthew.beard@rcn.org.uk
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