26th January 2016

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Former Secretary of State for Health and now Chair of the Confed
Stephen Dorrell
Last few tickets 

Invent new ones 
News and Comment from Roy Lilley
I'm really disappointed to write this.  Disappointed might be the wrong word.  Frustrated, maybe?  You see something so good but you know it will be ignored.  Something worth eulogising about but your gut tells you, not to bother.
All my working life I have known two absolute truths; you are only as good as the opinion of the last customer and you can't have delighted customers unless you have relaxed and happy staff. 
OK, going to work can't be a bed of roses every day.  There will be pressures, you are paid to cope with them; challenges, you are paid to meet them; problems you are paid to solve them.
However, you are not paid to be worked to a frazzle.
The customer-facing, front-line of any business is where the focus of every ounce of effort should be.  The interface between the company and the customer is the critical area where nothing but peak performance will do.  In the NHS it is doubly true.
Protecting the front line, funding it properly and making it fun to work there is key. We simply cannot afford to get the NHS 'customer', the patient-interface wrong.  I mean 'afford'.  Afford in the context of money.
I seem to remember reading; PHE put the cost of NHS staff absence at 2.4bn a year and agency staff bills in 20104 at 3.3 billion.
I had a chat with a former ward sister who now works as an agency nurse.  Really solid, reliable 'old-school' nurse who knows her way around the block... and back.  Why does she do agency?  Greater flexibility, less responsibility and no hassle.... and a bit more money.  What's not to like.
Want to cut sickness and agency?  Become a better employer.
Flog a horse hard enough and it will fall down dead; then you'll save money on the hay and make money turning the bones into glue.  But, you'll have to pull your own cart.
I contend you can trace just about every NHS woe to the front-line.  Quality, safety, value for money all track-back.  Leave it to the nurses and they'll fix most of it and if you treat them very nicely,  save you hard cash.  
The disappointingly, irritating thing is; we have the answers and ignore them.  We would rather pursue new answers.
We are fiddling about pretending to address the pivotal issue of safe staffing.  NICE, NHSE, Confed, Employers, Carter, they are all having a say but the wards are no safer and there is no money rattling in the tin.

What aspect of ego is it that drives people to reinvent solutions that already exist?
Instead, we make ourselves look busy; creating returns, forms, algorithms, adjust for acuity, ward size, experience, qualifications, the day of the week and the weather... when we could just ask the ward sister.
Or, we could use the safe staffing app that was developed in Nottingham and posted on the Academy of Fabulous Stuff archive months ago.  Why isn't it in every Trust and on every ChEx's iPhone.  And, developed to produce a national dashboard for us all to see.
And, most disappointing of all, why don't we have a serious look at the work of Prof Linda Aiken.  She has studied 617 hospitals in Europe and the US, all of whom are trying to get more for their money and improve outcomes.
She tells us (make time, please, to watch the full lecture and her knock-out slides, you will not be disappointed):
  • Across Europe nurses say there aren't enough nurses at the bedside.
  • Across Europe and the US, shortage at the bedside has little to do with a national shortage of nurses, it is more to do with what and how hospitals will pay for and conditions of work. 
  • Driving more care into the community means, in hospital, the acuity falls, the complexity and needs of patients goes up, creating a need for more highly skilled nurses, generating costs.
  • California hospitals, with mandated staff-patient ratios, are better, measured on all outcome indicators.
  • Patient satisfaction is in direct proportion to staff satisfaction.
World wide there is developed work for us to mimic, copy, lean on and steal.  What better alibi for theft than 'research in the interests of a great, safe workplace'!
Nurses are the canaries in the NHS mine.  Nursing is not the problem it is the solution.  Do we have to research, investigate, inquire and reinvent the wheel or do we know all this?
Therein my disappointment; we avoid the inconvenient truths and waste our time looking for new ones.
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Stephen Dorrell
Former Secretary of
State for Health
Chair of the Confed.
'the reforms were the biggest mistake of the Parliament'
Writes exclusively for us
 'An end to Annual planning'
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>> I'm hearing - Virgin's troubled take over of Kent Community Services has hit another problem and they are asking for a delayed start.
>>  I'm hearing - Monitor's new merged structure is starting to look remarkably like Strategic Health Authorities.  I do hope so!
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