As Roy Lilley said in the introduction to his conversation with Janet Davies Chief at The Royal College of Nursing, “Sometimes you get a bit of luck in your timing – the planets align – right guest, right time”. OK – it was also the day of the last minute cancelled Junior Docs strike, but the nursing profession has certainly been high in the news agenda too.  And Janet is head of an organisation that has 430 000 members (tried to corroborate this on web-site – sounds absolutely enormous!) Janet didn’t have a long commute from HQ at 20 Cavendish Square to The Kings Fund in the same square… except she was arriving from a meeting in Manchester.

Janet Davies

As always – a health warning. This is my views of the conversation at this NHS Managers Health Chat meeting, and my opinions added in too.  And this is more hands-off than ever – as I watched the event ‘as live’ on Periscope.  Not quite the same as being there, but hey, better than nowt when you are far away…

My overview? One Tweeter got it spot on. “I like Janet – so straightforward”.  I also felt commitment to her members, passion for the profession, and forthright hard-headedness.  Roy facetiously suggested she was more Doc Martens than cuddly, but I think we will brush past that.

We had the ‘do nurses really need a degree’ spat. I do understand the concept of ‘why should the only health Care professional you meet without a degree is the one most hands on’.  But I liked the additional argument of a degree level of education gives you added confidence to question on an equal level.  Those around you on the ward round are your peers, not superiors. It really does add a piquancy of depth of knowledge which boosts confidence.  And then the argument around bursaries and whether nursing should be the only degree that is ‘free’ to do.  Again, an argument from Janet that I hadn’t heard before.  The entry to a degree being the provision of a student loan could preclude many from getting on courses.  The returners after having a family; those who have already done one first degree – and more.  OK – maybe there needs to be provision for those groups.  But I see the old apprenticeship model, where nurses work on wards (and indeed in the wider community) and get paid for that whilst also studying for their degree, does sound a logical middle way?  I still like the idea of the new prospective student nurse being in the sluice room for the first week to see if they can hack the s*it that they will encounter during their career both physically and metaphorically, then at least they can pull out inexpensively and early.  No harm done…

The other major theme that reared its head for me was the law of unintended consequences.  Let me give you what I heard:

1. The current crisis of lack of nurses.  We don’t have enough in training (getting better now – but 3 year lag, of course). So safe staffing levels are not possible, or even attainable – we just don’t have the bodies. We cut nursing training places whilst Trusts were applying to become Foundation Trusts.  The easiest way to hit the balance sheet requirements was to cut nurse numbers (70% of the costs of running a hospital is staff costs). And then we end up with Mid Staffs?
2. Measuring the wrong things leads to the wrong outcomes.  Janet had also been Acting Manager of an Ambulance Trust.  The 8 minute rule for attendance was skewed by rural areas and central metropolitan areas.  So, people pressed the ‘set off button when nearly there!  People will always fiddle their way around a stupid non patient focussed target, in my experience.The
3. The Target Culture. We only ever measure what is easy to measure, not what is important.  And now, the unintended consequence is we can’t change the CGC and others because to do so looks like you don’t care about ‘quality’ anymore.  Outcome measures are the best success criteria?  And much harder to assess…
4. The Internal Market Makes workforce planning almost an afterthought…and almost impossible to do
5. No pay awards for 5 or 10 years. How can Mr Hunt then moan about agency nursing costs?  Guess what?  Nurses do an extra shift through an agency to help top up their pay to help pay the bills

There were more examples.  I am starting to think unintended consequences is why every reform in the NHS seems doomed to failure!

Conclusion? A string, passionate and very followable leader, who straddles the two RCN stools of being both a Trades Union and a Royal College rather admirably.  Nurses – I think you are in good hands.  And watch out if you are anyone else in high command in the health service…