Leading the event, Ann McMahon, the RCN’s Research and Innovation Manager, emphasised the importance of communicating nurse-led innovations far and wide, to educate and inspire others, including policy-makers and commissioners, and to spark dialogue and a collaborative approach between nurses.

The RCN is working with the Office for Public Management (OPM), with support from the Burdett Trust for Nursing, to empower nurses with the tools and skills to take forward innovations, and build the case to evidence the economic value and increase the impact of their own nurse-led innovations.

Delegates heard from Jill Nicholls, a clinical nurse specialist from NHS Tayside, who had a particular interest in demonstrating the value of a Heart Failure Nurse Liaison Service which she leads with other specialist nurses. The assessment which she carried out was supported by the RCN and OPM.

Jill admitted that she was spurred on to do the research by feeling frustrated that others were analysing the work of nurses, but yet didn't actually know what nurses do. She said: “I felt it was important for staff and service users to be involved with research about the service, to drive further improvements based on robust and specific data.” 

Jill and her team were optimistic that they were achieving targets and reducing unscheduled re-admissions. They were right; the economic analysis demonstrated that the service realised a 68 per cent reduction in readmission episodes when compared with usual care, and the average length of stay was reduced by 4.8 days per episode. Avoided costs were identified and combined from both settings of care, resulting in a minimum combined 'return per patient' of £489. 

Consultant Nurse Lee Cowie has also been supported by the RCN and OPM. He designed the community-based Intensive Therapy Service at NHS Fife Child and Adolescent Mental Health Service (CAMHS) as a result of the closure of the CAMHS inpatient facility.

Lee demonstrated the model of care to be economically viable and achieving continuous positive clinical outcomes, with 95.5 per cent of young people presenting with severe mental health difficulties within Fife avoiding inpatient admission.

At the Congress event, Karen Naya from OPM said that while undertaking an economic assessment can feel daunting, all nurses should be empowered to demonstrate innovation and its economic benefits, proving that nurses can take control. She advised nurses to be confident and to avoid assuming others know better, and highlighted how satisfying nurse-led innovation and research has been for nurses.

If you feel inspired to lead innovation and evidence its impact, you can find out more by contacting Dr Ann McMahon, RCN Research and Innovation Manager at ann.mcmahon@rcn.org.uk

Today the RCN urged the Government to take immediate action to tackle warning signs across the health service, including staff cuts, an ageing workforce, and soaring patient demand, which if ignored could be disastrous for the health service.

Through Frontline First the RCN has identified that there are now 68,880 posts in the UK which are earmarked to go before April 2015, with 24,836 already axed. This includes a decrease of 4,800 registered nurses and 4,042 health care assistants.

Dr Peter Carter, Chief Executive & General Secretary of the RCN, said: “Our latest Frontline First report paints a very worrying picture for the future of the health service, and the Government cannot afford to ignore these warning signs.

“Tens of thousands of posts have already been cut with even more expected. The effects are already being felt on the ground, with hospitals and emergency departments unable to cope with soaring demand.”

However, the increasing number of axed frontline staff is just one of many warning signs flashing across the health service. The report also found that the combination of nursing student places being cut and an ageing workforce could lead to a massive nursing shortfall in the future if the Government does not take action now.

Between 2010-11 and 2012-13 there has been a drop of 13.55 per cent in nursing training places across the UK, from 24,904 to 21,529. These cuts mean the workforce will continue to shrink as nurses who are retiring are not replaced.

Demand for health care continues to rise as complex long-term conditions become more prevalent, and hospitals and emergency departments are left reeling from the effects of a system under great pressure.

Community services can relieve some of the strain on hospitals by caring for patients before they require emergency treatment. However, the Frontline First report has found that while hospitals continue to lose resources, there has not been investment in community services to take up the slack. The number of district nurses in England fell by 39 per cent between 2002 and 2012, while preventable emergency admissions rose by 40 per cent over the same period.

The RCN has identified eight calls for action that are needed to avoid a nursing crisis in the future, including boards regularly monitoring up-to-date information on their workforce such as staffing levels and ratios of registered to unregistered staff. The RCN is also calling for greater investment in community and specialist nurses, who manage long-term conditions and reduce consultant appointments and hospital visits.

Dr Peter Carter said: “If the Government does not change course, the effects of these cuts are likely to be magnified as the number of newly qualified nurses continues to fall, and the health care needs of an ageing population continue to increase demand on the NHS.

“We need to see an immediate end to the short-term, slash and burn cuts to nursing staff levels and the failure to plan for the long term, which are damaging patient care and bringing the health service to its knees.”

Read the report here.

One of the most intense local issues in recent times, the battle against the pay cartel was won by working together, having a shared understanding, and using clear and consistent messages and communications to keep people up to date and active.

The event at Congress heard from people directly involved in the campaign and shared information and learning about the whole process.

RCN Communications Officer, Tracey Roberts – who co-led the event, said: “The pay cartel was clearly a huge threat to fair pay and conditions, not only to us in the South West, but potentially to the whole country if it had been successful. This threat aside, everyone involved in the RCN was brave enough to put their heads up and have their voices heard.

“Everyone; local reps on the ground, members working in the trusts involved, regional staff, was amazing. We had great support from our colleagues in other parts of the country, and fought together to make sure the message to the cartel was clear.”

You can find out more about the fight against the pay cartel on the dedicated Frontline First web pages.  

Dr Peter Carter, RCN Chief Executive & General Secretary

The Mirror - page 2 - Wednesday 27 March 2013

Nurses will breathe an overdue sigh of relief at Jeremy Hunt’s comments today that the NHS needs more of them on the ground.

I don’t relish saying this, but we have been telling the Government that for nearly three solid years.

In this job, I’m lucky enough to visit hospital wards and community teams every week.

When I do, nurses don’t complain about pay or pensions – they tell me that they just don’t have enough staff to do the job.

Nurses want to deliver ­compassionate care that makes patients feel like they are the only ones who matter.

Sometimes, however, this is ­impossible. Imagine a ward full of older patients where the nurses are expected to care of 10 people each.

It’s lunchtime and many of them will need help eating.

We know that, despite the best efforts of staff, not all patients will get the care they need.

It’s scandalous, but the blame doesn’t lie with our nurses – it lies with managers who let it come to this.

The Royal College of Nursing has released five reports since the ­Government took power, each spelling out the jobs crisis in our NHS.

Our most recent revealed 61,000 posts were at risk or had already been cut.

If Health Secretary Jeremy Hunt is serious about recruiting more nurses, it needs to happen today.

However what is left unsaid in their statement is that this is their position “for now”. We must not forget that their report published on 1 March contains the threat that if further cuts to national pay, terms and conditions are not agreed in the near future the cartel will reform and may take this forward themselves. 

During March and April trust boards will meet and consider the pay cartel’s report.  We know that some will want to put their pay cartel experience firmly in the past. Several trusts have already made a commitment to staff that they will not engage in any further work by the pay cartel should it reform. These trusts will adhere to national pay terms and conditions whilst working in partnership with staff unions to negotiate how flexibilities in Agenda for Change should be locally implemented – as they could have been doing for the past 10 years. 

Other trusts will accept the recommendations in the report but not commit to a formal move away from any future work of the pay cartel, therefore leaving the door open to rejoin the cartel and some may continue in the mean time to try to make changes locally. 

The RCN will continue to liaise closely with our activists and members to gather intelligence about what is happening locally.  Any move towards local pay will be robustly challenged by the RCN and we will be supporting our RCN representatives to ensure that they are able to make these challenges locally on behalf of members.  We will also continue to ensure that members and stakeholders such as our South West MPs are kept informed.

I want to take this opportunity to say thank you. Whilst our fight is not over, we have won a significant victory. If you have sent a letter to your MP, marched the streets with us or put up posters – thank you. Our fight has only been as strong as the passion our members have felt.

We couldn’t have done this without you.

Jeannett Martin, Regional Director of RCN South West, said: “The campaign by the RCN and other unions has been successful in diverting the South West pay cartel from their original intention to implement local pay systems across the South West region.

“We are delighted that Northern Devon Healthcare NHS Trust, Yeovil District Hospital NHS Foundation Trust and Dorset County Hospitals NHS Foundation Trust have given a clear commitment to a return to partnership working. We will work with other staff unions to ensure that staff interests are represented to employers.

“The RCN calls upon for all employers in the South West who had been a member of the pay cartel to follow the lead of these three trusts and confirm to their staff that they will not return to a local pay cartel if it re-emerges in future. This will be a first step in rebuilding staff trust and confidence.”

“Regional pay systems are not only unfair for staff, they are costly and complicated to implement and this wasted money ultimately damages patient care. We hope that the trusts can now focus on improving care for patients.”

The estimated saving in oxygen prescribing costs was in excess of £200,000 within the first two years. There are high levels of patient satisfaction with the service, particularly as the patient spends more time being supported at home, can understand and help to manage their condition, and they spend less time in hospital or in the hospital out patient setting. Referring clinicians are reassured that their patients are receiving the right advice and support.

"Like all change," recalls Alison, "when we first set out, there was some resistance, and we had to work hard to demonstrate the potential long term benefits; but now pride ourselves on the excellent working relationships there are between the hospital and community interface and between general practitioners and the respiratory team."

Further information
The Office for Public Management have used this work as a case study to demonstrate return on investment. How managing oxygen therapy in the community can save up to £1.1m per annum and improve quality of life for patients.

If you'd like to know more about this innovation, please contact Alison Graham, email: a.graham2@nhs.net

There is still a question about what the cartel thinks is ‘fit for purpose’. The report talks about it as being ‘capable of contributing to cultural change’ and ‘encouraging and rewarding leadership and performance’. Quite how the further changes suggested eg reducing annual leave, and working longer hours for no extra pay, would lead to improved individual performance and better care, is left unanswered. Our view is that poor working conditions can lead to demotivated, demoralised staff, which is bound to impact on patient care.  

The report sets out ways to ensure existing nationally agreed pay, terms and conditions are optimised ie to use the opportunities in AfC to their full potential. It is at the very least surprising that trusts are not already maximising the potential in AfC

It is staggering that trusts have paid £200,000 to fund a consultant to tell them what any of their own directors of human resources ought to have been able to. It is also surprising that the trusts seem to assume that these changes would not affect recruitment, retention or staff motivation. The cartel appears to assume that the changes they propose will have no affect on staff morale, yet we know that this has been a cause of great anxiety for all of our members.

Trusts that joined the cartel have damaged industrial relations and it will be difficult to restore the necessary trust and confidence. Rebuilding relations can begin when trust boards formally withdraw from the pay cartel and commit to a return to open and honest partnership working.

Joint union working has had an extremely positive impact on this campaign in the South West region and we must keep working together to ensure national pay and conditions remain protected. The RCN will continue to fight against regional pay and will keep you updated through these pages.

Read the response from RCN South West here.

Read the consortium's full report here. And their background document on optimisation here.

The Royal College of Nursing has described an agreement to amend the Agenda for Change (AfC) contract in England  as the "most effective way" to protect it as a national pay and rewards system. 

Dr Peter Carter, RCN Chief Executive & General Secretary, said the present political and economic climate was taken into account and pragmatic action has been taken for the benefit of NHS staff, RCN  members and ultimately, patients.

"This echoes what we were told by our members up and down the country; that the proposals were the best way to ensure all NHS staff receive equal and fair pay, no matter where they choose to live or work. However, we are clear that we expect all employers to stick to today’s agreement. The RCN will continue to strongly resist any moves to introduce changes locally," added Dr Carter.

The decision was made in yesterday’s NHS Staff Council meeting. The changes, proposed by NHS Employers, come into effect on 31 March 2013.

We were marching because after more than a year of stalled negotiations and broken promises we finally received a pay offer that members then rejected. Pay on Jersey is very different to that on mainland UK in that the pay is negotiated locally, there is no Pay Review Body making an independent recommendation – nurses here aren’t in the Agenda for Change pay scales and although it might look as though the nurses get a good deal, when the cost of living is factored in most nurses are significantly worse off than their mainland counterparts.

But it wasn’t just pay. A number of factors had combined to make members so angry. We were marching:

For fair and equal pay for nurses, midwives and HCAs: For too long pay has not matched that of nurses on the mainland or comparators on Jersey. Jersey is a small island – depending on nurses coming from the UK so they need to be competitive to attract the very best nurses

To address severe recruitment and retention difficulties: Jersey needs excellent nurses who stay on Jersey for the long term. A recent RCN survey showed that a third of nurses are thinking of leaving Jersey due to poor pay. We have to be competitive now and in the future.

To be ready for the future: The health White Paper on Jersey sets out a strong vision. We need more nurses to deliver the aspiration of new services for residents in Jersey, without better pay there simply won’t be the workforce to achieve this. We need to modernise the pay system so it is future proof and we don’t have to battle for fair and equal pay every few years.

We are lucky to have a very active branch on Jersey, the members all worked hard to make this day a massive success. Now, we wait to hear from the States Employment Board if the offer to nurses will be increased (media reports indicate it might). Watch this space.

Patricia Marquis, RCN Regional Director, South East Region

In four out of the five trusts currently being investigated, more than 1,700 jobs that have either already been cut or are due to go by 2015 include frontline clinical posts such as nurses.

The RCN argues that there is a direct link between nursing numbers and patient mortality. RCN Chief Executive & General Secretary Dr Peter Carter said: “There are important lessons that we all need to learn from the Francis Inquiry, but surely one of the first is that trusts cannot be allowed to let staffing levels, particularly clinical posts such as nurses, fall to unsafe levels. Even those posts that are not clinical roles still play an important role in patient care and patient safety. Trusts cannot keep cutting posts without disastrous consequences.”

The figures have been collected by the RCN through Frontline First, which monitors cuts to jobs and services across the health service. The RCN has consistently argued for the introduction of legally enforceable safe staffing levels and will now look in detail at the recommendations contained in the Francis report in order to hold trusts to account when staffing falls to unsafe levels.

Read the RCN response to the Francis inquiry.

Find out more about the report and findings on the inquiry's website.

The BHF currently funds or supports more than 800 health care professionals, the majority of whom are nurses, and we have invested millions of pounds in recent years in specialist nursing programmes and educational packages. These have led to the establishment and continued development of many branches of cardiovascular nursing including paediatric and adult cardiac liaison, heart failure, arrhythmia, congenital heart disease and grown-ups with congenital heart disease (GUCH).

Specialist nurses and frontline staff have made a dramatic impact on the health care services available to cardiac patients in the UK. Their expert and caring services have enhanced the quality of life for hundreds of thousands of cardiac patients and have reduced hospital mortality rates and readmissions, saving the NHS millions of pounds each year.

These types of posts are vital in delivering the Quality, Innovation, Productivity and Prevention (QIPP) agenda set out by the Department of Health as they improve productivity and have introduced new and innovative models of care, while at the same time relentlessly focusing on patient-centred care and clinical quality.

Specialist nurses have become a lifeline for those suffering from heart disease and provide a vital link between primary, secondary and tertiary settings. Patients and carers have come to trust our specialist nurses and value the face-to-face time made available. Their expert clinical and emotional support helps people with cardiovascular disease regain control of their lives every single day.

If specialist posts were cut, the quality of life for those suffering from heart disease would be greatly diminished, at a significant cost to the NHS.

Find out more at www.bhf.org.uk

As many of you will know, the RCN (along with the other health unions) embarked on a key consultation towards the end of 2012. We had seen what can happen when local employers get together to erode the pay of our members, most noticeably in the South West of England, and we knew we needed to sit down with employers on the national stage. We worked hard to negotiate a series of changes that, if agreed, would secure AfC and seek to avoid instances of regional pay.

The proposed changes included incremental pay increases linked more closely to local standards of performance, delivery and flexibility of pay arrangements for senior posts extended to 8c and 8d. There is also a proposal to end the unsocial hours element of payment during sick leave – so when a member who works unsocial hours is sick, they would no longer receive the unsocial hours payment as well as their basic pay. They would however continue to receive their basic pay.

In December, we put these proposals to you and asked you to attend your next board and/or branch meeting to discuss the changes. Now, RCN Council has considered the responses and commentaries from meetings throughout the English regions, as well as responses from individuals, and has decided on the next steps.

RCN Council analysed the feedback from the consultation in great detail. Overall, members were accepting of the changes, understanding the need for a flexible AfC and wanting to protect the national system. Of course, some members were angry that nursing staff were being asked to change their terms and conditions once more, something that is totally understandable. However, the general consensus was that these changes should be accepted, and that is what Council decided today.

So what happens next? It is anticipated that all of the NHS unions will have concluded their respective members by the time of the NHS Staff Council meeting on 26 February 2013, following similar consultations to that held by the RCN. The NHS Staff Council is the negotiating body for the NHS made up of representatives from the other unions, NHS employers and the Department of Health. At this meeting the staff side organisations will respond formally to the proposals. The RCN will take the view of its membership, and the subsequent RCN Council decision, to this meeting and we will keep you informed of the final outcome. If the NHS Staff Council decide to accept the changes, they will come into force from April this year. There will be no immediate changes following today’s decision.

If you attended a meeting, perhaps even organised one, or completed the online survey, let me say thank you. The journey to secure AfC is not over, but today marks a very important step and it could not have happened without you.

Dr Peter Carter is quoted, saying: “We despair about what we are seeing going on across the country. Even the most hard-nosed accountant would think it is bizarre that the NHS should lose thousands of front-line posts, and then end up at the mercy of agencies who can charge hospitals what they like.”

Read the full story here.

National negotiators have been working hard to reach agreements that retain as much of AfC as possible, protecting the national agreement, making it more difficult for employers to introduce local pay, terms and conditions. Following these negotiations, we are now in the position to consult with members.

This survey is to be completed by individual RCN members who are or have been unable to attend a branch meeting in person to take part in the Agenda for Change consultation.

www.rcn.org.uk/afcconsultationmember  

If you are a branch chair, or have been nominated to complete the survey following a branch meeting, please do not complete the survey above; instead, complete the survey found here:

https://response.questback.com/royalcollegeofnursing/afcconsultation2012/

If you'd like to know more about this innovation, please contact Louize Ainsworth, email: lou.ainsworth@stockport.nhs.uk

You can find out about other Lightbulb Innovations on the RCN website.

The RCN, along with other NHS trade unions, has been negotiating with employers around the proposed changes. Unions have been forced to negotiate changes as they faced the possibility of employers moving away from a national framework and towards regional agreements.

RCN Head of Employment Relations Josie Irwin presents the film, which covers the background of AfC, the proposed changes to members, the RCN’s position, and how the consultation process works.

Josie said: "We believe these proposals represent the most effective way of providing stability and protecting AfC as a national system of pay and terms and conditions, and are the best that can be achieved in the present political and economic climate.

"The proposals come as one single package so we will need to accept or reject all of them – they cannot be broken down into constituent parts for further negotiation."

For more information on the consultation, including a set of resources, visit our special Frontline First page.

I want to share the background to why we are having to consider changes, what they mean and why the decision is so important.

The RCN, alongside the other NHS trade unions, has been involved in difficult and protracted negotiations with employers about national terms and conditions for NHS staff - Agenda for Change - (AfC) since 2009.  This has been set against the background of the financial and economic crisis and the devastating impact this is having on public finances, let alone the NHS frontline.  

Over the summer, we asked local staff sides and RCN representatives for their views on a range of proposals to change AfC. The overwhelming consensus was that the RCN should continue to fight to retain the national AfC agreement and that if there were to be any changes these should be on a national basis. 

We have been successful in persuading the employers to move away from their original plan where they were looking to open up the possibility of local pay on a large scale and risked long lasting damage to national arrangements, recruitment and retention and ultimately patient care. 

So, we are now able to present a set of proposed changes to members just like you. Our fellow trade unions are also consulting on these proposals.  It’s now down to you to tell us what you think via your RCN branch.  The changes include:

• incremental pay increases linked more closely to local standards of performance and delivery
• The removal of the unsocial hours payment of sick pay
• Flexibility of pay arrangements for senior posts extended to 8c and 8d, while  maintaining equal pay principles.

We believe these proposals represent the most effective way of providing stability and protecting AfC as a national system of pay and terms and conditions and are the best that can be achieved in the present political and economic climate. 

The alternative would be employers all over England breaking away from the national arrangements leading to cuts in pay, annual leave, sick pay and unsocial hours arrangements. This would be a situation that benefits no one and we desperately don’t want to see it happen.

Importantly, these proposals come as a package, so we will need to accept or reject all of them – they cannot be broken down into constituent parts for further negotiation. 

So what can you do? The RCN wants to hear your views, and we will be consulting with our members through our board and branch structure. In the comings days and weeks, we’ll do everything we can to make sure you know about when and where your nearest meeting will be. If you can’t attend the meeting, we will make sure there is still in a way in which your views can be heard.

In the meantime, we have developed a number of resources to help you learn more about the proposals, the consultation and how you can get involved.

Resources for RCN members

You can read the proposals in full here.

Download our Frequently Asked Questions (FAQs) here.

Download our Member Factsheet here.

Resources for RCN Activists

You can read the proposals in full here.

If you're an RCN Activist, you can read specific Activist FAQs here.

Download our Activist Factsheet here.

We will be sending a clear message that the RCN and our members fully oppose the Cartel's plans to negatively change pay, terms and conditions for our nurses.

Members across the UK are welcome to join us at the demonstration. If you’d like to attend please let us know by emailing paycartel@rcn.org.uk. Members will be attending in their own time.

Marchers from all unions will assemble at College Green in Bristol (BS1 5UY) at 11:00am and the march will begin at 11:30am and travel through Bristol. 

For more information, including directions, see the official Facebook page. You can also email us at paycartel@rcn.org.uk if you have any queries.

We oppose any threat to these crucial posts and created our Nursing Network to support breast care nurses to develop their expertise. With over 800 members it’s free to join and members enjoy a host of benefits to enhance patient care, from sharing best practice to training opportunities and a chance to work more closely with Breast Cancer Care.

October (Breast Cancer Awareness Month) was a busy month for the network. As well as running one of our teleconference training sessions on Oligometastases, we also marked Secondary breast cancer awareness day. 13 October is dedicated to raising awareness of the different issues affecting metastatic breast cancer patients, and this year we published a new online toolkit to help nurses better support their patients. Developed in response to requests from our network members, Ensuring nursing provision for people with metastatic breast cancer, is a comprehensive, practical resource. It contains different modules covering a range of issues; from developing your nursing service to reflect current policy and national guidelines to suggestions about changing your service.

It also includes case studies from nurses in practice so you can see what others have achieved. It’s been designed as a flexible document that can evolve over time as developments in care progress. We’re asking our members for feedback on how they’re finding the toolkit and would love to hear from any RCN members who download the resource.

Now the rush of Breast Cancer Awareness Month has started to subside, it’s back to business as usual for the Network. We have more training sessions coming up later this month and are already planning ahead for next year’s calendar of events for breast care nurses. Take a look to see how we can support your practice in the future at www.breastcancercare.org.uk/healthcare-professionals

October 2010: Breast Cancer Care is pleased to add our voice to the RCN Frontline First campaign.

There are more than half a million people in the UK today who have been diagnosed with breast cancer and every year another 46,000 people will hear the shocking news that they have the disease. While survival rates are increasing, 12,000 people still die from breast cancer each year and our survival rates, particularly for the over 70s, do not compare well with other wealthy European countries.

We know that specialist nurses are critical to ensuring high standards of care for both primary and secondary breast cancer patients struggling to cope with the devastating effects of their diagnosis. We constantly hear from people with breast cancer how important this role is in helping them understand their diagnosis and treatment, and also in helping them access information and support. The NHS Confederation has estimated that ‘coordinated care’ could release up to 10% of cancer expenditure and we believe any loss of specialist breast cancer nurses would be a false economy.

We are extremely concerned about the potential loss of breast care nurse roles as result of the pressure to find savings in the NHS. Indeed all our evidence suggests that more of these roles are needed – particularly for those with secondary (metastatic) disease.

A recent survey of breast care nurses carried out by Breast Cancer Care showed that more than half felt the care provided to secondary breast cancer patients was inadequate, and many did not have the time or staff numbers to provide an effective service. We know that staff and managers are under massive pressure to deliver cost savings but, at Breast Cancer Care, we believe teams could be reconfigured and better training provided to ensure that breast cancer patients get the best care possible and essential nursing skills are not lacking.

As the impact of the Comprehensive Spending Review on NHS budgets is felt, and in light of  proposed reforms, we urge the government to do everything it can to protect existing specialist nurse posts. Losing these vital roles would mean our standards of care for breast cancer patients could begin to lag further behind other countries and this would be wholly unacceptable.

Dr Peter Carter, Chief Executive & General Secretary of the RCN, said: “The RCN has long been arguing that the pitfalls of regional pay are numerous and represent nothing more than an attack on nursing staff at a time when resources are stretched. It is promising that these arguments appear to have been listened to. This is testament to the hard work of our members across the region who have made their voices heard loud and clear.

“We hope this marks the beginning of a retreat and we urge the remaining trusts involved to follow the example set by their colleagues in Bournemouth, heed the advice of the RCN and realise that regional pay is not the answer.”

There were 20 NHS trusts in the consortium – also known as the south west pay cartel – which was formed to review Agenda for Change terms and conditions, including pay rates, number of working hours, amount of annual leave and sickness leave entitlement.

The report has captured the interest of the nation’s media with the report receiving extensive coverage in the Daily Express, The Daily Mirror, Metro, The Daily Telegraph, The Guardian, The Independent, The Sun, The Times and Daily Star as well as BBC News Online.

Dr Carter was widely quoted as saying: “Nurses are telling us that they do not have enough staff to deliver good quality care. The £3 billion the Treasury has clawed back for the NHS in the last two years should be reinvested back into vital jobs and services. The vast majority of patients are still receiving good care but it is irrefutable that the system’s under huge strain. One of the areas that we commonly see cause for concern is care of older people."

The RCN has also taken to the airwaves with Dr Peter Carter interviewed alongside Health Minister Dr Dan Poulter on BBC Radio 5 Live (1hr 39 in) as well as being interviewed for BBC Breakfast TV, Sky News and BBC Radio 4. The Minister stated that he did not reognise the figures we have used, but Dr Carter stood firm and explained the extensive process we have used to reach these numbers.

Meanwhile, RCN Executive Director of Nursing Janet Davies was interviewed live on BBC News Channel and LBC, while Howard Catton, RCN Head of Policy and International, appeared on BBC London TV and across a wide range of local BBC stations. All of the interviews stressed that the NHS was under huge strain and that patient care was being jeopardised by these short-term cuts to jobs and services.

At the halfway point in the Coalition Government, the RCN’s Frontline First campaign has identified more than 61,000 posts across the NHS in England that are now at risk or have been axed – up from 55,000 just six months.

Official figures from the NHS Information Centre also reveal that the NHS workforce has fallen by almost 21,000 since the Coalition Government came to power. This includes a loss of more than 6,000 qualified nursing posts.

The RCN is calling on the Government to take immediate action to stop trusts cutting vital posts and services for financial reasons, to protect the frontline and the growing health demands of the public.

These cuts come at a time when huge strain is being placed on the health service, amid a backdrop of an aging population, often with complex long term conditions. According to projections by the Office for National Statistics (2011), the percentage of the UK’s population over 60 is expected to rise from 22.6 per cent in 2010 to 28.5 per cent in 2035. In addition, the number of people with long term conditions has increased rapidly in the last few years. For example, between 2006-7 and 2010-11, the number of people affected by chronic kidney disease rose by 45 per cent.

RCN Chief Executive & General Secretary, Dr Peter Carter, said: “For the past two and a half years, the Government’s consistent rhetoric has been that frontline posts and services are being protected. Sadly, that is simply not the case. Tens of thousands of posts have gone and cuts are a now common occurrence on the ground, hitting jobs and services that patients rely on. Nursing is not being protected in the same way as some other clinical professions, with posts and training places often cut for purely financial reasons. We believe all clinical professions should be afforded equal protection. Currently, the nursing supply line is being choked and given the importance of nursing to provide high quality care, this has worrying implications for patients. Indeed, if this current trend continues, we fear the worst for patient care in this country.”

Read the full report.

In the first debate, Mr Bradshaw highlighted plans that are under way at 20 hospital trusts in south west England (SW pay cartel) to introduce a regional pay system. Along with several other MPs, Mr Bradshaw spoke of the huge volume of letters he had received from constituents expressing anger and dismay about the cartel. He described that: “...even before this plan is implemented, the mere discussion of it is having a devastating impact on morale [of NHS staff].”

He went on to quote from some of the letters he had received from nurses in his constituency, they wrote: “My staff are at breaking point. I predict a mass exodus and patients will not receive safe high quality care.”

Another constituent wrote: “Myself and my care workers are sick with worry over this and how I will be able to look after my family.”

And another told him: “I am the sole provider for a family of six and do two other jobs on top to cope. This will be the final straw.”

In the main debate later in the day, referring to the SW pay cartel and hospital trusts in the north east, Mr Burnham said that regional pay would be "...bad for the economy, bad for society, and bad for the NHS."

Several MPs who spoke quoted the RCN’s briefing for MPs, including Labour MP Kerry McCarthy who said: “The RCN warns that the NHS is simply not equipped for the added bureaucracy, time and expense needed to negotiate pay on a more local basis, and that this ultimately would take the more experienced staff away from the front line.”

Rt Hon Jeremy Hunt, Secretary of State for Health, when asked whether or not he supports regional pay responded by saying that it was the previous Labour government that established foundation trusts and, in so doing, the possibility of local flexibilities within the pay framework. Labour also had removed the power of the Secretary of State to issue directions to trusts over matters of pay and so it was outside of his power to decree that the cartel must cease. However, he said that the Government did not want to abolish Agenda for Change, collective bargaining or national pay scales.

Mr Burnham’s motion was defeated, as was to be expected due to the nature of Opposition Day debates, but this was a fantastic platform for the important issue to take, being debated passionatly for hours. You can watch the Westminster Hall debate and Opposition Day debate back online.

The first opportunity is in a Westminster Hall debate, tabled by Exeter MP, Ben Bradshaw on the introduction of regional pay specifically in the South West. The second debate is an Opposition Day debate tabled by Shadow Secretary of State for Health, Andy Burnham MP, in the main chamber of the House of Commons.

Ask your MP to attend the debates and speak up against regional pay on your behalf.

The Government will have to respond. They will have to tell us whether they are for, or against, the introduction of an unfair system, which will see your pay lowered and terms and conditions negatively affected.

We know that NHS trusts are beginning to explore the idea of introducing regional pay in the belief it will cut costs. In the South West 20 NHS trusts have come together to form a consortium to explore the option of scrapping Agenda for Change pay scales. Any move to local and regional pay structures would compound attacks on staff pay, terms and conditions which have included an increase in pension contributions, a two year pay freeze, as well as the announcement that pay will be frozen at one per cent for a further two years.

The RCN is committed to fighting regional pay alongside other trade union colleagues. Regional pay is unfair and it will fail to deliver what the trusts believe it will – a reduction in costs.

Both debates are important opportunities, and we need as many Members of Parliament as possible to attend and speak out.

Ask your MP to attend the debates and speak up against regional pay on your behalf.

In the past, all hospital admissions were assessed via A&E, and older people often ended up in environments that could not fully meet their complex care needs. Not only was this detrimental to patient health outcomes, it was also difficult for the health care professionals, who often found themselves caring for patients with very different levels of acuity in the same ward.

Now, decisions are made by a multidisciplinary team of medics, nurses and therapists, who are specialists in the complex care of older people, to ensure that patients are assessed and treated in the most appropriate place for their needs. This may be at home with support from community teams, a ‘step-down’ facility in a community setting, or an acute bed in the hospital. The integrated multidisciplinary team also includes community assessment teams (social workers, complex health nurse assessors and psychiatric nurses).

Fiona Howell, matron for elderly care, said: "Frail, older people need to be looked after in a specific way. They tend to be the patients that stay longest in hospital and need a lot of input from other teams such as social services and physiotherapists. On this unit we can give them the specialist approach to their care that they wouldn't get in A&E." Most initial assessments are made within 15 minutes of admission, with a decision to admit or discharge in less than 24 hours.

During its development, it became evident that the concept of the Frail Elderly Assessment Unit was unique to the University Hospital of North Staffordshire, and to date no comparable examples across the UK have been identified. Despite the infancy of this initiative, multiple benefits for patients and staff have already been identified and these include:
• improved patient experience and quality of care
• prompt identification of the most frail patients with the most complex care needs
• preventing unnecessary admission to acute wards
• preventing admission via A&E with direct access for GPs, community trusts and West Midlands Ambulance Service
• reduced lengths of stay on the elderly care wards (down from 30+ days to an average of 9-12 days); and
• increased staff morale (staff attrition rates have significantly reduced).

In October 2012 the FEAU moved into a purpose built unit, cohorted with the acute elderly admission wards. This provides a seamless journey for the patient. The unit consists of 20 beds (10 female and 10 male) and complies to the single sex agenda. 

There has been national interest in this project with visits from various trusts to replicate this work and the unit and the elderly care wards have recently been assessed for an Excellence in Practice Accreditation Award.

Not only has the Frail Elderly Assessment Unit been featured in the hospital's internal newsletter, but it has also been presented at the RCN 2012 Older People's Forum Conference in March this year.

Further information
If you'd like to know more about this innovation, please contact Amanda Futers, email: amanda.futers@uhns.nhs.uk

Coach loads of members travelled from all parts of the south west to join the TUC march on Saturday 20 October. They were joined on the march by RCN members from across the country, as well as RCN staff including Dr Peter Carter, Chief Executive & General Secretary, Tom Sandford, Director for RCN England, and Jeannett Martin, RCN South West Regional Director. The march was a peaceful protect against the Government’s austerity measures, which are resulting huge cuts across the public sector with NHS bosses in the south west, proposing to move away from nationally agreed pay, terms and conditions to cut staff wages.

Member Helen White was moved to post on the RCN’s facebook page about her experience:

“...First time I went on march, impressed with how everything was organised for us down here in the south west - will go again!! Also impressed with the support we got from members of the public as we walked passed them. We've all got to keep up the momentum and stand up for what we all know is right and ultimately what we know is right for our patients.”

Nurses make a difference

MPs have stated that they have never received so many letters on one issue as they have about the pay cartel in the south west. RCN members have sent 2,606 letters through the RCN’s online tool alone, with many others sending through their thoughts by post, and visiting MPs in their constituencies to raise their concerns.

Labour MP for Exeter Ben Bradshaw told a recent branch meeting that RCN members must keep up pressure on the region’s MPs so that their views are represented at the highest level.

At the recent party conferences Dr Peter Carter met with many MPs, who were supportive of our campaign and opposed to regional pay.

RCN meets cartel CEOs

The RCN South West regional team has co-ordinated a series of meetings with the chief executives of trusts in the cartel, joined by colleagues from other trades unions.

Members’ concerns have been raised in these meetings about the affects of draft proposals, and the devastating impact their membership to the cartel has had on staff morale has been discussed. It has been stressed that members want employers to negotiate nationally on terms and conditions. The range of problems trusts will face in the future if they step outside of the national agreements has been highlighted, alongside the cost implications of doing so and the effects on staff and patients alike.

The RCN has acknowledged the financial challenge being faced by trusts and want to work with CEOs to identify sustainable long term solutions to the problem rather than continue with this attack on staff.

Plymouth City Council

Plymouth City Council’s Health Overview and Scrutiny Committee held a special meeting to investigate the membership by Plymouth Hospitals NHS Trust (PHNT) in the South West Pay Cartel. RCN staff spoke on behalf of members. The day-long meeting was extremely thorough in presenting all the issues, with speakers from the trust, local economists, patient groups and other staff unions. Following the meeting the council announced that it would make nine recommendations to the trust, that:

(1) all staff are fully engaged in the consultation of any changes that affect them and their views demonstrably taken into account

(2) the trust formally considers the impact of any local pay scheme on the recruitment and retention of staff, particularly those with specialist skills

(3) the trust formally considers the impact of any local scheme on the city and sub-regional economy

(4) the South West Pay, Terms and Conditions Consortium formally seeks the views of other key public sector employers in Plymouth and the sub-region as part of the wider consultation process

(5) the South West Pay, Terms and Conditions Consortium and PHNT formally considers improved productivity, management and service redesign as an alternative to altering pay and conditions

(6) the trust ensures the existing appraisal and supervision arrangements are carried out with 100% of staff

(7) given expenditure of £7million pounds on sickness absence within PHNT, the trust is requested to produce and publish an effective sickness/absence management strategy

(8) the trust formulates and publishes a response to the challenges raised in the staff survey

(9) the trust returns to a future meeting of the panel to discuss progress against the above recommendations.

Plymouth Hospitals NHS Trust has accepted these recommendations. We have since learned that Cornwall County Council has adopted these recommendations and is writing to the Royal Cornwall Hospitals NHS Trust. These recommendations have been received with interest by other councils, many of whom have passed motions opposing regional pay.

The RCN will further participate in future meetings at Plymouth City Council on this issue.

Marching for A Future That Works for England, Wales and Scotland

RCN members will be marching in London this weekend, alongside other trade union colleagues (Saturday 20 October), highlighting the impact of cuts to health services and oppose to any plans to introduce regional pay.

Thank you if you’ve already signed up to join us. If you haven’t signed up, but would like to take part, please read the briefing and get in touch if you need more information. Contact details are supplied within the briefing document, or you can  get in touch with your regional office or RCN Direct.

If you’re in the RCN Northern Region or Scotland, you can join the march that is taking place in Glasgow. For further information about this event contact the RCN Scotland Communications Team on 07962 801005.

March for a fairer, better way in Northern Ireland

If you’re in Northern Ireland then you can join the Northern Ireland Committee of the Irish Congress of Trade Unions in Belfast on Saturday (20 October). Contact RCN Employment Relations Department administrators on 028 90 384 600 in advance, or the Communications Team for RCN Northern Ireland on the day: 07887 513 271.

DOWNLOAD THE BRIEFING NOW

“Nurses across the UK are hugely concerned about the proposed hike in NMC fees at a time when many are struggling financially. We believe that the proposed independent audit of the financial basis and assumptions behind the proposed increase still needs to be carried out swiftly, and its recommendations taken on board. This is essential for nurses and midwives to have confidence in the NMC as their regulator.

“The RCN remains committed to working with the NMC to help address the issues the organisation is facing. An effective, fit for purpose nursing regulator which can effectively uphold professional standards is vital for the public, patients, and the nursing profession.”

The NMC said: “Patients must be able to have confidence in the quality of care they receive from nurses and midwives, and we share the Government's commitment to improve nursing and midwifery regulation.

"The NMC’s Council has a responsibility to ensure that the organisation is adequately resourced for the future in order to deliver effective and efficient public protection. We welcome the Government’s offer of a grant to give us further options to contribute to the costs of regulating nurses and midwives. This will be discussed by our Council when it meets on 25 October."

The news follows 85,000 nurses using Frontline First to express their anger at the initial fee rise proposal, information that formed part of the College's formal response to the NMC's proposal.

Measuring the relative severity of obstructive sleep apnoea is often done by a respiratory team, involving an overnight stay in hospital. This is known as polysomnography. Due to the strange environment, the child's sleep is often broken and fitful, making it difficult to accurately measure the severity of OSA in the child. It's also disruptive to the family, as a parent has to stay overnight in hospital too.

As is often the case, the innovation turned out to be a simple one. Anne recognised that there is another very common way to determine OSA in children, which is using a pulse oximeter. Pulse oximetry measures oxygenation, and if used continuously, it can accurately measure the number of times a child stops breathing overnight, enough to result in a desaturation on pulse oximetery  thus measuring the severity of the OSA. The great advantage to this method is its ease of use, and certainly something that the parent could do at home.

"It's about putting patients at the heart of their treatment" says Anne. Instead of an overnight stay in hospital, the ENT team teach the parents how to set up the pulse oximeter at home, and perform the test. It reduces disruption to the family routine, reduces the added stress of being in a strange environment for the child, and removes the need of an overnight stay in hospital, and High Dependency Unit (HDU) admissions in particular. The service has been audited, and parents are extremely pleased.

 "The service has really taken off" says Anne, "and we have increased the clinical sessions to cope with demand." Not only is this a great example of putting patients first, but the reduction in overnight stays saves the hospital money. There's no reason why this innovative service redesign cannot be spread to other children's, and adults services. If you'd like to know more about this innovation, please contact Anne Harvey, email: Anne.Harvey@alderhey.nhs.uk

If you're interested in respiratory services, why not book to attend the RCN's next conference on 3 November 2012? Find out more here.