QNI Annual Conference 2019 - Healthcare in the Community
23-24 September 2019
The QNI’s Annual Conference took place on Monday 23 and Tuesday 24 September; the themes for the conference were, Day 1: Voice to Action and Day 2: Excellence in Action.
Day 1: From Voice to Action
Dr Crystal Oldman CBE opened the conference and announced that the QNI had recently been confirmed as the world’s oldest nursing charity by Guinness World Records. A short video message from American author and campaigner Suzanne Gordon was played to introduce the theme of the day.
Jenni Middleton, QNI Trustee chaired the first session of presentations and conversation by:
Jo Churchill MP, Parliamentary Under-Secretary of State for Health
Baroness Julia Cumberlege
Dame Donna Kinnair
Baroness Helen Newlove
Jo Churchill acknowledged the essential leadership role that District Nurses play in the community, to meet the demands of the ageing population. She said they are at front and centre of the NHS Long Term Plan, which will be reinforced through the extra £4.5bn for primary and community care. She said that the QNI had been enormously influential in ‘getting us there’ and said that key staff members must be given the support they need to do their job, digital equipment that works, and that we have to tackle the high vacancy rate.
Andrea Sutcliffe said that the QNI champions the work of community nurses and helps the public understand what they do. She spoke about the current NMC consultation and the upcoming 100th anniversary of nurse registration. She said that the NHS Long Term Plan contained too much emphasis on ‘what doctors think’ and far too little from nurses. Also in the TOPOL review only one nurse expert is cited. We have to challenge these misconceptions of nursing.
Dame Donna Kinnair said that nursing is a profession to be proud of and that we have to tell our stories with a united voice. She said the biggest issue was staff shortages and in order to address these we have to invest in continuing education and professional development. She claimed that she had been cautioned that the nursing voice was ‘getting too powerful’ in healthcare. However this would not deter the RCN which is just launching a new safe staffing campaign.
Baroness Helen Newlove claimed that the government was not backing up its words with actions regarding healthcare in the community. There are serious problems of organisation, for example GPs not speaking to District Nurses. The care that her father experienced when in a care home, with dementia, was ‘horrendous.’ She said that the DHSC did not understand the human cost of system failings. Quality care in the community can only be achieved with nurses, and without nurses the system hierarchy could not do their job. She pointed to long waiting times, too much paperwork, no mobile signals for technology and lack of communication between hospital and community as key problems. She ended by asking, why are you not paid more than you are?
Julia Cumberlege spoke about her long career working in local government and healthcare. She talked about the bombing of the Conservative party conference in Brighton and how the hospital was able to cope with the disaster because of careful planning. In her report on community nursing there were 14 recommendations – informed by speaking to patients about their experiences. She also spoke about recruitment, retention and return to practice and the need to address the workforce shortages by practical actions.
Questions and Discussion
- The following key issues were debated:
– People are being lost to the nursing profession because of the level of pressure they are under, including factors of work stress and low pay.
– The term ‘nurse’ should be a protected title and people should be valued as nurses.
– If nurses take early retirement there will be fewer nurses to train those in future, in key specialisms. There will be nobody with the skills to run the care pathways that have been created. People will leave the community and move into hospitals, because they do not feel safe in community settings because of staffing and skills shortages.
– Dr John Unsworth said that we should not need to pay commercial organisations to do what the NHS is capable of doing with its own knowledge and capacity.
Professor Alf Collins
Professor Collins explained the Personalised Care Agenda from his experience. He said that personalised care is a ‘hidden curriculum’ that is often learned on the job in an ad hoc manner. He said what patients say about their care is very consistent and only 38% of them say that health professionals ask them ‘what was important to them’. He said that we put a huge burden of care on people for example by making them attend multiple appointments for their care. The clinician and patient world views are completely different. We need to change the conversation from ‘what is the matter with you?’ to ‘what matters to you?’ Professor Collins spoke about the value of active listening and ‘teachback’ techniques, working in partnership with patients, asking them questions with varying degrees of assertiveness.
Matt King OBE
Matt King shared the story of his life, living with a disability, in a profound and moving speech. He suffered an accident playing rugby when 17 years old that left him quadriplegic. He described his experience of care, starting with 258 days in a hospital bed at Stoke Mandeville Hospital. He described his transformation from the mindset of a victim to one who relearned to be accountable for his own life choices. One of the key people in this process was a nurse named Tracy who helped him rebuild his life. He decided to go back to school, studied to qualify as a solicitor, took up skiing, completed the New York marathon. He learned again to focus on the things that he did still have in his life – his brain was undamaged, he had family and friends, and his own will.
Dr Michelle Howarth
Dr Howarth discussed the role of social prescribing in delivering personalised care. Historically the NHS has had the approach of ‘fixing people’ but this is not always a valid approach to people entering the system. Many people for example visit the GP because they may be lonely, not because they are ill. A community link worker can establish what is important to the patient and establish what organisations can offer non-medical interventions to improve lives. She said that social prescribing must be sustainable if it is to become established within the NHS and reduce costs on other parts of the system. Aligned with the third sector, it must have an inter-agency approach.
Professor Alison Leary
Professor Leary introduced the QNI’s new International Community Nursing Observatory. She observed that ‘nursing is most seen when it isn’t there’; when it is there, it isn’t seen. The QNI has a mission to explain the complexity of what District and other community nurses do. Their job is not task, leading to task, leading to task. It is expert assessment, psychological, motivational, personalised, expert. It represents excellent return on investment, and should be accessible and flexible. Nurses keep patients safe by vigilance, clinical acumen, and mitigate ‘rookie factors’. More nurse specialists means better access to care and treatment. There is a severe danger of reductionism. We are hoping to bust some myths about nursing and get some good quality data. Nursing should be a safety critical profession (as airlines are). Nurses voices save patient’s lives.
George Plumptre spoke about the work the National Garden Scheme is doing to support healthcare charities including the QNI. In May, the King’s Fund published a new report about the work these major charities do, including case studies. Charities have a huge and growing role to play in delivering the NHS Long Term Plan. Charities are more flexible and agile. Working with government there is potential for greater collaboration. The fall in funding for CPD by HEE is posing a serious risk to nursing education. However, the data provided by the ICNO will help. 2020 will be International Year of the Nurse, which gives us a great opportunity to showcase the profession and it’s vital importance to care.
Dr Alison While announced the winners of the poster competition (Day 1).
Dr Crystal Oldman closed the first day of the conference.
DAY 2: Excellence in Action
Dr Oldman welcomed delegates to the second day of the Conference and a second short welcome film by Suzanne Gordon was also screened. Dr Oldman announced that in 2020 the QNI would be holding a Festival of Nursing in the Community as a focus for our celebration of the International Year of the Nurse and Midwife.
The first session of the day was a Conversation with four chief nursing officers:
Dr Ruth May
Professor Jean White
Professor Charlotte McArdle
Wendy Nicholson (in place of Professor Viv Bennett)
Dr Ruth May spoke about her first eight months as CNO for England. She said that her priorities were firstly, workforce (the most important), secondly the reputation of nursing and thirdly speaking as one voice as a profession. She welcomed the £210m investment for front line staff and wider investment in education and training budgets. She said that we must invest in nursing leaders for the future and announced £130k for the training of GPN clinical directors of Primary Care Networks. She also announced that the new Act Now Home First e-learning tool to reduce delayed transfers of care would be demonstrated for the first time at the conference today. The Act Now Home First collaborative involves 20 organisations. She also spoke about the Retention Programme, which is slowing the reduction in staff turnover, and the need to attract more people to become student nurses. The ‘We are the NHS’ campaign has been updated as a public education campaign. She also said that must access all of our talents: 1 in 5 nurses have a minority ethnic background but only 1 in 20 have a leadership role.
Prof Jean White described the situation in Wales and said how important the relationship with the QNI was to NHS Wales. She said that evidence is vital to change policy and we have to ‘test things out’ to find what works. We also have to stop being obsessed with hospital care and work to end ‘pyjama paralysis’ especially for the elderly. She spoke about 3 pilots of ‘Neighbourhood Nursing’ taking place in Wales. She also said that Wales is training many new District Nurses, but that the NMC has cast doubt on the future of the specialist qualification. She said that we have to get care delivered in the community right, with new models of care.
Prof Charlotte McArdle spoke about the Team Transformational Work being carried out with QNI input and the Neighbourhood District Nursing model that is being developed. She said that home is the best place for care for most people. She also encouraged all delegates to engage with the NMC consultation about specialist practice, in the context of the increased complexity of care being delivered by nurses. She spoke about the Health and Wellbeing 2026 policy building on the District Nursing Framework 2020-26. She said that future was likely to be integrated nursing teams, offering 24 hour services, aligned with General Practice.
Wendy Nicholson spoke about the UN’s Sustainable Development Goals – there are 17 of them: https://sustainabledevelopment.un.org/?menu=1300 . She said that nurses are well placed to influence individual and community health in this context, for example in immunisations and screenings. She said that the paradigm of nursing care has changed, moving away from treating illness to improving health. She said that the next four years presented huge opportunities for nursing.
- A question and answer session followed including the following topics raised by the audience:
– Safer staffing, especially in England and Northern Ireland.
– How to get people to work together collaboratively.
– How safety and quality can be assured in neighbourhood nursing models.
– The ‘scandal’ of the number of homeless people living on the streets with untreated health issues.
– The decline of Health Visitor numbers and skill mix approach.
Holly is a blogger, speaker and patient leader who lives with a renal failure condition. She spoke about her life history and the experience of her condition, treatment options, and undertaking dialysis at home. She described the reality of living with kidneys that will again require transplant in the future and also the effect on her mental health of being enabled to live through the death of another person. She is involved in a range of voluntary work including peer support and feels that she has great privilege to work with health professionals and others to help them deliver personalised and person-centred care.
Baroness Dido Harding
Baroness Harding spoke about the huge growth in demand for health and social care, and the shortage of staff as the greatest challenge being faced. She said that employers have to be flexible in order to retain staff. We also need to be kind and inclusive in order to be successful employers. She said that the ‘norm’ at the moment is ‘top down and bullying’ and the NHS is not the brilliant employer we would like it to be. We have to address the leadership culture. The most urgent priorities currently are: (1) a lack of nurses to deliver the NHS Long Term Plan; (2) a greater emphasis on people development and management in the NHS.
- Discussion followed on the following topics:
– How to we release people for CPD now that there are so few nurses to do the work?
– How to we manage the Apprenticeship system including local variations?
– How to support student nurses; they cannot be treated in the same way as the rest of the student population and are at risk of exhaustion and poverty.
– The ‘exploitation’ of the social care workforce and the need for more social care staff. Baroness Harding said that if an extra £1bn was available, she would invest it in social care staffing.
– Flexible working – the risk that flexible working patterns will be the refuge of staff who are burned out.
– Bullying and racism – we have been talking about this for 30 years – we must hold Trust boards to account on these issues.
– The importance of compassionate leadership, even when things go wrong.
Dr Agnes Fanning
Dr Fanning spoke about the recent publication by the QNI and RCN of Outstanding Models of District Nursing. The report was informed by a 360 degree research exercise including CQC reports, commissioners, DN team managers, patients and GPs. The report can be viewed here: https://www.qni.org.uk/explore-qni/policy-campaigns/outstanding-models-of-district-nursing/ . The report argues that we need a DN SPQ to give nurses the skills to lead teams and manage caseloads with confidence. The report also identified barriers and made recommendations.
Prof Brian Webster-Henderson spoke about the work of the Council of the Deans of Health and the Cavendish Coalition https://www.nhsemployers.org/engagement-and-networks/the-cavendish-coalition. He spoke about the impact of Brexit on universities and the importance of the Nursing Now campaign. He lamented the fact that only a small number of nurses have the time to do good research. He spoke about attracting men into the profession and said we have to be able to answer the question that men ask ‘What will I be doing?’ He also said that cuts to nursing CPD budgets were preposterous. He said that apprenticeships were great in theory, but very difficult for universities to manage. He also said that there were problems recruiting staff to universities as salaries were not competitive.
Discussion followed about how to support nursing students with the cost of living while they train. Can we have ‘forgivable loans’ if people work for the NHS for a certain period?
There was also discussion around the serious lack of placements for nursing students in important specialities.
Dr Barbara Stilwell
Dr Stilwell spoke about the International Year of the Nurse and Midwife, and the Nightingale Challenge by Nursing Now. She said that this international social movement was supported by 300 employers and over 11,000 nurses are signed up. Find out more here: https://www.nursingnow.org/nightingale/ . She also looked forward to the publication by the WHO of the State of the World’s Nursing Report in May 2020. It was suggested that the QNI submit a paper on community nursing in connection with this.
Professor Alison While announced the winners of the poster competition (Day 2).
Dr Crystal Oldman thanked delegates, staff, trustees, sponsors, exhibitors and speakers and closed the conference.
Thank you to our sponsors: