The document discusses two things that are missing from the Darzi report on the NHS: 1) A focus on nursing as the essence of care delivery, and developing nursing leadership. 2) A focus on team managers, who are often nurses, and empowering them to effectively lead and motivate staff to improve patient experience. The document argues these two areas are needed to truly deliver personalized, dignified care as envisioned by Darzi.

1. What is missing from Darzi?
Nursing and Team Management

2. What is missing from Darzi?
• Lots of good things in today’s NHS –
shorter waiting times, National Service
Frameworks, improvements in services for
Coronary Heart Disease, Cancer and
Mental Illness, patient centred process,
the work of the Healthcare Commission
and NICE and resources.

3. What is missing from Darzi?
• Growing and worrying evidence of loss of
focus on patient experience including;
• Almost a third of the complaints about
hospitals referred to the Healthcare
Commission for independent review relate
to dignity and respect, nutrition and other
aspects of basic personal care including;

4. What is missing from Darzi?
• Patients left in soiled bedding and
clothing, no regular baths or showers or
oral hygiene, inappropriate or inadequate
clothing.
• Commission noted that care on general
wards fell well below the care provided on
specialist wards. Older patients were most
at risk because they were often most
dependent on good nursing care.

5. What is missing from Darzi?
• Commission Report on older people. Of
23 Trusts only 5 complied with all the core
standards for dignity in care. Formal
warnings to 8 Trusts including Barts.
• Darzi very clear on the issues – patients
want to be treated as people, care to fit
into their lives, the basics to be right, to be
treated with dignity and respect, notes to
be available and buildings to be clean.

6. What is missing from Darzi?
• Older people feeling neglected, treated as
an object, privacy not respected, needing
to eat with fingers, being rushed and not
listened to, beds not being cleaned, not
being helped to wash, mixed sex wards.
• All four of Darzi’s themes are relevant to
these issues – fair, personalised, effective
and safe.

7. What is missing from Darzi?
• Darzi says that “nurses have a key role”
but does not develop the theme.
• The first thing that is missing from Darzi is
an understanding about what is going to
deliver personalised care.
• Nursing is the most important process in
healthcare. Nursing is the essence of
care.

8. What is missing from Darzi?
• The danger of a former lay manager talking
about nursing but 37 years of working in the
NHS, career long interest in nursing started by
involvement in Briggs, 14 years experience as a
carer.
• The danger of nostalgia – bring back Matron!
But my support for nursing education within HE,
advanced nursing practice, nurse prescribing
and nurse consultants.

9. What is missing from Darzi?
• What we need is a crusade [an organised
energetic campaign] to focus on nursing.
• Nursing is the forgotten issue. Burdett
Report [Who Cares Wins] – NHS Boards
rarely discuss nursing. Targets and money
dominate the agenda.
• The crusade should include;

10. What is missing from Darzi?
• Leadership from the CNOs in the four
home countries working with NMC, RCN,
RCM, HVA, Queens Institute, Unison and
Universities with the full support of
Ministers and the CEs of the NHS in the
four home countries.

11. What is missing from Darzi?
• Nursing needs to be a priority at all levels
in the NHS – DH, SHAs, Trusts, and
PCTs.
• Managers need to understand nursing –
the most important process in their
organisations.
• Directors of Nursing need to be
encouraged to talk about nursing!

12. What is missing from Darzi?
• We need to ask;
• The public, patients and carers about their
experience of nursing, and what they
would like to change.
• Applicants for nursing why they want to be
nurses and what they expect to be doing.
• Schools of Nursing about the education
and training process and about values and
behaviour as well as knowledge and skills.

13. What is missing from Darzi?
• Nurses at all levels about their work, they
issues they face and what it means to be a
nurse in the UK today.
• Other staff, including doctors, about their
views on nursing.
• Nursing needs to be at the heart of the
NHS.
• Only improved nursing can deliver care
that is personalised.

14. What is missing from Darzi?
• Only improved nursing can deliver real
attention to dignity, privacy, cleanliness
and nutrition.
• Nurses need to be valued and
appreciated.
• Nurses need to see real evidence that
nursing is a priority at all levels.
• Nurses need to be empowered to focus on
the essence of care.

15. What is missing from Darzi?
• The second thing missing from Darzi is a
focus on Team Managers.
• The people of the NHS –the staff – work in
Teams.
• The managers with the most potential for
effective change are the Team Managers
because, as Beverly Alimo Metcalfe says,
leadership is a contact sport!

16. What is missing form Darzi?
• It is the Team Managers who can deliver
performance, productivity, and good
quality patient experience.
• Only Team Managers can manage, lead
and motivate staff effectively.
• Research suggests that Team Managers
need to provide support, feedback,
development, training and clear job
content.

17. What is missing from Darzi?
• Darzi acknowledges that “ some staff are
not listened to and trusted” and that “ staff
often feel left out of the changes that are
happening”.
• Darzi set up David Nicholson’s group to
consider how to put the business of care
at the heart of what local NHS Boards do
and to focus on leadership.

18. What is missing form Darzi?
• However there is no mention of a focus a
on Team Managers.
• The two things missing from Darzi are;
• A focus on nursing – the essence of care
and on Team Managers the real
managers of the NHS.
• There is a close connection between the
two issues.

19. What is missing from Darzi?
• Most Team Managers are nurses.
• Only Team Managers are close enough to
patients, carers and front line staff to make
a difference to patient and carer
experience.