NHS 70 Interview: Royal College of Nursing

As part of July’s NHS 70 anniversary celebrations, Health Business will be publishing a number of interviews with those working within and for our health service. Here, we pose some questions to Janet Davies, chief executive and general secretary of the Royal College of Nursing

The face of nursing today looks very different from how it did when the NHS was first created 70 years ago. What would you say have been the biggest changes over that period?
There has been enormous change but the motivation of nurses - enabling people, empowering people, caring for people with compassion - remains exactly the same. What motivated our nurses in 1948 is exactly the same as it is now. But healthcare and health need has changed beyond all recognition. Nurses can now be found leading cutting edge research, prescribing drugs, running clinics, and holding top management positions both in the NHS and independent sector. Specialisms exist now that would have been unthinkable at the beginning of the NHS, and it is not unusual to find specialist nurses training junior doctors in certain areas. The population and patient need is great and growing so we have now been left in the position where we don't have enough nurses. As the needs of the population become increasingly complex, the profession must continue to rise to the challenge.
At such an important time for the nursing, midwifery and AHP workforce, how is the nursing industry responding to some of the challenges that it is facing in 2018?
It’s been a long time coming, but the industry is at last beginning to respond to calls for a more flexible way of working that places greater emphasis on staff well-being. Nursing staff have a right to a healthy work-life balance, and flexible working opportunities not only improve staff performance and reduce unplanned absences, but support the recruitment and retention.

The RCN has long been campaigning to improve conditions, particularly around nurses missing rest breaks, and lack of access to food and drink. These issues have only become more pressing, as understaffing has left too few nurses covering depleted rotas and trying to do the best they can. In these circumstances it can be difficult to find time for breaks, but they are vital, both for the safety of nurses and their patients. Dehydration, for example, affects concentration, which triggers fatigue - essentially as it is not just a well-being at work issue but an issue of safety.

RCN guidance spells out the duties employers have to staff, but also provides clear, practical steps employers can take to make sure staff are able to look after themselves properly, and by doing so provide the best care to patients.

Alongside other health professions, leading figures within the nursing sector have commented on the need for services to improve. Realistically, what does improvement look like?
Training is key to improvement, yet too many nurses have had career development opportunities snatched away as the Health Education England budget for continuing professional development has been cut by 60 per cent over the past two years, from £205 million in 2015/16 to £83.49 million in 2017/18.

Nurses make up half the NHS workforce and, as a society, we cannot afford for their training to be an optional extra. These short-sighted cuts must be reversed. For the sake of patient safety, nurses must be allowed to keep up-to-date with developments and advanced into tomorrow’s nurse leadership positions.

Within the history of the NHS, given current problems, one thing that stands out is the magnitude of nurses who have come from overseas and made a contribution to improving care in the UK. This is highlighted with the 70th anniversary of the arrival of Empire Windrush this year as well. Just how important is it that staffing shortages are adequately addressed, both inside and outside of the UK?
The NHS has a proudly international history and even now its staff are drawn from 200 countries around the world. But, following the Brexit vote, our European nurses have put up with two years of uncertainty, mixed messages and even being used as ‘bargaining chips’. There are 40,000 unfilled nurse jobs in the NHS in England alone and that number would rise further if EU nationals felt no choice but to leave. Nurses returning home, or giving Britain a miss entirely, are doing so because their rights are not clear enough. Theresa May must use every opportunity to say they are welcome here and valued in health care.
Starting to stem the loss of nurses is welcome but the real battle is to inspire young people to join the profession. We need to grow our domestic workforce, and it is vital the Government does more to encourage people to study nursing, through incentives and financial support.
Staffing shortages are the most serious problem affecting not only the nursing profession, but our healthcare system as a whole, because it has a direct impact on patient care. We need a comprehensive, long-term workforce strategy which determines the real demands that our ageing growing population places on health and care services.
And it’s not enough to stop at the NHS. Given the significant proportion of nurses needed across all sectors, any plan based solely on the NHS, or even the wider public sector, will likely fail. There need to be enough trained nurses in our country that an individual choosing to pursue a career in the independent sector has no detrimental impact on the NHS – tens of thousands of nurses work in social care.

The knowledge and skills required from registered nurses today are obviously very different from what was required ten years ago, never mind 70 years ago. With this change likely to continue into the future, where does the sector go from here? What do you expect to change in the next decade?
The UK is behind some other countries in its use of artificial intelligence and robotics in healthcare, but we expect to see greater use of technology in healthcare. This must be managed to ensure patients, and the nurses who care for them, see genuine benefits. Several hospital pharmacies in the NHS are now using robots to pack prescriptions and reducing dispensing errors. Meanwhile the Edinburgh Centre for Robotics is currently developing SoCoRo, a ‘socially competent robot’, to ‘deliver behavioural training’ for adults with Autism Spectrum Disorder.

But increasing use of technology must work in harmony with the profession, not against it, and the RCN is working to understand the challenges and opportunities the future holds for nursing.

Janet Davies is the chief executive and general secretary of the Royal College of Nursing. Janet is a mental health nurse by background who, prior to joining the College, was a Director of Nursing and then chief executive of an Ambulance Trust.