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13th May 2016
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News and Comment from Roy Lilley
In case you missed it; yesterday was International Nurses Day.  Why yesterday?  Coz it was Florence Nightingale's birthday.  IND used to be on another day but UNISON petitioned to get the date changed.
 
Contrary to popular belief, I have not met her personally...
 
So, what would Flo' make of nursing today?  We know she was a tough cookie.  She said:
 
"I attribute my success to this - I never gave, nor took excuses..."
 
Blimey.  She also said:
 
"... very little can be done under the spirit of fear." 
 
And:
 
"... the first requirement in a hospitals is that it should do the sick no harm."
 
Roll that lot up and you might get somewhere close to; 'Protect the frontline, fund it properly and make it fun to work there... and watch your problems disappear!'
 
Messages that were spoken years ago, ringing in our ears, today. 
 
Flo was convinced it was the voice of God that called her to nursing.  She pestered her posh family and eventually trained in Germany.  In 1853 Flo' went to a filthy hospital in the Crimea.  She got nurses cleaning up but patients still died.  It was discovered they were drinking contaminated water.  The hospital was built on a sewer.   
 
Flo' was much more than a nurse; she was a statistician and a mathematical genius.  She made her public health points in the now famous 'Rose' diagram that revealed the terrible truths of war; 16,000 out of 18,000 deaths were caused by poor sanitation.
 
In 1859 she published her most famous books - Notes on Nursing and Notes on Hospitals and the next year, a nursing school was founded in her name.
 
What would Flo make of todays nursing?
 
There are over 70 schools of nursing that appear to have varying degrees of competence and outcomes.  The variability would probably concern her?  It does me.
 
One in four nurses now come from overseas.  Since 1997, 90,000 international nurses have registered here.  

Flo?  What do you think?  

She would say overseas nurses make an important contribution but we should grow more of our own... just guessing.
 
Training?  Looks like Flo might have trouble here.  On the one hand the NMC key delivery areas of quality, evidence base; integrity; compassion, respect, protecting dignity; health promotion; partnership working; planning, designing, delivering, and improving services would please her.
 
However, this may not; each training establishment has its own approach to delivering the NMC core.
 
Internationally, there are huge variations in courses and approaches.  In the UK, deciding on what nursing course to apply for is a complete mystery.  Where to go, what course? 
 
Each university sets its own entry criteria.  Some train using simulation, some are virtual.  As far back as 1999 there have been calls to make nurse training more 'practical'.  Curricula have been rebalanced but is it really still the case a nurse can leave training having never put a needle into a real person?
 
Prior to 1990 national bodies determined a national curriculum and a state examination.  Today?   
 
What would we tell Flo?
 
Universities, which appear to vary considerably in terms of quality of education and ratings, determine their own curricula and examinations and we can't guarantee degree standards are the same across the whole sector.

Some Trust have gone to the trouble of establishing their own pre employment assessment centres, for literacy and numeracy.  Ouch!
 
Other countries, such as the USA and Hong Kong, maintain standard pre-registration examinations for nursing making it possible to compare the quality of teaching and learning across departments.
 
If Flo' discovered each Uni in the UK spends vast amounts of time and money on designing curricula, delivering syllabi and palavering around with regulators; would she say their energies and resources might be better directed? I think so.
 
What Flo' actually said tells us all we need to know:
 
"What cruel mistakes are sometimes made by benevolent men and women in matters of business about which they can know nothing and think they know a great deal."
 
Have a good weekend. 
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Health Chat
Duncan Selbie
Chief Executive Public Health England
In conversation with Roy Lilley
21st June - King's Fund 5.30pm
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Sir Andrew Dillon
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Gossip
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This is what I'm hearing;
if you know different,
tell me here
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>>  I'm hearing - after Brexit, all being well (so to speak) Number 10 is planning a push on the NHS, getting the targets back on track.
>>  I'm hearing - there is a row in Reading; the LA worked up coz West Berks is included in the Transformation Footprint with Oxfordshire and Buckinghamshire, led by Oxford CCG.  No consultation and they see it as a dastardly plot to downgrade RB in favour of Oxford.  Come on children, play nicely.
>>  I'm hearing - four hopefuls standing to replace Maureen Baker as outgoing chair of RCGP.  Unusual?  Interesting to look at the politics.
>>  I'm hearing - a serious rethink is likely over targets. Actual numbers seen in 4hrs, just over 21m, the highest ever but 3.1% short of the target that was set in very different times.  
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Dr Rodney Jones
Analysis
Hospital Bed Occupancy
and deaths (all cause mortality) in 2015
Read it exclusively here.
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