Caring for Patients

1. Caring for Patients
Elaine Whitby
Royal College of Nursing
Improving Patient Care Conference
November 2015

2. My brief
With the NHS facing unprecedented financial
and resource pressures, what difficulties do
front line staff face in meeting the standards
and quality of care they provide?
Setting the scene for later speakers
Explore difficulties + so what?
– If we understand the pressures, how do we help
create the climate for staff to thrive?

3. Likely CSR announcements (Nov
2015)
• 25/40% real cuts are expected for most departments
(Social care? Public health?)
• Public sector pay capped
• Treasury could define protection for health services
to only commissioned services (source: Kings Fund)
• CQC budget likely to be cut by up to 40%
• HEE budget could be cut – impact on bursaries
• Funding presented as being sufficient to deliver 7DC
• Context is unlikely to improve

4. What does good care feel &
look like?
“Sheila’s presence reassured me … by the bed,
kneeling next to me, in the doorway. She was
just a ward sister who lived with a tortoise and a
husband … but I believed she would make
things better. It was never anything she said. It
was something in her face.
Outside my room … I know she took my mum
and Tracey aside and gave good news as even
handedly as she gave bad, and then consoled
and listened.”
Patient, Ben Watt 1996

5. Care &
kindness
CompetenceTrust

6. Difficulties for front line staff -
recent reports …..
NHS staff survey
2013 2014 difference
% satisfied with quality of care
they can deliver
77.75% 76.34% -1.41%
% agreeing that their role makes
a difference
90.16% 89.55% - 0.61%
% witnessing potentially harmful
errors, near misses & incidents
in the last month
31.61% 31.05% -0.56%
% suffering work related stress
in last 12 months
38.61% 39.50% 0.88%

7. Reports cont …
Volume & pressure of work
September 2015, RCGP survey of 549
practices:
– 10.2% of full time equivalent positions are
vacant. Workload has rocketed - 60m more
consultations than five years ago but
stagnant workforce numbers. GP services
under pressure & working exceptionally
long hours to cope with demand.

8. So what do you think?
What are the difficulties you face in
meeting standards/providing quality?

9. Tensions/issues
Uncertainty about safe staffing level
guidance v ability to balance the books
Volume of data collection, inspection
etc.
Recruitment difficulties & new roles/role
substitution – concerns of accountability
& spreading registered staff too thinly
Reduction in education & development
opportunities

10. What might help?
No panacea
Not addressing policy issues today
What can staff/teams/organisations do?

11. Staff engagement
Compelling evidence that organisations in which staff
are engaged and valued deliver better quality care
including:
– lower mortality rates
– better patient experience (treated with dignity &
respect)
– healthier and happier staff, with lower sickness,
absence and staff turnover
Organisations with a disengaged workforce are more
likely to deliver care that falls short of acceptable
standards

12. Engagement cont …
NHS staff survey indicates levels of staff
engagement are increasing, but wide variation
Engaged staff should be more likely to have the
necessary psychological resources to show
empathy and compassion to patients, despite the
pressure
Engaged staff may provide our most efficient
mechanism for addressing negligence or poor
standards of care.
(King’s Fund; West et al)

13. Innovation/guideline/programme
Problem or issue to be improved
Design & implement approach that fits local need –
with the team!!
Ideas
contested
& debated
New,
shared
knowledge
generated

14. Summary
Current context very challenging & may become
more so
Aim for competent, caring staff:
– Build patient trust
– Improve patient outcomes & experience
Evidence that engaged workforce = higher quality of
care
Try to prioritise, choose your initiatives carefully,
involve staff in the challenges & decisions
Support them as much as possible