Chapter 1: The context of nursing
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Source: Adapted from NHS England ([24], p.11) with permission of the NHS.
Political context
Nurses are the largest group of employees in the NHS, so the context of nursing in the 21st century is shaped by the situation in the NHS. The aforementioned Leading Change, Adding Value: A Framework for Nursing, Midwifery and Care Staff (NHS England [21]) (Figure 1.1) was based on the NHS's Five Year Forward View (NHS England [20]), which highlighted the changes taking place in society:
- changes in personal health needs and preferences as we live longer with increasingly complex and more long‐term conditions, as well as a need to take increased responsibility for our own wellbeing
- changes in technology and developments in medical research with opportunities arising from these advances that need to be embraced to further enhance treatment and care
- reductions in funding provision because of the global recession that began in 2008.
Figure 1.1 Leading Change, Adding Value: A Framework for Nursing, Midwifery and Care Staff. Source: Reproduced from NHS England ([21]) with permission of the NHS.
Unwarranted variation
One of the core principles of the NHS when it was founded 70 years ago was that it should ‘meets the needs of everyone’ (NHS Liverpool Heart and Chest Hospital [26], p.1; see also NHS England [23]). This has continued to guide the development of the NHS; however, as identified in the Five Year Forward View (NHS England [20]), changes in society are contributing to three distinct gaps that, if they are not addressed, will impact the long‐term provision of healthcare and increase inequalities:
- Health and wellbeing: a focus on prevention is needed or the inequalities in health will continue to grow and the budget for healthcare will need to be spent on avoidable illness and not on the development of new treatments.
- Care and quality: health needs will go unmet unless we reshape care, harness technology and address variations in quality and safety (NHS England [24], p.8).
- Funding and efficiency: without efficiencies, a shortage of resources will hinder care services and progress (NHS England [24], p.8).
An implicit part of the role of nursing is therefore to be an integral part of closing these gaps, whether at a strategic, national level or locally at the bedside or in the outpatient department. It is suggested that the impact of these gaps is exaggerated because of ‘unwarranted variations’, which is ‘a term used to describe inequalities that cannot be justified by variations in geography, demography or infrastructure’ (NHS England [24], p.9). At a local level, nurses can be involved in challenging unwarranted variations in the ways shown in Box 1.2.
Box 1.2
Unwarranted variation: turning intention into action
- Taking a closer look at what we do: for example, benchmarking our procedures against the evidence‐based procedures in The Royal Marsden Manual of Clinical Nursing Procedures.
- Uncovering activities that we need to change, add or take away.
- Challenging established practice because we understand that service can be delivered in a better way: for example, using the online version of The Royal Marsden Manual of Clinical Nursing Procedures to upload and disseminate agreed examples of good practice across an organization.
- Striving for high‐value care: for example, reviewing equipment and the medication involved in procedures, or exploring whether procedures are being carried out by the most appropriate member of the team.
NHS Long Term Plan
The NHS Long Term Plan (NHS England [25]) sets out a new service model for the 21st century. This responds to ‘concern – about funding, staffing, increasing inequalities and pressures from a growing and ageing population’ and optimistically holds ‘the possibilities for continuing medical advance and better outcomes of care’ (NHS England [25], p.6).
The plans set out have various implications for nursing. The key chapters of the NHS Long Term Plan with direct relevance to nursing practice in an acute setting are set out in Table 1.1 with reference to the chapters in this manual that might be of specific significance to nurses who are involved in implementing new ways of working.
Table 1.1 The NHS Long Term Plan (NHS England [25]) and The Royal Marsden Manual of Clinical Nursing Procedures
| New ways of working identified in the NHS Long Term Plan with direct relevance to nursing practice | Relevant chapter(s) in The Royal Marsden Manual | Related content in The Royal Marsden Manual |
|---|---|---|
| Chapter c01: A New Service Model for the 21st Century | ||
| Personalized health budget and self‐care | Chapter c05: Communication, psychological wellbeing and safeguarding | Information giving and decision making. |
| Same‐day emergency care and clinical standards for critical illness |
Chapter c12: Respiratory care, CPR and blood transfusion
Chapter c13: Diagnostic tests
Chapter c17: Vascular access devices: insertion and management | Nursing procedures for emergency care, e.g. CPR. |
| Improved discharge | Chapter c03: Discharge care and planning | Processes and procedures for arranging discharge with Social Services. |
| Chapter c03: Further Progress on Care Quality and Outcomes | ||
| Whole chapter | All chapters | The foundation of this textbook is to provide evidence‐based procedures and to underpin rationale for the day‐to‐day procedures used by nurses in the acute setting with the aim of promoting quality care for the best outcome. This is discussed in more detail in the section below. |
| Chapter c04: NHS Staff Will Get the Backing They Need | ||
| Workforce changes, including increased flexibility and access to professional development to help manage the pressures of working in the NHS | Chapter c19: Self‐care and wellbeing | This chapter specifically considers strategies to help nurses cope with the pressures of working in the NHS. |
| Chapter c05: Upgrading Technology and Digitally Enabling the NHS | ||
| Whole chapter | n/a | This theme is not specifically addressed; however, references are made where appropriate to digital support for procedures, plus the online version of the manual is continually being enhanced. |
