The paper aims to 'set out a shared purpose' for staff in those roles, with six key areas for action. But why do we need a new vision for nurses, midwives and care-givers? And what difference will this vision make?
Two years ago, the Prime Minister's Commission on the Future of Nursing and Midwifery in England published a vision for nursing and midwifery called Front Line Care, which seems to have disappeared into oblivion. And only five months ago, the Nursing and Care Quality Forum (NCQF) published a letter to this Prime Minister with perfectly sensible recommendations about what to do about nursing. The Chief Nursing Officer is working with the NCQF but the vision does not refer to its recommendations.
The new vision differs a little from the earlier ones. It focuses much more on nurses' and midwives' roles in prevention and health promotion and on ‘making every contact count'. Strangely, given the focus on care and compassion, it does not mention nurses' contribution to caring for the half a million people who die each year, fifty percent of whom die in hospital. The NCQF has been explicit that quality of care is linked to staffing, skill mix, and nurses and midwives being able to spend time with individual patients. This new paper acknowledges that lack of time, lack of support, long shift patterns and expanded roles contribute to the apparent lack of empathy in some areas of nursing. However it defers tackling these challenges until the next stage of the work, without saying when that will start or how many stages will follow.
Fundamentally however, what is troubling about this vision and the others is the attempt to create an independent vision for nursing, midwifery, and care-giving separate from the rest of the health care system. All the visions acknowledge that nurses and midwives are members of a 'wider team', but they are not co-produced with health professionals and managers or with patients and relatives. Of course the professions have their own cultures, their own bodies of knowledge and practice, and their own hierarchies and ways of working. And values and behaviours in nursing and midwifery are critically important. But nurses, midwives and care-givers look after patients in the context of organisations, not in isolation. It's simply not possible to deliver reliable, compassionate care 24/7 unless the system as a whole makes it a priority and the most powerful people in the system actively demonstrate their commitment to the values and behaviours that support caring. Read the excellent 'Preventing Abuse and Neglect in Institutional Care of Older Adults' (PANICOA) Dignity in Care report, or the hundreds of pages of testimony to the Mid-Staffordshire Inquiry, or the report of the investigation into Winterbourne View and then ask yourself how much change nurses, midwives and care assistants can achieve on their own, and without the active support of others in the system.
In the USA a growing number of organisations are appointing Board-level Chief Experience Officers. In the absence of such a role on the NHS Commissioning Board, I would like to see a vision for care for patients and their relatives, jointly written by the Chief Executive, the Chief Nursing Officer, the Chief Medical Officer, the Director of Patient Experience and the Chief Financial Officer and signed off by the whole Board. The Board, by virtue of its position, will shape the wider culture of care and working practices across the whole of the health care system. How good it would be to see those at the top modelling the collaborative leadership and close working that patients and relatives need between the nurses, doctors, therapists, managers and support staff who look after them.
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