Report to IPEC Review of Mental Health Learning Disabilities Nursing within the Trust 1st July 2010

1. Report to IPECReview of Mental Health & Learning Disabilities Nursing within the Trust1st July 2010

2. Folio goes here Background to Review The Trust Board commissioned a review of the current Nursing structure and leadership Inquiry report into Mid-Staffordshire NHS Foundation Trust in February 2010 requests Trust Boards to review the management and leadership of the Nursing staff to be assured that patients are receiving safe care The purpose of the review is to ensure the Trust has: Excellence in Nursing leadership and structure Reduce any risk to patients Prevents systems failures, circumstances and working practices that led to the report into Mid-Staffordshire NHS Foundation Trust in February 2010. This brings a return to ‘Back to Basics’ which supports Nursing responsibility, accountability and authority.

3. Folio goes here Signature Strengths of Mental Health & Learning Disabilities Nursing This review sets out to make known and understood: The identity of Nurses The value and core signature strengths of Nurses The role performance and actions of Nurses The Nursing impact upon how patients & carers experience our services What nursing outcomes from their work are That the Nursing culture is driven by compassionate attitudes and caring as a number one priority

4. Folio goes here Signature Strengths of Mental Health & Learning Disabilities Nursing This review also sets out to make known and understood : Nursing has strength of attention to detail and small things that are important to patients and carers Nursing has strength of positive relationships Nursing has strength of timely actions by doing and saying the right thing at the right time for patients and carers Nursing has Strength of expert knowledge and ability for consideration of life coaching when caring for person and their family

5. Folio goes here Why Do We Need To Change? Variance of Nursing roles and job titles make our profession look very confusing to patients, carers and staff Patients and carers want to know very quickly ‘who is in charge here’ Current Nursing structure does not clearly define Nursing role performance expectations and the accountability of Nurses within the structure Patient direct care time not at optimum level Expert Nurses are not utilised to their potential for impact on patient care Nursing care quality has often failed in perceptions of patients and carers Nurse leadership standards have variance in role performance, competency and confidence

6. Folio goes here What People Have Told Us They Would Like to Improve Examples include: Job Titles – too many and confusing Operational Role of Ward Managers too great Ward Managers infrequently work shift patterns on the ward The time spent on direct patient care, relative contact Excessive time spent coordinating and undertaking educational management Inadequate support for Nurses with clinical supervision and personal development planning The Nursing career pathway No capacity to utilise competency in leadership roles for Nurses with specialist training, for example Nurse prescribing Fears around the graduate profession and how Nurses without this will survive in the workforce

7. Folio goes here How People See The Improvements We Could Make Nursing professionalism, status, role performance and identity to be developed and recognised throughout the Trust Job Titles that are understood by everyone Leadership to be strengthened, visible and ‘felt’ by patients, carers and staff Leadership of clinical nursing quality to be the priority Patients and carers to have much more time spent with Nurses Focus to be on Nursing activity Educational support at practice level in the teams on a daily basis Taking away tasks that are non Nursing Consistency and stability Accessibility of expert Nurses and clear expert Nurses roles Working shifts and being visible as a team leader/ sister/charge nurse Reduction in time spent off the ward to bare minimum

8. Folio goes here How People See The Improvements We Could Make Nurses having influence from ward to board Need for Corporate Nurse leadership outside of divisions Embrace more Nurse led activities Roles with clarity, leadership, discipline, standards and boundaries that everyone understands Educational and expert support in teams Allowing Nurses to Nurse and lead Nursing Education for Health Care Assistants Reducing administrative components and duplication of paperwork

9. Folio goes here Recommendation 1 We will change: By developing a Nursing Strategy to work alongside the Trust Multi Professional Care Strategy.

10. Folio goes here Recommendation 2

11. Folio goes here Recommendation 3 We will change: The identity (protecting the title ‘Nurse’ and job titles) role performance and impact of Nursing within inpatient settings will be led by a Sister/Charge Nurse. Every Community Mental Health Service will having a Sister/Charge . This will also support more Nurse led services for the Trust

12. Folio goes here Recommendation 4 We will change: The Trust will establish three Senior Clinical Nurse posts within the care pathways. They will have the lead for the Nursing quality culture of the Darzi principles, patient and carer experience, patient safety and nursing effectiveness and excellence in line with the Trust Quality Strategy

13. Folio goes here Recommendation 5 We will change: By developing and clarifying the Nursing practice principles for every Registered Nurse to ensuring we meet the ‘High Impact Changes for Mental Health’ (DoH 2010) and prevent a recurrence of the Mid Staffordshire circumstances

14. Folio goes here Recommendation 6 We will change: By introducing a programme of implementation for the ‘Re-designation of Registered Nursing Roles’ within the existing Nursing workforce to focus on ‘Nursing role performance’ and ‘Nursing role impact’.

15. Folio goes here Recommendation 7 We will change: Confirm and publish guiding Nursing Practice principles for portfolio management of the professional Registered Nurse and Health (Promotion) Care Assistants

16. Folio goes here Recommendation 8 We will change: Through embedding leadership into systems and processes of the Trust by re-establishing an enhanced ‘Serve to Care’ programme of learning for Registered Nurses. This ‘Masterclass’ will bring together the Learning and Development Team, Senior Nurse experts and partnership working with Divisional teams across a patient care pathway. This will be supported by the Trust Leadership Strategy and incorporate productive leadership, ‘Leading Empowering Organisations’ (LEO), service improvement methods (Productive Care Pathway)

17. Folio goes here Recommendation 9 We will change: Implement the ‘Releasing Time to Care’ (Productive Care Pathway) implementation and service improvement methodology across all clinical teams to influence the thinking, values and culture of the Trust.

18. Folio goes here Recommendation 10 We will change : By undertaking an organisational readiness assessment and preparation for introducing the Advanced Nurse Practitioner role.

19. Folio goes here Recommendation 11 We will change: By further progressing the Assistant Practitioner East Midlands Project Guidance and introduce this role into the Trust to strengthen Nursing practice.

20. Folio goes here Recommendation 12 We will change: By further strengthening and enhancing the Nurse Consultants’ level of accountability and authority in leading clinical services within the Trust.

21. Folio goes here Recommendation 13 We will change: By undertaking an organisational readiness assessment and preparation for transitional arrangements to an all graduate Nursing profession.

22. Folio goes here Recommendation 14 We will change : Through planning a communication strategy and recognising that for a new role identity for Nursing to be implemented and sustained, it will be essential for all Nurses to be clearly understanding ‘what it means for them’ during the re-designation process.

23. Folio goes here Recommendation 15 We will change: By being open to exploring the ‘Magnet Recognition Accreditation Programme’ and the partnership opportunities that may exist with South London and Maudsley NHS Foundation Trust to improve patient outcomes and significantly have a healthy work environment for our staff.

24. In Conclusion The Trust has: Listened to views Understood them Combined this will international evidence for practice Made a commitment for change and improvement Turned views, wishes and evidence into Actions For improved patient and care experiences of our Nursing leadership For safer care and prevention of failures For confidence and pride to return to Nursing For public perceptions and confidence to be improved