Finger on the pulse

first_img Comments are closed. Related posts:No related photos. The newly appointed Chief Nursing Officer for England, Sarah Mullally, iscertainly not the nonentity one NHS insider described her.  Her background of working in the healthservice helps her ensure that policy is formed by front-line staff, by NicPaton When Sarah Mullally was appointed chief nursing officer for England inNovember 1999, she was dismissed by one nameless NHS insider as “anonentity”. Mullally was certainly not a familiar figure within the NHScorridors of power when she took on the role of the Government’s most seniornursing adviser. Her predecessor, Dame Yvonne Moores, had been the only person to hold allthree CNO posts, England, Wales and Scotland. By comparison, Mullally, just 37when she was appointed, came to the Department of Health with no politicalexperience. A former acting chief executive of Chelsea and Westminster Healthcare NHSTrust, Mullally’s nursing career includes teaching at St Thomas’ Hospital, bothas a senior staff nurse and clinical teacher, followed by a stint at the RoyalMarsden as a specialist cancer nurse and a ward sister at Westminster Hospital.It was only after this that she moved into administrative and managerial roles,rising to the Chelsea and Westminster job in 1998/99. High profile advocate of nurses Nearly two and a half years on, Mullally is beginning to make her mark,confounding the conspiracy theorists who suggested that the then NHS chiefexecutive Sir Alan Langlands and chief medical officer Liam Donaldson had beenlooking for someone quiescent for the role. She has been a high-profileadvocate of Britain’s 420,000 nurses, midwives and health visitors, treading afine line between growing demands for the return of the matron and a moretraditional nursing function while working to promote the widening clinicalresponsibilities that nurses have on modern wards. For instance, in January last year she conceded there was a growing problemof nurses neglecting their patients, but she has also seen the introduction ofnurse consultants. She was closely involved in the launch in February last year of the firstnational benchmarking standards for nurses, midwives and health visitors. Andin July last year she was appointed co-chair of the Government’s externalreference group working on drawing up its national service framework for kidneypatients. In person, Mullally comes across as friendly, if not exactly gushing,efficient and, of course, for a top Government appointment, totally on message.She dismisses the suggestion that coming into the DoH as an outsider might havemade her job harder. “I have just got on and done the job actually,”she says, but adds: “Coming out of the service has helped me to ensurethat policy has been formed by front-line staff.” Mullally makes sure she gets out of her Richmond House office to visitnurses at work at least two to three times a week, something she considersvital. She reels off an impressive list of where she has been in the past week,an itinerary that criss-crosses the country. “It is a real privilege to see what nurses are doing. I have theopportunity to listen, to see what nurses and midwives are doing, what isinnovative,” she explains. “There are real similarities between the job I am doing, being adirector of nursing, and being a ward sister. It’s about working as a team anddoing your job as well as the team you have got. It is about walking the patch,providing a role model and clearly stating what is the vision.” The big difference with the chief nurse’s job, however, is the size of thejob and the level of responsibility – of transferring her leadership role to anational level. “I am not a paediatric nurse, I am not a midwife. There are many thingsI am not. But what I am is someone who can facilitate those nurses, give them avoice. The real challenge is the scale that you do it on,” she says. Return to work policy Mullally has been vocal on the need for more flexible working practiceswithin the NHS and the need to encourage nurses who have left the service toreturn, two issues that are closely intertwined. Figures published by theGovernment in December last year showed a net increase of more than 10,000nurses and midwives working in the NHS last year and a gain of 27,000 since1997, something Mullally is particularly pleased about. The Government’s planfor the NHS set a target of 20,000 new nurses between 1999 and 2004. “Although we have not solved the problem, the number of nurses that arereturning to the NHS continues to go up. That, I think, is the result of a hugeeffort. When I talk to nurses, their concern continues to be getting the rightnumber of staff. They have recognised that we are beginning to do somethingright,” she says. Recent advertising campaigns encouraging nurses to come back have had theadded bonus of working to change public perceptions about the profession, whichstill at times appear to be locked in a time warp between Hatti Jacques andAngels. NHS Direct, the nurse-led helpline, has also proved positive, sheargues, in showing people that nurses have a much wider role to play in amodern NHS than changing bed pans or turning patients. “But there is no doubt that the media does not always portray nursingas it should do,” she laments. “There is clearly a lot of work to doabout how we educate the media.” Occupational health nurses For OH nurses, confusion over what they do is, of course, compounded by thefact that employers often do not seem to know what they want from them – nursesable to hand out sticky plasters and aspirin or highly qualified specialistpractitioners? Mullally argues it is beholden on the OH profession to make the case for howOH nurses should be perceived and what their role in the workplace should be.The debate about the most appropriate qualification for OH nurses, and whetherit matches what employers, public or private, really want, is one that must beaddressed. “What we need to do, working with employers, is to ensure that we aredescribing the role, and ensure that people are clear in knowing what they canexpect from that service,” she says. If an employer has an OH service it must have people within it who arecompetent to do the job, she stresses, but it is also right that OH servicesoffer a mix of skills at different levels. This is particularly an issue in aservice that, like mainstream nursing, is suffering from a lack of fullyqualified staff. While GPs see themselves very much as the gatekeepers to the health service,OH nurses, argues Mullally, have a key role to play in promoting public health,particularly in working with employers and employees on access to public healthservices. Primary care trusts The fulcrum in this relationship is increasingly going to be the primarycare trust, she argues. PCTs have a responsibility to assess the health needsof the community and, as such, as time goes on OH nurses are going to findthemselves working ever more closely with such bodies, a process that hasalready begun in some parts of the country. “I believe that OH nurses are key public health practitioners. The keyrelationship in the future, I believe, will be the relationship betweenoccupational health nurses and primary care trusts. “What are the services that are being provided and do they meet theneeds of this community? PCTs are the organisations that are going to lead theassessment of health needs in the community. “If PCTs have that responsibility, they will want to be talking to OHnurses. Historically OH nurses have always been keen collaborators. The issuefor them will be understanding their role and what the processes are,” shesays. Ultimately, she sees a partnership developing between employers, OH nurses,community health teams and PCTs to tackle public health needs in a much morejoined up way. Within this partnership, the bridge between public and privatethat OH nurses can provide may well prove critical. But it is not only within the wider public health arena that OH nurses canplay a more important role, asserts Mullally. The exposure that OH nurses haveto the commercial world, and the lessons that can bring with it, isunder-recognised within the NHS. “Occupational health nurses understand what it means to have ‘consumers’,”she says. Specialist practitioners need to structure their service decisionswith the employer; they have to provide a commercial service. “It is about how you listen to the different stakeholders and changeyour service as a result. And it is not always about listening to those who canvoice their views the most,” she adds. NHS Plus The launch by the Government in November of NHS Plus sent a clear signalthat ministers were finally recognising this point. Under NHS Plus, OHdepartments within NHS trusts are encouraged to outsource their services to thewider community, in particular to small and medium-sized enterprises that maynot currently have access to OH services, on a commercial basis. The service is linked to a national network, with services flagged up on adedicated website for employers and employees. By clicking on where they are inthe country, employers are able to see what OH services are available to them. Mullally agrees NHS Plus will never replace commercial services or indeedNHS OH services. But what it will do is make channels of communication thatmuch easier. “It is about OH nurses working together across OH boundaries. They canlearn from each other to ensure the spread of best practice. It is very much atwo-way process,” she says. A key achievement of her time in office so far, Mullally argues, was last February’slaunch of national benchmarking standards. Essence of Care outlines bestpractice in eight areas – principles of self-care, food and nutrition, personaland oral hygiene, continence, bladder and bowel care, pressure ulcers, recordkeeping, patient safety and privacy and dignity. The benchmarks, which Mullally describes as a “practical toolkit”are expected to play a key part in helping nurses audit their work and improvestandards. Nurses, including OH nurses, can adapt them to fit into their ownwork areas. She is also proud of the number of nurses who have gone throughleadership programmes, some 32,000 at the last tally. Yet she adds: “There is no doubt that working in an organisation thatemploys 1.3 million people, bringing about any cultural change is tremendouslydifficult. Rather than us being patient advocates, I want to enable patients tobe their own advocates.” She may not be as much of a political animal as her predecessor, butMullally’s goals as CNO are admirably simple – to improve the experience ofpatients and to raise standards. “I want people who have used the NHS to be satisfied with theirexperience,” she says. The National Health Service is not all bad and not all good, she admits.”The challenge is to make it more consistent. If you talk to people abouthow they define the quality of care, it will come back to the fundamentals ofnursing – hydration, nutrition, privacy, dignity and cleanliness.” Finger on the pulseOn 1 Mar 2002 in Personnel Today Previous Article Next Articlelast_img read more