Framing the Nursing and Midwifery Contribution. driving up the quality of care

Transcription

1 Framing the Nursing and Midwifery Contribution driving up the quality of care

2 DH INFORMATION READER BOX Policy Estates HR / Workforce Commissioning Management IM & T Policy Planning / Finance Clinical Social Care / Partnership Working Document Purpose For Information ROCR Ref: 0 Gateway Ref: Title Framing the Nursing and Midwifery Contribution: driving up the quality of care Author Publication Date Target Audience Department of Health - CNO'S Directorate 23 Jul 2008 Directors of Nursing, Directors of HR, Nurses, Midwives, Health Visitors Circulation List Directors of Nursing, Directors of HR, Nurses, Midwives, Health Visitors Description Cross Ref Superseded Docs Action Required Timing Contact Details For Recipient's Use This document sets out a direction of travel for the professions. We welcome comments on the ideas that we have set out here, and we would like to engage further with stakeholders to take the work forward, including cosidering the priorities and the resources and other implications of any future work. We will do this through the professional networks that already exist and other stakeholders. Next Steps Review - A vision for Primary Care and Community - High Quality Workforce - Primary Care Strategy N/A 0 N/A 0 N/A Janice Sigsworth Deputy Chief Nursing Officer Room 529, Department of Health Richmond House, 79 Whitehall London SW1A 2NS

3 Framing the Nursing and Midwifery Contribution driving up the quality of care Contents Foreword by Ann Keen MP, Parliamentary Under Secretary of State for Health 3 Introduction from the Chief Nursing Officer 4 1. Nurses 5 2. Midwives Nurses, midwives and health visitors in primary and community care Conclusion Our intentions 17 July 2008

4 Framing the Nursing and Midwifery Contribution: driving up the quality of care 3 Foreword As nurses and midwives we all want to deliver the best possible quality healthcare for our patients, to meet the challenges of a changing society, and to enjoy fulfilling careers. These ambitions are set out in High Quality Care for All 1, the final report of Lord Darzi s NHS Next Stage Review which presents a vision for improving the quality of care for everyone in the country. Framing the Nursing and Midwifery Contribution draws together the work programme to progress actions for nurses and midwives heralded by High Quality Care for All, and the supporting documents, A High Quality Workforce 2, and Our Vision for Primary and Community Care 3. This important paper will help us build on the traditions and values of professional nursing and midwifery, while refocusing attention on delivering the highest standard of care for our patients, and building an NHS that helps people stay healthy. These ambitions can only be achieved if nurses and midwives step up to the leadership challenges offered by the Next Stage Review. We know that much innovative work is already underway throughout the country. We want to use this work as a springboard from which to bring everyone up to the highest standards that we know we are capable of delivering. Framing the Nursing and Midwifery Contribution sets out the variety of work streams and activities, both planned and underway, which form an integrated strategy and which mean that nurses and midwives can maximise their contribution to high quality patient care and improved health outcomes. It shows how we will build on Modernising Nursing Careers 4 and the Midwifery 2020 programme 5, and take forward their ambitions. We signal some crucial intentions, particularly in the field of pre- and post-registration nurse education, which will resonate for today and tomorrow s practitioners. It is vital therefore that nurses and midwives everywhere are aware of what is happening and that they become as involved as they can with this important agenda. I hope that this document will help you keep abreast of the changes taking place, and inspire you to be ambitious, confident and feel part of the exciting new future that awaits us all. Ann Keen MP Parliamentary Under Secretary of State for Health 1 High Quality Care for All: NHS Next Stage Review final report, Department of Health, A High Quality Workforce NHS Next Stage Review, Department of Health, NHS Next Stage Review: Our Vision for Primary and Community Care, Department of Health, Modernising Nursing Careers: setting the direction, Department of Health, Midwifery 2020 is the UK-wide review of midwifery education and careers.

5 4 Framing the Nursing and Midwifery Contribution: driving up the quality of care Introduction High Quality Care for All, the final report of the NHS Next Stage Review, is a landmark document for the future of healthcare in our country. When I spoke with Lord Darzi early this year, it was clear that quality in healthcare was central to all of his thinking and that his challenge extended to nurses and midwives at every level in the NHS. We know that nursing and midwifery are fundamental to high quality healthcare. There is hardly an intervention, treatment or healthcare programme in which we do not play a significant part. This means we are in a powerful position to improve the quality of care across the NHS and play a major role in improving health outcomes. In Framing the Nursing and Midwifery Contribution I have brought together some of the specific pieces of work that we have been working on. These have contributed to the NHS Next Stage Review and show us the direction for the future of contemporary nursing and midwifery. We have worked with nurses and midwives across the country to be clear about what would enable continuous improvements to standards of care. Patients and the public rightly expect high standards of care. We know, however, that there is variability in the standard of care and this presents challenges to us as professionals. To address this I have commissioned two reports from the National Nursing Research Unit to help us understand these issues in more detail: Nurses in Society and Metrics state of the art. These will be published in the Autumn I have also set up a quality of midwifery care project to take forward improvements in maternity services. If we are to achieve the high quality care we all strive for there must be fulfilling career opportunities for nurses and midwives and we must make clear to the public that these are exciting and rewarding professions. Our consultation into post-registration careers and continuing education is reported on in Towards a Framework for Post-Registration Nursing Careers, and the accompanying Equality Impact Assessment. In addition we have commenced a programme of work to transform community services, which I am delighted to sponsor, to ensure we support and maximise the potential for nurses, midwives and health visitors in developing and delivering excellent community services. I hope that Framing the Nursing and Midwifery Contribution gives you a reference point that you can read easily and share more widely. We welcome your comments and invite you to continue to contribute to this work to ensure that nurses and midwives remain at the heart of delivering high quality healthcare. Dame Christine Beasley Chief Nursing Officer (England)

6 Framing the Nursing and Midwifery Contribution: driving up the quality of care 5 1. Nurses Priorities for enhancing the quality of care Nursing is fundamental to high quality healthcare. Nurses deliver care across all settings and are in a powerful position to improve the care that patients experience across the whole NHS. From our discussions with nurses and nurse leaders in all settings, four broad themes have emerged. They are to: 1. reaffirm nurses as advocates and guardians of the quality of care 2. improve the quality of the care by a range of mechanisms including strengthening leadership, developing methods of assessing their contribution, defining accountability and identifying supportive structures 3. modernise nurses careers so they can meet expectations; and 4. recruit and retain the most able candidates. Two task and finish groups were formed to focus on: the role of the nurse; and nursing metrics. The groups met four times between March and June The role of the nurse This group had two goals: to describe a compelling and inspiring portrait of contemporary nursing, rooted in the profession s traditional values, and relevant to a modern NHS; and to use this work to influence the perceptions of the public, patients, and other professionals; to reinforce the ideals of the profession to nurses themselves, and to attract the most talented into nursing. The group foresaw a future in which nurses take ownership of the quality of care, holding themselves and others to account for the delivery of the highest standards and having the authority, skills and mechanisms at their disposal to drive forward continuous quality improvement.

7 6 Framing the Nursing and Midwifery Contribution: driving up the quality of care The Next Stage Review offers an opportunity to develop the role of nurses in improving health and wellbeing through both prevention and evidenced-based care to individuals, families and communities. This represents a high aspiration and signals the desire of many for the profession to reach its potential to make radical improvements for patients. The table below summarises the ambition for nursing expressed by the group. Vision of the future of the registered nurse Role of nurses Values and mindsets Careers Public perception Practitioners, partners and leaders at the heart of care, coordinating multidisciplinary teams and resource, across care settings and agencies. Carers, advocates, and managers of care pathways, working in partnership with patients. Influence and credibility from point of care to boardroom. Accountable for quality of nursing care, and an accountable partner in the whole patient experience. Clarity about, and commitment to, the values of the profession: integrity, compassion, continuous improvement, advocacy and partnerships working. Continually challenging and improving care quality and championing patient experience. Pride in the work of nurses and ambition for nursing as a profession. Confident innovators, keen for our contribution to be demonstrated. Respected, socially valuable profession offering inspiring, rewarding and fulfilling careers. Degree level education and training, balancing practice with theory, with continuous career development. Flexible, personalised career paths across practice areas and fields (practice, academia, practice development, management). Highly qualified, competent professionals with relevant experience and expertise. Conscientious, competent, safe, compassionate, care-focussed and patient-orientated. Source: DH Role of the Nurse Task and Finish Group

8 Framing the Nursing and Midwifery Contribution: driving up the quality of care 7 In addition to the work of the task and finish groups we sought views from delegates at the Royal College of Nursing Congress in Spring 2008 and also took oral evidence from about 30 key stakeholders about what made a good nurse. The detail of this work will be published in Nurses in Society which will recast the role of the nurse as a partner, practitioner and leader. Nursing metrics This group set themselves two tasks: development of a model defining clear accountabilities for the quality of nursing from point of care to the boardroom; and development of a set of measures to identify and quantify the quality of nursing care. The metrics will encompass safety, effectiveness and compassion and we will work with the NHS Medical Director to incorporate these within the clinical dashboard approach that is being developed for the whole clinical team. The group laid a foundation for the development of robust metrics for contemporary nursing, shown in the table overleaf. This will be built on in the coming months, in partnership with the profession. We have also commissioned the National Nursing Research Unit to publish Metrics state of the art as a starting point in Autumn 2008.

9 8 Framing the Nursing and Midwifery Contribution: driving up the quality of care Development of robust metrics Aim Develop a starting point, not the finished article Focus on the acute sector first Aim to measure outcomes, not processes Measure outcomes influenced, not solely controlled, by nurses Rationale Quickly developing a robust indicative set of metrics will demonstrate to nurses and nurse leaders that nursing care quality can be defined and measured, and will act as a platform for further work. Stress-testing and iterative refinement of metric sets can only be achieved through practical use and evaluation in the field. Demonstrating the usability of nursing care quality metrics in one setting will act as a spur to the development and roll-out of metrics in other settings. Metrics more readily available for the acute setting, making it a natural starting point. Many of the domains and categories of care, and some individual metrics, will be applicable across settings. Focus on outcomes means that we measure, drive and incentivise the achievement of the end goals of nursing care, not merely the performance of actions. Allowing nurses and nurse leaders, as skilled clinical professionals, to judge the best way to deliver outcomes provides flexibility across settings and practice areas. Activity-focused metric systems can be prone to gaming. Isolating outcomes solely determined by nurses is difficult if not impossible. Focusing on outcomes for which nurses can realistically be held accountable, rather than outcomes which nurses alone determine, is consistent with the vision of the nurse as practitioner, partner and leader. The work will be overseen by a new National Quality Board of which the Chief Nursing Officer will be a member. Modernising Nursing Careers Modernising Nursing Careers was launched in September 2006 and has made much progress. The findings from two consultations are being published, one led by the Nursing and Midwifery Council, and one by the Department of Health, reviewing preregistration nursing education, and post-registration careers and continuing education, respectively.

10 Framing the Nursing and Midwifery Contribution: driving up the quality of care 9 Many of their themes have been taken forward, expanded and developed within the nursing proposals in A High Quality Workforce and are summarised below: shift to a graduate registered nursing workforce a foundation period of preceptorship for nurses and midwives improve transparency and promote fairness in funding for student placements, in tuition and in continuing professional development facilitate the development of proportionate revalidation arrangements stronger clinical academic careers take a pathway approach to nursing careers support for careers in prevention, health promotion and community health national standards for advanced and autonomous roles. Recruiting and attracting the best candidates For nursing to deliver the ambitious agenda it has set for itself, it is essential that we attract the highest quality candidates. We attract many good candidates but for some of the more able candidates, nursing appears to rank far below comparable professions, like teaching, as a career choice. We believe nursing can and should do better. We believe nursing should be ranked amongst the top career choices for high potential candidates and that it should be regarded as a worthwhile career for highly talented and motivated people. As a precursor to securing the best, we must understand and agree the basic attributes of a good nurse. We believe that four steps will ensure nursing attracts the high quality candidates it deserves: define the attributes and values that make someone a great nurse design a recruitment process that selects those attributes and values develop career packages to attract people of the required calibre to nursing market those career packages appropriately and effectively. We must then ensure that nursing offers a career package that will appeal to high-performing candidates. The Modernising Nursing Careers programme has begun this work.

11 10 Framing the Nursing and Midwifery Contribution: driving up the quality of care 2. Midwives The quality of midwifery care in the NHS must reach the first class standards of excellence to which the profession aspires and which women and their families expect. The midwifery profession rightly has high ambitions. We are already set to increase the number of midwives by up to 4,000 over the next five years, unless the birthrate falls, so that we can provide better care for women and their families. The profession expects its practitioners to be: knowledgeable and highly skilled advocates for the women in their care accountable for the quality of the care they give and the services they manage able to measure and articulate the quality of their care confident at exercising a high degree of influence within organisations and across networks that provide maternity services. Midwives priorities were explored at a number of workshops and midwifery leaders debated ideas in order to develop priorities which articulate how midwives can contribute to driving up the quality of care. These are shown in the table overleaf.

12 Framing the Nursing and Midwifery Contribution: driving up the quality of care 11 Priorities for driving up the quality of midwifery care 1. Enable midwives to influence, lead and coordinate womancentred services 2. Reaffirm the identity of midwives and the image of midwifery 3. Ensure midwifery career pathways are fit for purpose 4. Demonstrate the value of midwifery through outcome data 5. Support midwives in leadership roles Organise integrated and safe midwifery and maternity services delivered by a multiprofessional team around the woman ensuring widespread initial and early access to midwives and maximal continuity of care. In partnership with women, help navigate them through whatever care pathway they need. Promote services which provide maximum choice, access, safety and continuity of care. Articulate a compelling, inspiring portrait of the midwife that is both rooted in the values of the profession and relevant to tomorrow s NHS, stressing the full breadth of the role in a multiprofessional team. Attract the most talented candidates to the profession. Reinforce midwives understanding of their role, contributions and responsibilities as team members and lead practitioners and to build their confidence and pride in their profession. Complete the move to a degree-based profession, with flexible access to programmes and a dynamic curriculum to respond to the ways in which the delivery of care is changing. Ensure there is appropriate investment in and opportunities for postgraduate learning and statutory supervision. Ensure systems and information support Booking-to-Boardroom accountability for the quality of care and reflect integrated services and maternity networks. Demonstrate the value of midwifery. Ensure midwife leaders have the managerial and leadership training to undertake their roles effectively. Promote the contribution of midwives and statutory supervisors in organisations governance structures. Enable direct access to board level with additional influence across the whole health economy including with commissioners and local authorities. Properly prepare and support heads of midwifery to undertake their roles effectively.

13 12 Framing the Nursing and Midwifery Contribution: driving up the quality of care We must respond to what matters to midwives. In particular, midwives want to: be the clinician that pregnant women are more likely to contact first to access services broaden their responsibilities to help pregnant women navigate their way around health and social care services so they can access a range of services to meet all their needs regardless of complexity position themselves to be able to lead the transformation of services become more likely to take on leadership roles at a variety of organisational levels use of metrics measuring the quality of care increase their influence on boards and in the commissioning process through strengthening the role of the head of midwifery. To achieve these goals, we must continue to plan for the future and recognise the particular challenges of attracting and retaining the next generation of midwives who can care with compassion, lead services and work in teams which collaborate across organisational and professional boundaries. Education and career pathways for midwives Midwives must be able to access first class education to underpin delivering care of first class quality. The education provided needs to be dynamic so that midwives in the future can work flexibly and deal expertly with a range of situations, in a variety of settings, from the healthy and normal to more risky, uncertain and clinically complex situations. Education also needs to reflect the future direction of maternity care by ensuring that the development of midwifery careers and the roles of maternity support workers are closely aligned to the Maternity Matters 6 care pathway. Reaffirming the professional identity of midwives and the image of midwifery will enhance midwifery as a career of first choice. Consequently, the midwifery profession: aspires to become an all-graduate profession at the point of registration will undertake a review of postgraduate midwifery career pathways which need to be fit for purpose 7 will aim to enhance the confidence of midwives to practise competently on qualification during a foundation year will take opportunities to construct clinical academic midwifery careers with the implementation of the UK Clinical Research Collaboration recommendations 8. 6 Maternity Matters: choice, access and continuity of care in a safe service, Department of Health, This review has been initiated as part of Midwifery 2020, a UK-wide twoyear project. 8 Developing the Best Research Professionals. Qualified graduate nurses: recommendations for preparing and supporting clinical academic nurses of the future. Report of the UKCRC Subcommittee for Nurses in Clinical Research (Workforce), UK Clinical Research Collaboration, 2007.

14 Framing the Nursing and Midwifery Contribution: driving up the quality of care Nurses, midwives and health visitors in primary and community care Primary and community care services provide care advice and support for millions of people every day and we aim to make these services even more accessible and responsive in delivering healthcare and prevention services to individuals, families and communities. Community nurses, midwives, and health visitors have contributed to the development of Our Vision for Primary and Community Care and will be key to delivering High Quality Care for All. The strategy sets out ambitions for both high quality personalised care and promotion of health and wellbeing. Community practitioners have long understood and practised with this dual focus on personal healthcare and community health improvement and are ideally placed to lead and deliver the vision. Our Vision for Primary and Community Care sets out a vision: where people shape services giving people more say and more choice and more control in their own healthcare which promotes healthy lives and tackles health inequalities working with key partners where services are continuously improving quality through effective clinical leadership, new freedoms and improved infrastructure where public and clinical professionals are leading local change and developing best practice and joined up local services. These are set out in more detail in Our Vision for Primary and Community Care and accompanying summary Our Vision for Primary and Community Care: what it means for nurses, midwives, health visitors and allied health professionals. Community nurses, midwives and health visitors have the commitment and enthusiasm to lead and deliver this change. We

15 14 Framing the Nursing and Midwifery Contribution: driving up the quality of care have heard from many practitioners and managers that national leadership is needed to harness this commitment and support community practitioners to maximise the opportunities presented by the Next Stage Review and Our Vision for Primary and Community Care and to provide enablers to take forward locally-led change. Community teams will have more influence and opportunity to develop the kind of services they and their patients and communities want to see, with greater accountability to demonstrate that high quality is delivered. The Transforming Community Services Board (involving practitioners, strategic health authority representatives, Department of Health policy, and professional leads) will steer a programme of work encompassing: clinical and service improvement to develop clinical and leadership skills to deliver high quality evidence-based care and services that promote health and wellbeing with action on inequalities business improvement so that performance and outcomes can be demonstrated and benchmarked and thus driving up quality and reducing variation in performance. The aim is to develop practitioners so that they can extend their clinical skills and roles, transform service through multidisciplinary clinically-led commissioning and develop entrepreneurial approaches to providing services which meet local need. Nurses, midwives and health visitors will have increased influence on transforming the service by being involved in a range of activities. These will include practice-based commissioning, integrated care centre pilots, and care planning for people with long-term conditions in a relationship where patients and practitioners meet as experts. There will be new opportunities to improve health and reduce health inequalities, both for specific groups such as embedding the Child Health Promotion Programme and by making sure that clinical interactions have the potential to improve health. We will invest in generating the evidence base for quality and excellence, and in the resources and mechanisms required to support continuous improvement in quality. This will include developing the professionally popular Productive series 9 for community services and refreshing Essence of Care. New approaches for the provision of services will be promoted with nurses, allied health professionals and other staff having the right to request that primary care trust boards consider establishing social enterprises, while retaining their right to access the NHS pension scheme. 9 The NHS Institute for Innovation and Improvement is developing the Productive series; refer to This is a year-long work programme. We will do all we can to engage and enthuse community staff through focusing on effective

16 Framing the Nursing and Midwifery Contribution: driving up the quality of care 15 communication of key programmes tailored around client and care groups. It will develop leadership approaches and tools to support excellence and provide the mechanism for services to demonstrate the high quality healthcare and health promotion which is, and increasingly will be, delivered as close to home as possible.

17 16 Framing the Nursing and Midwifery Contribution: driving up the quality of care 4. Conclusion Nurses and midwives are the largest frontline clinical group in the NHS. They are the people who are in most close contact with patients and users throughout the day and night in all healthcare settings. They make an enormous contribution to the development of the quality of healthcare. This has always been so, and nurses and midwives themselves are traditionally held in high regard in the minds of patients, clients and the public. Our vision of the future needs to be communicated to the members of the professions in a way that makes the vision tangible, compelling and inspirational, and demonstrates to each and every nurse and midwife what they can do to bring it about. We are working with SHAs, nurse directors and key stakeholders to get that message across. High Quality Care for All gives us the impetus and the mechanisms. Delivering this level of improvement is a challenge we can unite around, and success will be our contribution to the NHS in this, its sixtieth year.

18 Framing the Nursing and Midwifery Contribution: driving up the quality of care Our intentions Intention 1 We will launch a new document reaffirming the role of the nurse in a modern society. Actions A paper setting out the vision will be launched in Autumn There will be a comprehensive communications strategy targeting key stakeholder groups. This will include a series of national road shows with events planned for future Chief Nursing Officer's business meetings and annual CNO Summit in November Nursing metrics will be developed as a first step towards improving the quality of nursing care everywhere. A paper setting out the state of the art in nursing metrics will be launched in Autumn The Chief Nursing Officer will progress work on an indicative set of nursing metrics overseen by the new National Quality Board. 3 The current programme of work to modernise nursing careers and educational pathways will continue. Additional work streams will ensure we recruit and retain the best candidates; explore options for becoming a graduate profession; develop plans for a formal foundation period for newly registered. nurses. In July 2008 the Chief Nursing Officer will launch the report setting out the results of her consultation on post-registration nursing careers. This will include a comprehensive equality impact assessment. Plans for taking forward the recommendations of the UK Clinical Research Collaboration for developing clinical academic careers will be announced. Additional work streams will be added to the Modernising Nursing Careers programme and overseen by the UK Modernising Nursing Careers Coalition.

19 18 Framing the Nursing and Midwifery Contribution: driving up the quality of care Intention 4 Midwifery leaders will develop metrics to help improve the quality of services and experience of women and families. Actions A Steering Committee has been established to drive this work. A publication setting out the direction of travel for the profession is expected in Autumn We will ensure that education and career pathways are reviewed. Plans for Midwifery 2020, a UK-wide review of midwifery careers, are already in place. 6 Actions will be taken to secure the nursing and midwifery contribution to Our Vision for Primary and Community Care. A Transforming Community Services Board has been formed to drive the overall programme of work. We will ensure that staff are engaged in developing and implementing the vision. Detailed work programmes to develop toolkits and to implement levers to deliver evidence-based innovative primary care and community services will take place. Results will be expected to appear sometime in the following year. There will be stakeholder engagement at all points with emerging themes shared at key stages throughout the process. This document sets out a direction of travel for the professions. We welcome comments on the ideas that we have set out here, and we would like to engage further with stakeholders to take the work forward, including considering the priorities and the resources and other implications of any future work. We will do this through the professional networks that already exist, and other stakeholders.

20 Framing the Nursing and Midwifery Contribution: driving up the quality of care 19 Acknowledgements We are grateful to the chairs of the nursing task and finish groups: Nursing metrics Professor Anne Marie Rafferty Professor of Nursing Policy and Dean of the Florence Nightingale School of Nursing and Midwifery, King s College, London Role of the nurse Julie Burgess Chief Executive, Birmingham Women s NHS Foundation Trust and to the members of the groups and those who contributed directly or by questionnaire to the evidence gathering process. We are also grateful to those who participated in the midwifery workshops and those who attended the Primary and Community Care stakeholder conferences and expert groups.

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