Moving care in the community

Royal College of Nursing (RCN)

Moving care to the community: an international perspective
Moving care out of hospitals and into the community has been a UK wide priority for over a decade; however despite the government’s commitment to invest in the community, there is a mismatch between reality and rhetoric. This report sets out the current policies and initiative in the above-mentioned countries to move care closer to home; outlines the impact of these reforms on the nursing workforce; and offers recommendations for key stakeholders in the UK.

District Nurse numbers falling

The number of district nurses in England fell by 39 per cent between 2002 and 2012, while preventable emergency admissions rose by 40 per cent over the same period.

Extract from RCN website

“Short sighted cuts to the nursing workforce are still taking place across the NHS despite being identified as an important factor in the catastrophic failings at Mid Staffordshire, according to the Royal College of Nursing (RCN).

Today the RCN urged the Government to take immediate action to tackle warning signs across the health service, including staff cuts, an ageing workforce, and soaring patient demand, which if ignored could be disastrous for the health service.”

The King’s Fund: Frontline first

Royal College of Nursing (RCN)

Frontline first: protecting services, improving care
This report reviews the state of the NHS workforce as the coalition government’s term reaches its halfway point. It finds that nursing is suffering from cuts while other professions are increasing in numbers. It argues that these figures reveal a looming crisis in nursing, as the demand for nursing care increases. It cites the formation of Health Education England as an opportunity to take a long-term approach to workforce planning and secure the future supply of nursing staff.

Latest news and guidance from The King’s Fund

Royal College of Nursing (RCN)

Supporting apprentices in the workplace
This leaflet provides advice and information for RCN representatives supporting apprentices in the workplace, and identifies areas for concern, such as pay below the legal minimum, poor quality training and ‘pre-employment apprenticeships’ with no pay. It also defines an apprenticeship framework and looks at the employment of apprenticeships in health care among young workers and established older workers.

Delegating record keeping and countersigning records: guidance for nursing staff 
This guidance draws on the Nursing and Midwifery Council (NMC) code to clarify issues of delegating record keeping and countersigning records for nursing staff and employers.

NEWS system to provide a ‘step-change’ in patient safety

Extract courtesy of

The Royal College of Physicians (RCP) has launched a new National Early Warning Score (NEWS), to recognise very sick patients

A report on NEWS was produced by a multidisciplinary working group and clinical observation charts and e-learning materials have been provided by the NEWS educational programme, funded by the RCP, Royal College of Nurses (RCN), National Outreach Forum and NHS Training for Innovation.

On each acute hospital bed, a chart records patients’ pulse rate, blood pressure and temperature, but different NHS trusts use different types of chart, leading to a lack of consistency in the detection and response to acutely ill patients.

The NEWS system allocates a score to six physiological measurements; respiratory rate, oxygen saturations, temperature, systolic blood pressure, pulse rate and level of consciousness.

The more measurements vary from what would be expected, the higher the resultant score. These six scores are then aggregated into one overall score which, if high, will alert the medical or nursing team of the need to escalate a patient’s care.

RCP believes this provides the basis for a unified approach to assessment and continuous tracking of patients’ clinical care, standardised training of all staff and standardised data on regional variations in illness severity.

NEWS also provides detailed recommendations on actions for each score, and the e-learning materials aim to help trusts with implementation. NEWS has been evaluated against existing systems and proved to be as good as, or better, with greater sensitivity when triggering alerts.

A recent study of 1,000 adults dying in acute hospitals in England estimated that around one in 20 deaths in hospital, or 11,859, were preventable by improved clinical monitoring, fewer diagnostic errors and good drug or fluid management. Professor Bryan Williams, chair of the working party, estimated that around 50% of these deaths, 6,000, could have been prevented by using NEWS.

He said: “This new National Early Warning Score has the potential to transform patient safety in our hospitals and improve patient outcomes, it is hugely important.”

Professor Derek Bell, chair of the NEWS educational subgroup, said adopting NEWS would be “one of the most significant developments in health care in the next decade”.

And RCN director of nursing and service delivery, Janet Davies said: “There is nothing nurses and doctors should prioritise more than patient safety, and this system, if implemented across the board, will be a great leap forward for patient care.

“I hope that every Trust will read this report and adopt this system as soon as possible, as countless lives could be saved in the future by adopting this simple process.”

Guidance from GMC and RCN

General Medical Council (GMC)

Continuing professional development: guidance for all doctors
This guidance was published to help doctors across the UK keep their knowledge and skills up to date throughout their working life. It is aimed at helping doctors as they reflect on their practice, prepare for their annual appraisal, and ultimately for their revalidation. It was developed in co-operation with doctors, medical Royal Colleges, employers, patients and the public, following widespread public consultation earlier this year and emphasises that doctors must take account of the needs of their patients and their healthcare teams when considering the learning they may need to undertake.

Royal College of Nursing (RCN)

Advice for RCN members during British Medical Association (BMA) industrial action
This guidance is for nursing staff who may be affected when members of the BMA take industrial action on Thursday 21st June. The RCN is not involved in the dispute and members will be working as normal on that day.

RCN: New technology guides for nursing staff

RCN launches new technology guides
These guides are aimed at helping nursing staff utilise technology to complement their clinical practice. The guides cover: using technology to complement nursing practice, using telephone advice for patients with long-term conditions, using text messaging services, developing and using websites and using telehealth to monitor patients remotely.

Royal College of Nursing (RCN)

RCN launches new technology guides
These guides are aimed at helping nursing staff utilise technology to complement their clinical practice. The guides cover: using technology to complement nursing practice, using telephone advice for patients with long-term conditions, using text messaging services, developing and using websites and using telehealth to monitor patients remotely.

Online survey of NHS health professionals 2012

From The King’s Fund

This joint union survey is asking RCN members working in the NHS about their views on pay and working conditions. The findings will be used to help inform the RCN’s next submission to the NHS Pay Review Body, which makes recommendations to the Government on the level of pay and pay-related terms and conditions for NHS staff. The survey closes on Friday 8th June 2012.

The role of school nurses in providing emergency contraception services in educational settings

Royal College of Nursing (RCN)

The role of school nurses has extended to provide emergency contraception and advice on sexual health to school-age students in education settings, following OFSTED’s report on sex and relationship education in schools (2006). This updated RCN position statement aims to clarify the responsibilities of school nurses when they are providing emergency contraception to students in education settings. It also highlights the importance of appropriate training, experience and working together with education providers and looks at the laws around providing emergency contraception to under 16s and the duty of confidentiality.

King’s Fund news:

Royal College of Nursing (RCN)

Mandatory nurse staffing levels
Despite older people often having the most complex needs, this report suggests they regularly suffer from a severe shortage of nurses and health care assistants (HCAs), coupled with an inappropriate skill mix of HCAs to nurses. It calls for a ‘patient guarantee’, setting out the number of nurses needed on older people’s wards.

Spirituality in Nursing care – free online resource from RCN

This online resource supports nursing staff to explore the issue of spirituality in an interactive and reflective way that develops self-awareness and highlights implications and considerations for nursing practice. It will aims to be of use to all health care professionals, allowing them to engage with and address important questions about the spiritual aspect of care.

New from The Kings Fund: 21 October

Response to the NHS Future Forum consultation (second phase)
This document presents the RCN’s response to the second round in the listening exercise conducted by the NHS Future Forum. The second round focuses on public health; information; and education and training.

When someone asks for your assistance to die: RCN guidance on responding to a request to hasten death
This guidance aims to support the relationship between patients and nurses, protect the vulnerable and set out the legal position for health care workers. The document emphasises that assisting a suicide is illegal but provides practical examples of how to deal with difficult conversations and deliver good quality end of life care.