Tag: safe staffing

#ACMHN2018

Big thanks to the Board of Directors of the Australian College of Mental Health Nurses (ACMHN) for inviting me to speak at the 44th International Mental Health Nursing Conference, or #ACMHN2018, which took place in Cairns between 24th-26th October 2018. Never having been to Australia before, and indeed having never before left Europe, this was a big deal and I was grateful for the opportunity.

The theme for the conference was ‘mental health as a human right’, and the three days opened with a memorable welcome to country given by Yidinji tribal elder Henrietta Marrie followed by music and dance. Keynote speakers reflected well the conference theme in their talks, variously focusing on tackling health inequalities (including amongst Aboriginal people), suicide prevention in LGBQTI communities, rural mental health, human rights progress in Ireland (and more). Concurrent presentations were also very high-quality. Worth noting, too, is how the ACMHN used its conference to raise awareness of its campaign, being run in concert with other health care organisations, to demand that children and families seeking asylum and currently being held on the island of Nauru be brought to Australia.

In my keynote I elected to speak about mental health policy, services and nursing in Wales and made the point that the Welsh approach to health care is different from that found elsewhere in the UK, or in other parts of the world. To illustrate this I spoke about the Mental Health (Wales) Measure, the introduction of both future generations and safe staffing legislation and the imminent appearance of a Framework for Mental Health Nursing prepared through the All Wales Senior Nurse Advisory Group for Mental Health.

I realise that in the UK we have nothing quite like the ACMHN: a professional organisation comprised of subscribing members, which represents its field, acts as a credentialing body (nursing education in Australia being a generalist one) and which lobbies for better services and higher standards. The College has a Board and an elected president, the current incumbent being Eimear Muir-Cochrane, and employs a team including Kim Ryan as salaried chief executive officer. The ACMHN performs no trade union function (like the RCN, Unite the Union, and Unison in the UK), and does not register or regulate nurses (as the NMC does). Australia looks to have a number of colleges and associations organised along the same lines as the ACMHN, and I’ve found this site which lists bodies advancing practice and representing members in the fields of critical care, midwifery, children and young people’s nursing, and more.

#ACMHN2018 was an excellent experience, and I was pleased to meet roomfuls of fine and interesting people. For the record, #ACMHN2019 takes place in Sydney between 8th-10th October 2019, with the theme of ‘integrated care’.

Safe staffing (again)

safe staffingJust over a year ago I posted a short piece on this site on safe staffing, particularly noting the work of Shaun Lintern and John Baker in alerting people to the importance of this in the mental health nursing context. Since then, the Nurse Staffing Levels (Wales) Act 2016 has passed into law, and the Welsh Government has opened this consultation on its draft statutory guidance for Local Health Boards and NHS Trusts. My colleague Aled Jones is coordinating a School of Healthcare Sciences response.

Here in Wales, the duty to calculate nurse staffing levels is currently limited to adult acute medical and surgical inpatient wards. In each NHS organisation with responsibilities in these fields, the Government’s draft document refers to the appointment of a ‘designated person’ with the job of calculating nurse staffing levels using three elements:

  • professional judgement;
  • use of an evidence-based workforce planning tool; and
  • a consideration of the extent to which patients’ wellbeing is sensitive to nursing care.

Making these calculations, I can only imagine, will be a mighty challenging task requiring in-depth understanding of individual wards, the characteristics of patients admitted, and use of a tool which has (so far as I understand it) yet to be finalised.

Meanwhile, via John Baker I learn today of this new publication by NHS Improvement on safe, sustainable and productive staffing in mental health services. This is not about safe nursing staffing, but is about interprofessional staffing in specialist mental health services. Here I read of expectations around right staff, right skills and right place, right time and also spot a rapid review of the relevant literature. This begins with the understated observation that, ‘the issue of safe and sustainable staffing in mental health is complex and research is lacking’. I should say so. The time is ripe, I think, for some serious independent studies in this area.

 

#MHNAUK meets in Leeds, and talks work and roles

MHNAUK members in Leeds
MHNAUK meets in Leeds

Mental Health Nurse Academics UK met yesterday in Leeds, hosted by John Baker and chaired by Joy Duxbury. Our discussions were wide-ranging: proposed changes to the composition of the English NHS workforce signalled by the introduction of associate nurses; the arrival, in England, of student fees for nursing degrees from 2017; safe staffing (see also this editorial in the Journal of Psychiatric and Mental Health Nursing); plans for #NPNR2016; arrangements for a second student mental health nursing conference; the Shape of Caring; England’s Five Year Forward View for Mental Health; guidance for adult field nurses caring for people with mental health problems; this year’s Skellern Lecture and JPMHN Lifetime Achievement Award; the current call for papers for a themed care planning and coordination issue of the Journal of Psychiatric and Mental Health Nursing (which Michael Coffey, Alan Simpson and I are co-editing); and the hot-off-the-press announcement of a Foundation of Nursing Studies-sponsored review into the role of mental health nurses.

In this post I’ll largely confine myself to some thoughts on the mental health workforce and on the place of nurses within this. Yesterday’s discussions in this area exercised MHNAUK members greatly. Proposed changes to the occupational mix to be found within mental health services, debates over nursing numbers and safe staffing, and new arrangments for the funding of education have the potential to trigger significant turbulence in an already-complex system of care. MHNAUK members rightly identified how the appearance of a new associate nurse role, sitting in between health care support workers and registered nurses, will trigger unrest. This is always the case when professional jurisdictions come under pressure (see here and here for papers I have co-written which expand on this point). In this current case, some registered nurses will see new associates as a threat to their hard-won jurisdiction. At a time when nurses are pressing for safe staffing, some are likely to argue that the introduction of associates will also open the door to role substitution and eventual reductions in numbers of registered nurses, thereby threatening both quality and safety.

Should associate nurses appear, we can be certain that plenty of inter-occupational jostling will take place as support workers, associates and registered nurses (amongst others) negotiate their relative positions and assert control over areas of work. In this regard, abstract descriptions of the tasks which new associates will (and will not) be permitted to carry out will provide only the most limited of guides. Differentiations between who does what will inevitably be hammered out in the workplace.

And what of the cross-UK implications for all of this, given that the Department of Health’s associate nurse announcement is for England only? To me it is unclear how new associates will be regulated, or how transferable their future qualifications might be should any wish to move to, say, Wales. Across the four countries of the UK important differences are appearing in the ways people are prepared for health care practice, and in the funding of this. Student nurses will pay fees in England from next year, but student nurses in Scotland will not and will continue to receive a bursary. Here in Wales (unless I’ve been asleep and have missed a piece of essential news), we will need to wait until after our forthcoming Assembly elections and the formation of a new Welsh Government for an announcement on future financial arrangments for nursing education. Perhaps we’ll hear more about the shape of the future Welsh NHS workforce then, too.

Safe staffing

In a post on this site last year I drew attention to the (highly contested) decision by NICE to suspend its work on safe nurse staffing in inpatient mental health settings. Now, and with thanks to Shaun Lintern from the Health Service Journal (and to John Baker, who amongst mental health nurses has worked particularly hard to keep this issue alive), NICE’s evidence review in this area has just been published.

Here’s how the news was broken earlier this week:

Here’s a quick summary. Seven research questions were asked in the review, with searches made of fifteen databases for evidence published since 1998. To be included, studies had to report on at least one of:

  • staffing in relation to outcomes;
  • staffing in relation to factors (such as service user factors, environmental factors);
  • staffing in relation to factors and outcomes.

Studies were eligible for inclusion if they reported findings from inpatient mental health areas serving people of any age. Outcomes of interest included serious incidents (e.g., self-harm, violence), delivery of nursing care (e.g., levels of contact) and other (e.g., nurse vacancy rates). Following a process of searching and sifting just 29 papers were finally included, and subject to quality appraisal. And the conclusions? Here they are, as extracted by John Baker with a call for action:

 

Mental Health Nurse Academics UK meets in Nottingham

I was unable to make Thursday evening’s Skellern Lecture and Journal of Psychiatric and Mental Health Nursing Lifetime Achievement event hosted by Patrick Callaghan at Nottingham University. My congratulations to Ian Norman and to Marion Janner, this year’s very worthy award winners. As it happens, Ian was one of my PhD examiners. My following of Thursday’s proceedings from afar, via Twitter, tells me I missed a treat.

I was, however, able to make the trip to Nottingham for Friday’s summer term meeting of Mental Health Nurse Academics UK (MHNAUK). This was held in the new, and rather impressive, Institute of Mental Health building:

Here’s a picture I took of the sculpture, titled House for a Gordian Knot, displayed at the entrance to the Institute’s main building:

We had three local presentations. First up was  Paul Crawford, who gave a broad overview of the Creative Practice as Mutual Recovery research programme which he leads, followed by Andrew Grundy giving an account of qualitative findings from the Enhancing the Quality of User Involved Care Planning in Mental Health Services (EQUIP) study. EQUIP is an important, NIHR-funded, programme of work which (along with COCAPP and COCAPP-A) is producing evidence of how care planning is being done and how it might be improved. Here’s a photo, taken and shared by Karen Wright, of one of Andrew’s final slides outlining steps to successful user involvement in this process:

Tim Carter talked us through his freshly-minted mixed methods PhD, in which he investigated the use of a preferred-intensity exercise programme for young people with depression. I thought this to be a very well-designed study, which generated considerable discussion around the active ingredients of the intervention and plans for a future follow-up.

Elsewhere Lawrie Elliott, editor of the Journal of Psychiatric and Mental Health Nursing, was welcomed by the group to give an update on developments at the journal in his first year at the helm. I really liked what I heard, and said as much in our discussion. Quality of papers, and relevance to mental health nursing, are being prioritised. Word limits have been increased to allow for more in-depth analysis in accepted articles. To extend its reach the journal now has a Twitter account, which can be followed by clicking the following link:

Ben Thomas from the Department of Health opened a discussion on the future of the Student Mental Health Nursing Conference, the inaugural event having taken place at the O2 Arena in London in February this year. As I understand it, much of the organising was done by staff and students at Greenwich University: well done, them. A group of MHNAUK members representing different universities has agreed to collaborate to keep this initiative going, and with a view to turning it into a cross-UK, rather than an England-only, opportunity.

Following David Sallah’s meeting with MHNAUK in York in March 2015, Joy Duxbury and Steven Pryjmachuk chaired a discussion on the current status of the Shape of Caring review. Since returning from Nottingham I have found that Health Education England is planning to sound out opinion through a series of events running into the autumn. Details are to follow.

Thanks particularly to John Baker, in the weeks leading up to this latest meeting MHNAUK published a response strongly criticising the announcement that the National Institute for Health and Care Excellence (NICE) was ending its work in the area of safe staffing. This decision, defended two days ago by Jane Cummings (Chief Nursing Officer at NHS England), has also been challenged by others including Sir Robert Francis and now the Council of Deans of Health. The Safe Staffing Alliance campaigns in this area, and MHNAUK will continue to make a contribution via a further response the outline of which was agreed in Nottingham. As a reminder of some of the key evidence supporting the importance of registered, graduate, nurses for quality and safety follow this link to an earlier post on this site and this link to a recording of Linda Aiken delivering the Winifred Raphael Memorial Lecture at the University of South Wales on October 1st 2014. And, for those interested in how #safestaffing is shaping up differently across the countries of the UK, follow this link for a record of the progress of the Safe Nurse Staffing Levels (Wales) Bill through the National Assembly for Wales. Following this link brings you to a report reviewing the evidence, commissioned by the Welsh Government and produced by a team led by Aled Jones in the Cardiff School of Healthcare Sciences.

Fiona Nolan shared progress on her survey of mental health nursing research interests and expertise in UK higher education institutions. And, finally, on behalf of the organising and scientific committee Russell Ashmore, Laoise Renwick and I took the chance to update MHNAUK members on progress for the 21st International Network for Psychiatric Nursing Research conference.

#NPNR2015 takes place at the Manchester Conference Centre on Thursday 17th and Friday 18th September 2015. We think the programme is shaping up perfectly, with keynote speakers including England’s National Clinical Director for Mental Health Dr Geraldine Strathdee, Prof Shôn Lewis from the University of Manchester, Mark Brown who ran One in Four magazine and is now involved with The New Mental Health, and André Tomlin who runs The Mental Elf service. We have symposia, workshops and concurrent sessions with papers accepted from presenters around the world, a walking poster tour and the opportunity for fringe events. Make your booking now!