Nursing numbers

Next week I’ll be in London for this year’s Eileen Skellern and JPMHN Award evening, hearing Mick McKeown give his Making the most of militant and maverick tendencies for mental health nursing Skellern lecture and Patrick Callaghan deliver his Lifetime Achievement Award address. The day following, June 14th, I’ll be at Kingston/St George’s chairing the summer meeting of Mental Health Nurse Academics UK. One of the things we’ll we talking about is NHS England’s Interim People Plan, which looks to be prioritising mental health nursing as an occupational group in need of support. Here’s a short piece I wrote yesterday for the MHNAUK website, complete with a toxic-looking figure showing the decline in applications for nursing degrees:

The NHS needs more mental health nurses. The most recently available data on the size and composition of the workforce in NHS England, for February 2019, records a total of 36,290 mental health nurses. This compares to an NHS England mental health nursing workforce in September 2009 of 40,602.

Published on June 3rd 2019, the Interim NHS People Plan is about supporting the people needed to deliver NHS England’s Long Term Plan. Chapter 3 addresses nursing, this being the profession where the greatest shortages are found and where the most urgent and immediate action must be taken. Mental Health Nurse Academics UK welcomes the identification of mental health nursing as a priority group, and notes the Interim People Plan’s statement that what must now happen is:

[…] a detailed review across all branches of pre-registration nursing, including a strong focus on the steps needed in mental health and learning disability nursing to support growth in these areas.

The Plan echos Mental Health Nurse Academics UK’s view that undergraduate degree courses offer the best way to secure a future supply of nurses. It also reproduces a figure pointing to a sharp decline in applications for nursing and midwifery courses in England since the removal of bursary support (specifically, a 31% decrease between 2016 and 2018):

Annotation 2019-06-06 120912

Extracted from Interim People Plan, p24

The Interim People Plan places an emphasis on what it refers to as ‘the offer’ made by the NHS to its staff. Mental health nursing needs a better offer if it is to improve the recruitment, retention and support of its current and future members. Mental Health Nurse Academics UK will be looking for concerted action in these areas.

My view is that this decline in applications was entirely foreseeable in the context of the removal of bursaries in England. As it happens, students of nursing and other health professions commencing their programmes of study in Welsh universities in Autumn 2019 can expect to be supported through the award of a bursary, in return for working for two years post-qualification in NHS Wales. That’s a good deal, in my book, and is something presented as part of the country’s wider #TrainWorkLive initiative. I’m not entirely sure how far this ‘Welsh offer’ (to borrow the language of the People Plan) is known throughout other parts of the UK: so I’m happy to give it a nudge here.

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May review

2019-05-20 18.41.32.jpgEarlier this month I joined colleagues at the main meeting of the #MHNR2019 scientific committee, held (as the conference itself will be) at the RCN in London. We had a good number of abstracts to work through, submitted by people from the UK, the US, Australia and elsewhere. The programme is being worked on now, and people will not have long to wait before learning the outcomes of the panel’s deliberations. As an aside, whilst the conference committee always welcomes proposals for workshops as well as for concurrent sessions, posters and symposia we were reminded, when we met, of the importance of workshops promising to make delegates work. This is doubly important given that a workshop typically occupies the same amount of time on the conference programme as do three concurrent talks: so they have to sound engaging, and interactive, and not read like a plan for a 90 minute lecture.

For me this month also included a trip to St Angela’s College in Sligo for a stint of external examining for the College’s Postgraduate Diploma in Community Mental Health Nursing. It’s a good course, attracting applicants from all around Ireland, in which students learn about recovery-focused practice, therapeutic relationships, formal therapies, the context for care and care coordination, and more besides. It’s complex work being a registered nurse, and that’s why in all parts of the world the profession is (or is becoming) a graduate one for new registrants, with specialist courses like this one in Sligo being offered at post-registration level. I mention this as, tediously, nurses (and their friends) are once again having to defend the value of an education which involves time in practice but also, crucially, study for a degree.

Finally, this is my 16th unbroken annual trip to the Hay Festival. When I was first here the event was a relatively small-scale affair, held in the town’s primary school. It’s a much bigger enterprise now, located on a site some half a mile out of town to which many thousands of visitors arrive each day. This year I’ve listened to talks and round table discussions on the interminable horror that is Brexit, the making of (and the intentions behind) Our Planet, the invasions first of the Vikings and then on D-Day, and more.

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COCAPP-A main findings paper

COCAPP-ACOCAPP-A, funded by the NIHR Health Services and Delivery Research Programme, investigated care planning and coordination in inpatient mental health services. It was led by Alan Simpson, and I was mighty pleased to have been part of the research team. The full, 270 page, report appeared in 2017. Now, a derived paper reporting main findings has appeared in the journal BMC Psychiatry. Lead authored by Michael Coffey this article amounts to a more modest 18 pages, which means it stands a chance of actually being read by people able to make use of it.

As a gold open access article the paper is free to download to anyone with an internet connection. As a taster, here’s the abstract:

Background: Involving mental health service users in planning and reviewing their care can help personalised care focused on recovery, with the aim of developing goals specific to the individual and designed to maximise achievements and social integration. We aimed to ascertain the views of service users, carers and staff in acute inpatient wards on factors that facilitated or acted as barriers to collaborative, recovery-focused care.
Methods: A cross-national comparative mixed-methods study involving 19 mental health wards in six service provider sites in England and Wales. This included a survey using established standardised measures of service users (n = 301) and staff (n = 290) and embedded case studies involving interviews with staff, service users and carers (n = 76). Quantitative and qualitative data were analysed within and across sites using descriptive and inferential statistics, and framework method.
Results: For service users, when recovery-oriented focus was high, the quality of care was rated highly, as was the quality of therapeutic relationships. For staff, there was a moderate correlation between recovery orientation and quality of therapeutic relationships, with considerable variability. Staff members rated the quality of therapeutic relationships higher than service users did. Staff accounts of routine collaboration contrasted with a more mixed picture in service user accounts. Definitions and understandings of recovery varied, as did views of hospital care in promoting recovery. Managing risk was a central issue for staff, and service users were aware of measures taken to keep them safe, although their involvement in discussions was less apparent.
Conclusions: There is positive practice within acute inpatient wards, with evidence of commitment to safe, respectful, compassionate care. Recovery ideas were evident but there remained ambivalence on their relevance to inpatient care. Service users were aware of efforts taken to keep them safe, but despite measures described by staff, they did not feel routinely involved in care planning or risk management decisions. Research on increasing therapeutic contact time, shared decision making in risk assessment and using recovery focused tools could further promote personalised and recovery-focused care planning.

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#MHNR2019

#MHNR2019With just under one month to go before the deadline for submission of abstracts for the 2019 running of the International Mental Health Nursing Research Conference I thought it an idea to draw attention to this top tips post from two years ago. As I suggested then, conference guidelines are there to be followed. For the past couple of years we’ve published criteria for abstract selection, including information on the structured presentation of quantitative, qualititative and non-empirical abstracts.

And, whilst I’m writing about #MHNR2019, now is a good time to link to this MHNAUK post announcing Sue McAndrew as Mental Health Nurse Academics UK Lecturer for 2019. Sue works at the University of Salford, and will be drawing on her work in children’s and young people’s mental health.

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#MHNR2019, A Framework for Mental Health Nursing, and MHNAUK meets in Birmingham

MHNR2019The call for abstracts for the 25th International Mental Health Nursing Research Conference is now live, with this year’s conference organised under the theme of From Global to Local: Mental Health in a Connected World. We’ll be meeting, for the first time, in London: specifically, in the RCN HQ in Cavendish Square. This is also the year that we’re working with the International Society of Psychiatric/Mental Health Nurses, and we’re hoping the event has a truly international feel. The deadline for receipt of nominations for people to deliver the Annual MHNAUK Lecture at #MHNR2019 has passed, and the commitee will be deliberating over the coming weeks before an announcement is made.

MHN FrameworkMeanwhile, on Mental Health Nurses’ Day, February 21st, here in Wales a new ten year Framework for Mental Health Nursing was launched at Cardiff University’s Hadyn Ellis Building. The Framework contains 13 pledges organised through four key themes: Professionalism, Voice and Leadership; Workforce and Education; Promoting Population Health and Wellbeing; and Quality and Safety of Care. It is also replete with exemplars of good practice.

One day after the Framework launch I was in the fine surroundings of the University of Birmingham for 2019’s first meeting of Mental Health Nurse Academics UK. A note of the event, which was attended by almost 50 people, can be found here. The meeting was a full one, with updates on both the REF and the TEF, experiences of course validation reflecting new NMC standards and more besides.

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Introducing the MENLOC study

menloc logo 5A big part of my work this year is this recently funded evidence synthesis in the area of end of life care for people with severe mental illness. This is a cross-university study, supported by the National Institute for Health Research (NIHR) Health Services and Delivery (HS&DR) Research Programme, which also features service user researchers and a stakeholder advisory group populated by people with experience in both the mental health and end of life care fields.

Here, from our protocol, is a summary of what we’re up to:

The aim of this project is to synthesise relevant research and other appropriate evidence relating to the organisation, provision and receipt of end of life care for people with severe mental illness (including schizophrenia, bipolar disorder and other psychoses, major depression and personality disorder) who have an additional diagnosis of advanced, incurable, cancer and/or end-stage lung, heart, renal or liver failure and who are likely to die within the next 12 months.

Outputs from the project will be tailored to stakeholders, and clear implications will be drawn for the future commissioning, organisation, management and provision of clinical care. Recommendations will be made for future data-generating studies designed to inform service and practice improvements, guidance and policy.

In this context, summary objectives are to:

  1. locate, appraise and synthesise relevant research;
  2. locate and synthesise policy, guidance, case reports and other grey and non-research literature;
  3. produce outputs with clear implications for service commissioning, organisation and provision;
  4. make recommendations for future research designed to inform service improvements, guidance and policy.

This review will be conducted according to the guidance developed by the Centre for Reviews and Dissemination (CRD) and will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations. Reflecting Evidence for Policy and Practice Information (EPPI) Centre principles, opportunities will also be embedded into the project to maximise stakeholder engagement for the purposes of both shaping its focus and maximising its reach and impact.

Searches will be developed initially using Medical Subject Headings (MeSH) and text words across health, social care and psychology databases from their inception. In consultation with a stakeholder advisory group, supplementary methods will be developed to identify additional material including policies, reports, expert opinion pieces and case studies. All English language items relating to the provision and receipt of end of life care for people with severe mental illness and an additional diagnosis of advanced, incurable, cancer and/or end-stage lung, heart, renal or liver failure will be included. All included citations will be assessed for quality using tools developed by the Critical Appraisal Skills Programme (CASP), or alternatives as necessary if suitable CASP tools are not available. Data will be extracted into tables, and subjected to meta-analyses where possible or thematic synthesis with help from NVivo. Strength of synthesised findings will be reported where possible using GRADE and CerQual.

Information derived from the processes described above will be drawn on in an accessibly written summary. Uniquely, this synthesis will comprehensively bring together evidence on factors facilitating and hindering high-quality end of life care for people with severe mental illness, who have an additional diagnosis of advanced, incurable, cancer and/or end-stage lung, heart, renal or liver failure, and evidence relating to services, processes, interventions, views and experiences. Implications will be stated for the improvement of relevant NHS and third sector care and recommendations will be made for future research.

menlocRight now, having convened a first advisory group meeting, we’re busy searching and sifting for evidence mostly through reviewing citations identified in a series of comprehensive database searches. I’ll be posting more here as the study progresses, but for the detail a good place to go is here for the published protocol.

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Coordinating mental health care

Hot on the heels of the publication of this paper from COCAPP, I’ve had two opportunities in recent weeks to present the content to (very select) groups, first at City, University of London and then at the South Wales Mental Health Nursing Journal Club and Seminar Group. Because I can, I thought to share the slides: so here they are, for anyone interested:

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