The Ward Round: Managers in a uniquely tough position

Workforce was placed front and centre of last week’s planning guidance, sending a message to all NHS employers about the pressing need to take staff recovery, retention and recruitment seriously.

NHS England also published an entire board paper on “supporting staff”, in which plans were set out to develop a “wellbeing dashboard tool”. This would measure wellbeing using various indicators, such as sickness absence and “the number of health and wellbeing conversations”.

This reminded me of Number 10’s pre-pandemic plans to launch a morale tracker - but perhaps less said about that the better.

Measuring staff wellbeing is important, but only if employers have the means to improve it and if they themselves are not penalised if seen to be lagging.

The importance of recovery and leadership’s role within this was also emphasised by Amanda Pritchard in her healthcare leaders update this week. Ms Pritchard discussed how the pandemic had “reinforced everything we knew” about the impact senior leaders can have on staff wellbeing.

Ms Pritchard also pointed to a piece of work done by Avon and Wiltshire Mental Health Partnership Trust, which set out its “compassionate approach” for helping teams and leaders recover from the pandemic.

It called on leaders to adopt “trauma-informed principles” and suggested this could fundamentally change how “leaders lead”.

NHS managers are in a uniquely tough position at the moment. AWMH’s piece of work said senior leaders must respond first by engaging in their own self-care, but how many people have the space or bandwidth to prioritise this at the moment?

How generic nursing standards could affect the long-term plan

As the pandemic has loosened its grip on the NHS, other things have finally been given some breathing space. One issue that piqued my interest is the development of new specialist nursing standards by the Nursing and Midwifery Council and the reaction this prompted from 10 community nursing leaders.

Several national bodies and unions said in the letter that draft proposals from the NMC would effectively dilute the current standards for specialist community nursing roles.

The NMC is reviewing the standards for several post-graduate, specialist nursing qualifications, including district nursing and community psychiatric nursing.

As part of its review, consultancy firm Pye Tait was commissioned last year to analyse multiple engagement events and feedback on the themes raised, with new draft standards then put forward in November.

But the letter from several bodies, including the National District Nurses Network, Queen’s Nursing Institute, and Royal College of Nursing, said: “It is regrettable that [the Pye Tait] report dated the 27 November 2020 and presumably received by the NMC a short time after this date, does not appear to have influenced decision making in respect of the standards.

“Papers produced for NMC council’s agreement were published only three days after publication of the 122-page report from Pye Tait…

“We remain concerned that the core standards of proficiency will not facilitate delivery of the NHS priorities… and that the standards as they are will therefore not be fit for purpose. In our view, it is therefore imperative that the NMC reconsider their position in respect of bespoke standards.”

The NMC published a rebuttal to the letter, saying it was not reliant on the final Pye Tait report to inform the content of the standards, and it was simply a “thematic review of what was said at the [engagement] events”.

Andrea Sutcliffe, chief executive of the NMC, also said: “We know there are different views so we are keen to share the draft standards as soon as possible and we’re committed to a collaborative consultation process.”

A risk to specialist courses 

Steph Lawrence, executive director of nursing and allied health professionals at Leeds Community Healthcare and Leeds GP Confederation and letter signatory, told me she was concerned there was a risk that universities could react to the new standards by ceasing to offer the district nurse qualification, because employers might decide they don’t need it.

She added: “The risk to patients is that in some parts of the country you don’t have any specialist district nurses. The things you learn are about managing and prioritising a caseload and understanding the health needs of the population you serve. If we lose that how will we deliver the NHS long-term plan?”

Crystal Oldman, chief executive of the QNI, also stressed: “We really need the NMC to succeed in this in order for the delivery of the long-term plan to be realised.”

Alison Leary, chair of healthcare and workforce modelling at London Southbank University, described the draft standards as “a missed opportunity to put patient safety first”.

The consultation will run for 16 weeks from 8 April so there is still time to thrash out a compromise, but community nursing leaders are clear about the impact going down the generic route could have on future supply and patient safety.