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Looking ahead

Regular readers may recall that in Nursing in Practice issue 79 I identified two issues that need addressing to support effective, safe and efficient nursing services. Both elements have now been echoed by greater minds than mine and with real influence in healthcare policy and patient advocacy. The issues concerned the dire national shortage of nurses and especially the variation in staffing levels in the community. There are established hospital nurse/patient ratios but GP primary care and community services have no such recommended numbers. I suggested that nursing home staffing ratios should be reviewed.   

Now the Rowntree Foundation has published a report on the crisis in care homes, with poor pay and low staffing resulting from inadequate investment. It cites that 78% of frontline care staff earn an average of £6.45 per hour, just 14p above the minimum wage. It contends that low pay and poor staffing numbers are inextricably linked and impact directly on the quality of care for our most vulnerable citizens. In addition, anecdotal information indicates overseas workers with initially poor spoken English are attracted to independent nursing home employment, often creating communication difficulties for residents with complex needs and high levels of dementia. Healthcare regulator the Care Quality Commission (CQC) has been called upon to review workforce numbers and staff pay. I would go further and encourage nurses (under their professional code) and families to report staffing concerns as a potential safeguarding issue. The second challenge I made has been echoed by my new hero - Simon Stevens, the new chief executive of NHS England. I suggested nursing teams should merge their roles: the ability, capacity and willingness of nursing home nurses, district nursing teams and practice nursing to work together should be addressed.

Joined-up nursing offers patient continuity and co-ordinated responses to individual patient needs. Stevens has encouraged such reconfigurations and gone much, much further by suggesting multi-speciality community providers should be created from GP and hospital services with mental health and social care as partners. He advocates that care homes could become providers of more health and rehabilitation services with nursing leadership. This, and more, is set out in a refreshingly short and clear report published in October - the Five Year Forward View (FYFV). It indicates that over the next five years the NHS needs to change to remain affordable and that the public's health and lifestyle choices must alter to reduce demands on the NHS. It is a radical shake-up. He is a brave man; after collaboration with all influential NHS bodies, he has set out the actions and moreover, the additional budget required to deliver a sustainable NHS and challenged the political parties to commit to it. As voters we will be increasingly wooed by political parties prior to the 2015 election with the NHS at centre stage; we need to be sure there is additional funding, not a jiggling of existing funding, for an increasingly long-lived, complex and demanding population.

There is real imagination in the FYFV with main four foci, all affecting nursing. Stevens wants hard hitting action on lifestyle, obesity and alcohol risks; he wants to give carers and volunteers more support with patients having more control over their health and social care; he sets out new models of care that break down existing boundaries between providers and he outlines how local arrangements and payments can exist, including cottage hospitals. He wants to strengthen the NHS frontline. There is no mention of private providers and open market forces.

Simon Stevens has won my admiration by recognising the importance of nurses in establishing and running reconfigured services outside of hospitals - including midwives setting up NHS-funded services in the community. He has won my allegiance by advocating better pay for nurses and an end to repeated pay freezing, saying pay levels should flexibly mirror performance, recruitment and retention.

Nursing representatives have welcomed the high profile of the profession in the FYFV, endorsing that paying nursing staff a fair wage is key to its success. Have you ever noticed that high salaries are still justified as a way of attracting the best executive managers to the NHS? So why would we not use the same argument for attracting the best nurses? Will Steven's strategic direction be the lifeline the NHS needs? The NHS does need to change to survive. The NHS will always need nurses but currently nurses need nurturing and hope. Yes, this plan has promise and optimism.