What will it mean for my mum?

Policy & Management

Dr David Foster

Deputy Director of Nursing and Midwifery Advisor

Department of Health, 79 Whitehall, SW1A 2NS

E: david.foster@dh.gsi.gov.uk  T: 020 7210 5520

Twitter: @DavidFosterDH

Visiting Professor at Buckinghamshire New University and King’s College, London

The world is changing, but life goes on. The NHS reforms brought about by the Health and Social Care Act 2012 are being embedded, but the pace and complexity of nursing work continues. It feels, at one and the same time, as though there is confusion about who is doing what, and yet absolute clarity that front line nursing is crucial to the health and well-being of patients, families, communities and populations. And it doesn’t matter where you are in the system: I may be at the Department of Health, but when I need to make sense of the new NHS architecture or new policy, I frequently ask myself the “so what” question - “what will it mean for my Mum?”.

My journey to the office involves a commute to Westminster.  I emerge from the tube onto the pavement and gaze up at Parliament along with many other civil servants.  It’s a reminder that I am a servant of the Crown, that I was appointed to serve ministers and that I am unusual.  Not many of the other suits striding along Whitehall will have the peculiarity of being a nurse and a midwife as well as being a civil servant.  I have been at the Department of Health for five years – having started on a six month secondment to work on the quality of midwifery care when Lord Darzi was a health minister.  Now I am deputy director of nursing with a remit for nursing and midwifery in public health and nursing in social care.  It has not been a straightforward transition from being a director of nursing in the NHS and adapting to the rarities of a government department, but it has been insightful.  One thing I have learned is the value of national nursing leadership to influence decisions – often behind the scenes and in a way that cannot be made public.  And, as a consequence of the Act, we are fortunate in the new architecture to have two authoritative national leaders in Jane Cummings, who is the Chief Nursing Officer for England at NHS England, and Viv Bennett, who is Director of Nursing at the Department of Health and also for Public Health England.  They advise the government and have influence across health and social care. 

Jane is the professional lead for all nurses and midwives in England, except public health nurses, school nurses and health visitors, for whom Viv is the professional lead.  Through her role at NHS England, Jane is also concerned with patient safety and experience as well as staff engagement and safeguarding.  Meanwhile, Viv works on public health, on the new health visitor service, strategy and policy, and as government advisor she has an international role especially with the European Union. Both Jane and Viv worked together to create the nursing, midwifery and care staff strategy and vision Compassion in Practice.

Compassion in Practice the national nursing, midwifery and care staff strategy and is built around “six Cs”..

The six Cs are:

  • Care – “what we do day-to-day, we take care of people”
  • Compassion – “not what we do, but how we do it, treating patients with dignity and respect”
  • Commitment – “there needs to be a nursing commitment to improve outcomes and do the right thing”
  • Communication – “we must think about the way we communicate with colleagues and managers as well as patients, relatives and carers, but this C is also about me and my desire to use social media to engage more and deliver key messages”
  • Courage – “being brave enough to do the right thing and speak up when you are not happy with something your organisation is doing”
  • Competence – a high level of competence is required to deliver support and advice that affects lifestyle changes that benefit the health and wellbeing of families and communities

Compassion in Practice is a living document.  It has six areas for action which can be found here

And the progress that has been made one year on can be found here

The public and media focus on nursing is intense. Much of this has been brought about by the Francis inquiry into Mid Staffs hospital. The reports generated by Robert Francis QC were poignant, exposing and challenging. His 290 wide-ranging recommendations have been responded to by the government. That response can be found here

This is a weighty publication and you would be forgiven for thinking that it is too much to wade through and that, given it was about hospital care, it is not relevant to the rest of the nursing community. But you would be wrong; it cuts to the essence of nursing, our professionalism and our ability to sustain giving high quality care day in, day out in good times and under pressure. It is a call for every nurse to make sure we are able to instil public trust and confidence in everything we do; far from easy, but essential. 

Staffing is often cited as an issue when services are poor. There is much debate in this area. On some occasions there is enough staff, but they are not always doing the right things. And many think that having mandated staff to patient ratios will be beneficial.  Regardless of the rights or wrongs of that, it is a helpful requirement of Compassion in Practice for all organisations providing NHS funded care to publish their staffing levels regularly and relate them to the quality of care and patient experience. This will, I am sure, create both heat and light and in doing so also create an atmosphere which will generate local evidence about how good staffing and outcomes are. But, for me, the staffing debate has been for too long now focused on hospitals and, as Compassion in Practice says, we need to develop evidence based staffing levels for community, primary and other care settings.              

I sit on a number of national committees. One of those is developing a Community Nursing Strategy; this brings together Health Education England, NHS England and other interested parties. In looking at the workforce requirements of the future, we recognise that workforce planning and professional territorialism need to adapt to future needs. So what will this mean for my Mum? She wants to be treated quickly and preferably in her own home. She wants this to be done by kind and competent staff. She is not really going to be exercised about who employs them or trains them, but she does want some assurance that they are all talking to each other and that, as she is the topic of their conversations, she is involved - particularly in the decision-making. She wants a coordinated service with no gaps. But I fear, unless we radically review what we do and how we do it through the eyes of patients, we will replicate the past and get drawn into how many practice nurses, district nurses, school nurses and so on we think we need. And then we are in danger of getting distracted by issues such as regulation and advanced practice instead of capitalising on the freedoms of the current system to design what our patients really need. 

People don’t live in hospitals. Our services are about caring for them where they live.

Visiting various services is an important and pleasurable part of this job. And I was recently struck by one organisation (which is a social enterprise) how much of this staffing agenda has been tackled innovatively – after all, as the chief executive said, “People don’t live in hospitals. Our services are about caring for them where they live” – and the organisation is responsive to this and run accordingly. 

The new landscape of the NHS is sometime confusing, but there is also a lot of opportunity for nurses to design and redesign their future. Too many innovations get buried rather than shared and, although I am not very good at it, we need to embrace new social media to share our experiences and messages. For that reason the professional officers at the Department of Health all have ‘Twitter’ accounts to improve our accessibility. It’s turning out to be a very useful way of hearing new ideas and particularly to hear from the newest generations of nurses about their views and priorities. So you might not get to sit on the national committees, but you can influence what people think by joining debates on Twitter, by blogging and getting involved. After all, as the philosopher Immanuel Kant (1724 – 1804) said “The best way to predict the future is to invent it”.