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Speech by the Rt Hon Alan Johnson MP, Secretary of State for Health, 30th April 2008: Royal College of Nursing

Thank you very much, Jason, it’s a great pleasure to be here.

Can I say at the outset, It’s been a genuine pleasure to work with the Royal College of Nursing over the past ten months since I became Secretary of State for Health. I worked with you before about three years ago, when as Secretary of State for Pensions, RCN was instrumental in the negotiated deal that we came to which I think was fair for everyone. You helped me then and I was greatly impressed by the standard and professionalism of your officials, and in particular Peter, its been a great pleasure working with you and to have what I regard as a very good working relationship.

Throughout its history, the RCN has been utterly consistent in its commitment to improving quality of care for patients. Never opposing change for opposition’s sake, the college has been a critical friend of the health service, and an astute voice on behalf of the profession and a strong advocate for patients.

Context

My purpose today is to do a little bit of looking back and quite a lot of looking forward. 

Looking back, because this year marks the 60th anniversary of the NHS and it is right that we should celebrate an institution which is probably the most revered and cherished than any other in British society. And forward, because the Health Service has always had to change and adapt to ensure it keeps pace with advances in medical science and new technology.

Last July, I announced that there would be no more structural changes in the NHS for the foreseeable future. No more reorganisations of primary care trusts, no more tampering with strategic health authorities. Instead, we would focus all of our attention on what really motivates those who work in the NHS:-  improving patient care. How to make the NHS, which is world class in so many respects, world class in all respects. My colleague, Professor Lord Ara Darzi, one of the pioneers of keyhole and robotic surgery has led this process, but the work has been done by thousands of doctors, nurses, healthcare professionals, patients and the public in each region of the country, including the 400 nurses who have been involved in the Clinical Pathway Groups.
The results of these deliberations will be unveiled soon.

As we look back to the momentous events of 1948, it’s as well to remember that the RCN has always been a passionate and dedicated supporter of the founding principles of the NHS, in contrast to many other medical bodies. There is a kind of received opinion about the creation of the NHS; as if it emerged from political consensus and wide professional support. In actual fact, it was bitterly contested at every step of the way, both inside and outside of parliament. Prior to 1948, it was nurses, working in voluntary hospitals coming into daily contact with the suffering of those who couldn’t afford to see a doctor, who gave the strongest professional support to a healthcare system free at the point of need and available to all, irrespective of wealth or background.

The then president of the College in 1948, Dame Louisa Wilkinson saw this as a great opportunity to establish finally that nurses were not, in her words: “handmaidens of the medical profession,” but part of an “active, loyal and wide awake partnership with the medical team.”

One of Nye Bevan’s first actions as Minister for Health in 1946, was to produce a Charter for Nurses, which sought to end the maternalistic exploitation of nurses and hospital workers – an unhappy feature of hospital life that had gone virtually unchallenged for generations. The new Charter improved salaries and training facilities established a groundbreaking 96 hour fortnight for hospital nurses.  It also brought greater protection for nurses, who could be dismissed on the slightest whim of the all-powerful matron, if the way they dressed or the way they conducted their personal life didn’t adhere to their hospital’s strict code.

The RCN, of course, pre-dates the NHS by twenty years, and this year marks your 80th anniversary.  The challenges that we face today are not just different from those of 80 and 60 years ago – they are very different from those of faced just 20 years ago.

In 1928, when the College of Nursing received its Royal Charter, life expectancy for men was 56 and for women around 60 years. In the same decade, the first ever insulin injection was given to fourteen year old Leonard Thompson, to treat his type one diabetes. The fact that he survived for two and a half more years after that was seen as a major advance in medical science.

Life expectancy for men and women has increased by nearly twenty years since then and those with long-term conditions such as diabetes can also expect to live well into their 60s and 70s.

In the last thirty years, we’ve seen huge increases in survival rates for childhood cancers. In the late 70s, only 42 percent of children with cancer survived. That figure is now around 70 per cent. There are over 25,000 adults in this country alive today who wouldn’t have been survived into adulthood 30 years ago.

Twenty years ago, we saw the introduction of screening for breast cancer, which now saves 1,400 lives each year, and for cervical cancer, which saves 4,500 lives each year.

And in the last ten years, the mortality rate for cardiovascular disease has fallen by forty per cent, and for cancer by 17 per cent.

But the 21st Century and the retirement of the baby boomers brings very different challenges some of which are in part a product of the success of the NHS. Centenarians are now the fastest growing age group and there will soon, for the first time in our history, be more pensioners in this country than children

Rising levels of obesity, if unchecked, will lead to huge increases in cardiovascular disease, diabetes and some cancers. It will be a tragic reversal of fortune if the impact of the astonishing advances in medical science of the last sixty years is diminished because of a growth in preventable, lifestyle diseases.

As you have been debating this week, In the face of these challenges, the role of nursing is changing.  It was always much more than simplygiving care, important though that is. Today, you commission, oversee and direct care as well. Out-dated hierarchies are increasingly being discarded as more nursing is self-directed, with nurses leading multi-disciplinary teams not just in NHS settings, but also in education and social care.

Careers/training and development

A key foundation for a strong, confident nursing profession is training and development – something which the Royal College of Nursing has campaigned passionately for throughout its history. It’s a passion for the RCN because it’s a passion for individual nurses who raise their issues with me on virtually every hospital visit as I go around the country.

When the department developed modernising medical careers with the Royal College, eighteen months ago, we said we needed to reform the career framework for nurses so that training and continuing professional development reflected the changing requirements of the profession and provided more opportunities for returners and mature entrants who take up nursing as a second career.

We are currently working with the profession, through the Darzi Review, on what training and education for nurses should look like – including looking at whether to follow other health professions, and opt for graduate-level registration.

There is strong case for this – all other health professions in England are moving towards this goal. Nurses are expected to operate with increased autonomy and responsibility, they work in more complex, varied environments and many spend years topping up their qualifications to degree level once they are registered.

But before we take this step and we will take this step together, we must be absolutely sure that graduate-level registration doesn’t hinder recruitment.

The responses we’ve received from the many of you who took part in the post-registration nursing careers consultation, demonstrate that there is an appetite for reform. Many make the sensible point that we shouldn’t throw out the good things about the current system, simply for the sake of change.

The Nursing and Midwifery Council will also report on this issue in June – and we will work with RCN and others on the best options for the profession.

In particular, we will consider what more needs to be done to ensure registered nurses can access to training and development throughout their careers. Some Trusts are very good at this, but it’s patchy, and too many duck their responsibilities.

I am amazed at the sacrifices nurses make to acquire training that benefits the service. Nurses should not be expected to use their holiday time, or their hard earned pay for training that helps them meet the needs of their patients. This would be unacceptable in other professions – there’s no reason why it should be acceptable for nurses. High quality training and development is essential to supporting high quality care.

The Healthcare Commission Survey demonstrates that 92 per cent of in-patients consider the care they received as being good, very good or excellent.

When patients talk about quality of care, they generally mean the quality of nursing care.

Nurses are best placed to identify when things are going wrong – whether it’s a patient’s condition that is deteriorating, or simply noticing that a patient is worried or ill at ease with their surroundings,  that they have a problem with the equipment that’s being used.

This role is even more important in an era where patients are more demanding. They are right to expect a high-quality service in a clean, safe environment. The reputation of Britain’s hospitals and clinics lies in your frequently washed hands.

Thanks to the colossal efforts of the workforce, we have curbed the dramatic rises in healthcare associated infections. The latest figures show a 30 per cent drop in MRSA and a 23 per cent fall in Clostridium difficile over the same period last year. But this is a fight that will need to continue, as it will in healthcare systems across the world, many of which do not produce statistics and of those who do few are seeing the same reductions in infection rates. You know more than any one that  Maidstone and Tunbridge Wells was a failure of management which must never be repeated.

Poor nursing care and unclean hospitals are exceptions. But it is vital to remember how quickly hard-won reputations can be lost, and the damage that substandard levels of care can do to public confidence. It is nurses who the public look to in order to maintain high standards of care, and to challenge any deviation from these central principles, and it is nurses that we must look at to empower them to carry out the role that the public expects them to have.

Productive wards/paperwork

To focus properly on a safe, high quality healthcare environment, nursing staff need to be able to spend the maximum time administering to patients, rather than to paperwork.

I appreciate how frustrating it must be, when nurses feel they are being diverted from direct care for patients by unnecessary bureaucracy.

You know how best to run your wards.  Indeed, there is clear evidence that where managers and leaders empower nurses to make changes in how wards are run, there are dramatic improvements in patient care.

In a recent visit to Nottingham, I was hugely impressed by the Productive Wards Pilot, where ward-based nurses, led by the ward sister, are given time to examine how their ward is organised, and to make changes that allow them to spend more time with patients.

As you know only too well, ward-based nurses can often spend as little as a quarter of their time on direct patient care, with the rest being consumed by paperwork, handovers, chasing down equipment and unnecessary journeys back and forth because of poor layout or slack organisation.

On a typical ward in the productive ward programme, frontline staff, suitably empowered, found that by making small changes like altering patient handover time, re-organising storage facilities, and making better use of data,  they could double the time spent with patients, reduce the time they spent on paperwork, improve the accuracy of patient observation and minimise overstocking and meal wastage.

I was deeply impressed by what I saw on  Fleming Ward, at Nottingham City Hospital.  This was by no means a problem ward – by any standards, it was already performing well. But by taking small but significant steps, nurses have made enormous improvements to patient care.

The most important aspect was that rather than being something that was imposed on the ward by innovation-crazed management consultants, the project was something that nurses on the ward wanted to do – they applied to be part of the programme and they have total ownership.  This is the fundamental reason why it works.

Eighty per cent of Trusts are currently involved in the programme. But only two Trusts are applying iys principles systematically across all their hospitals. We need to do more and I am therefore looking at how the programme can be extended. I want to work with the RCN and others to see more wards involved in this programme, so that more nurses will be able to reduce the amount of time they spend on unnecessary paperwork and thereby increase the time they spend with patients doing the job they were trained to do.

Conclusion

In the future, as in the past, the NHS will rely on high quality nursing – in hospitals, GP surgeries, the community and the crucial area of adult social care.

This makes the Royal College of Nursing a key ally: historically it has led the way in promoting the nursing profession. It is now an octogenarian campaigner for better patient care.

As we move the level of investment in the NHS from 3.5 per cent of GDP in 1948 and 5.6 per cent in the nineties, towards the European average of 9% over the next three years, we will work with you to ensure that extra capacity, plus additional resources equals an unremitting focus on quality.

Your members in the past have helped to create the tremendous legacy we are fortunate enough to inherit. Your members today will be instrumental in ensuring, that for the National Health Service, life begins at 60.

Thank you