This document provides a summary of the consultation findings and a response to the comments received.

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The 2013/14 programme will begin with a national reminder lung cancer symptom awareness campaign in July 2013, with a further national campaign planned in autumn 2013 and two regional campaigns in early 2014. The decision about which campaigns will run in addition to the lung campaign will be taken once further evaluation data from this year’s campaigns become available.

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As a result, from 26 March 2013, this Chief Nursing Officer bulletin website will no longer be updated and these pages will be archived by The National Archives (TNA).

We will redirect our website addresses to make sure you can still access the archived information.

For all future updates, please refer to the NHS Commissioning Board

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A PDF version of this month’s bulletin can be downloaded here.

Gateway reference number: 18867

This is the last edition of CNO Bulletin published by the Department of Health. As a recipient of this bulletin, your email address will be transferred to the NHS Commissioning Board, unless you request otherwise. If you do not want your email address shared, please email CNO-bulletin@dh.gsi.gov.uk before 26 March. For more information about the NHS Commissioning Board’s planned publications, please contact seth.edwards@london.nhs.uk.

You can also visit www.commissioningboard.nhs.uk

Disclaimer: Unless otherwise stated, guidance referred to in the bulletin has not been commissioned or endorsed by the Department of Health – it is evidence that organisations and professionals may find helpful in improving practice. The National Institute for Health and Clinical Excellence is the Department’s provider of accredited evidence and guidance. This information can be found on the Institute’s website at www.nice.org.uk

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Robert Tunmore, our professional editor, bids a fond farewell to the CNO Bulletin

This is the last CNO Bulletin from the Department of Health, the end of an era and the start of a new one. The next edition will have a different look and feel. As part of the new health and care system, it will in future come from CNO at the NHS Commissioning Board.

The bulletin was first published in April 2001, and just three more were published by the time I started six months later, as nursing editor for the CNO’s Professional Leadership Team. My initial aim was to get the bulletin out as a regular monthly communication from CNO.

Over the years, the content has reflected the diversity and the challenges, the constants and the changes of the nursing and midwifery professions and their contribution to delivering high quality care. A glance through the CNO Bulletin archives gives a fascinating insight into the breadth and diversity of nursing and midwifery and offers a particular perspective on our social history.

Focusing on what matters

As you would expect, some of the enduring themes focus on providing safe, high quality care, improving both the patient’s experience and the public image of nursing, strengthening clinical leadership and promoting nursing and midwifery as challenging and rewarding careers.

I have seen and heard how the bulletin has been used to inform practice and shape policy, as preparation for interviews, for team meetings, updates and discussions, as well as providing an authoritative, accurate and (usually) concise sources of policy related information for nurses, midwives and health visitors.

Evolution of a bulletin

While there have been strong, consistent core themes, there have been quite a few changes, not least in the way it is delivered. Originally, it was sent out by post to subscribers, the most senior nursing and midwifery leaders, then in December 2002, as an optional email version.

Having volunteered it as a guinea pig for trials of new channels of communication, it has now been adapted and delivered as the current online version. It has been part of an evolutionary process, moving on with developments in digital communications and social media, reaching an ever wider and more diverse cross section of the nursing and midwifery community.

Credit where it’s due

I would like to thank everyone who has contributed articles and features, along with examples that have helped translate policy into practice. It has been a great privilege to be part of this process. It has given me the opportunity to engage with some of the greatest nurses and midwives in the country, to meet students and newly qualified staff, and to work closely with some of the key nursing and midwifery charities and organisations, who have all had a voice to reach this important audience.

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Here are just a few of the commitments colleagues made from up and down the country!

“In surgery at we (lead nurse, matrons and ward sisters) will ensure that all inpatients with dementia have a patient profile.”

Georgina ‘George’ Kenney, Lead Nurse in specialist and general surgery and urology at University Hospitals, Leicester NHS trust

“As a second year student nurse, I pledge to make a difference and always put patient care first.”

Shelley Thompson, 2nd year student, Nurse at University of Teesside.

“As a student nurse, I pledge that everyone should be treat as an individual, wishes and beliefs to met. All care to be provided with a smile!”

Paige Davison in her  final year and will qualify in august as a paediatric nurse at Northumbria university

“As a student nurse and care maker, I pledge to share and inspire people with my experience of the Expo event to improve the NHS.”

Amanda Bain, third year student nurse studying adult pathway, Teesside University, County Durham and Darlington

“I pledge to ensure every nurse at every interaction with patients/relatives or carers asks: ‘do you have any questions?”

Marsha Jones, senior ward sister on a respiratory and nurse led NIV ward, Worcestershire Acute Trust

Find out more about NHS Change Day and the many other pledges made by NHS staff here.

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The introduction of PHBs follows the end of a three-year pilot scheme and the publication of an independent evaluation, which found that the quality of life for people with PHBs significantly improved, with some even seeing a drop in their attendance at hospital.

The national rollout will begin with patients receiving NHS Continuing Care, who will have the right to ask for a budget by April 2014. Locally NHS health providers can offer them to others who they feel may benefit from the additional flexibility and control.

The Government has also announced that the existing pilot sites will also be able to offer:

• Direct payments for health care and a public consultation will be launched on updating regulations to enable this nationally
• A practical toolkit that pulls together the wider learning from the pilot and will give NHS professionals the information they need going forward. It includes a new DVD of stories, from budget holders and healthcare professionals.
• £1.5 million funding to support early rollout until April 2013, when delivery responsibility will transfer to the NHS Commissioning Board
• Building on the learning of the 70-plus pilot sites, regional learning hubs will help the rest of the NHS to introduce personal health budgets by the 2014 target. Nine areas ‘Going further, faster’ will demonstrate how to mainstream personal health budgets, including integrated health and social care personal budgets.

The experience of patients and nurses to PHBs has been positive, Wendy Train a Community Matron at the pilot sites in Hull explains how PHBs benefits patients:

“PHBs enable patients with a long-term condition or disability to have choice, flexibility and control over the care and support they are receiving. The pivotal outcome of a Personal Health Budget is the happiness of the patient and their family with an improved quality of life, independence, involvement and choice in their care. This enables them to manager their health and symptoms at home, which most importantly keeps them out of hospital.”

Wendy Train, a community nurse at one of the pilot sites in Hull, believes PHBs offer patients choice, flexibility and control

Alison Rodman a Community Matron also from the Hull pilot site says that nurses are not only able to prevent unnecessary hospital stays for patients because of PHBs but also enable service users:

”PHBs can improve both self-confidence and knowledge. PHBs enable the patient to take control over conditions and situations, while also allowing the patient to monitor their own health in their own environment. The introduction of PHBs has allowed me to make a difference and see how beneficial that individual difference can make to a patient, these positive outcomes have a wide range of effects including alleviating depression.”

For more information on Personal Health Budgets, visit the Department of Health site

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The need to put the patient first and reinforce patient centred care is a central facet to every one of the Francis report’s recommendations. However, the QNI believe that in order for the recommendations to have an effect the issue of staffing levels of skilled nurses must be dealt with in tandem

Crystal Oldman, Chief Executive of the QNI said, ‘the QNI’s Right Nurse, Right Skills campaign has, since 2011, highlighted the loss of skills within community nursing teams and the problems that this brings. It is time that the NHS acknowledged that a shortage of qualified nursing staff in hospitals and the community leads to poorer health outcomes for patients, especially for those who are most vulnerable and dependent’.

The view that nursing should have a stronger voice within NHS institutions is a shared by both the QNI and the Francis report, another recommendation strongly shared by both the QNI  and Francis report is the issue of the regulation of healthcare assistants.

As Crystal Oldman went on to say, ’the report calls for the regulation of healthcare assistants, something which the QNI has consistently advocated in recent years. Regulation of HCAs is at least as important in the community – where care is often delivered behind closed doors – as it is in hospitals. Our report ‘Nursing People at Home’ (2011) highlighted the issue that many patients were unable to tell who was a registered nurse, and who was a HCA. This must be addressed’.

‘If the NHS is to keep the public’s trust it has to invest in a properly skilled and well-led nursing workforce, supported by regulated healthcare assistants, trained to deliver the care that we want for our loved ones and ourselves.

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The culmination of Professor Tuazon’s ten-day visit was her meeting with Crystal Oldman, chief executive of The Queens Nursing Institute (QNI), and other leading nurse educators at the QNI on the 11 February.

Compare and contrast

The meeting identified specific areas for learning and collaboration between the Philippines and the UK. These included a comparison of the way in which community health needs assessments are undertaken here and in the Philippines, by identifying the nursing skills and education required to meet those needs. While there is access to community nursing through the NHS, the Philippines have no such structure, with community nursing delivered on a public health based system. There is also little in the way of home nursing as its provision is based upon the ability to pay for private health care.

The comparison between the cultural aspects of nursing care in the Philippines and the UK also reveals differences, such as Philippine nursing students learning about community health on a whole population basis, not just visiting homes to deliver care like their British counterparts.

The meeting also addressed differences in community nurse training and examined the cultural influences behind Filipino nurses’ reputation for care and compassion.

Worthwhile exchange

The meeting’s success in sharing knowledge was highlighted by Professor Tuazon: “The QNI provide a blueprint for the high quality community nursing service required in the Philippines. I would like to explore the potential for a similar system of recognition of excellence in community nursing there.”

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