Blueprint that makes sure standards of nursing care never slip to second-rate

Andrew Moore on how one hospital’s failure led a new focus on excellence

In a previous role as an Associate Nurse Director, I provided support to people who had made complaints about care and treatment. One case had a particularly powerful impact on me.

It required me to support a family who were unhappy with aspects of their mum’s end-of-life care, which had included poor communication and inadequate symptom management.

You only get one chance at getting this care right and, unfortunately, as a result of their experiences, the family had lost all trust in their NHS board. I was determined to provide answers to their questions as well as an authentic apology for aspects of care that fell below the standard

expected. It was also important to me to try to make sure that others didn’t have the same negative experience by seeing that improvements were made.

This experience still resonates strongly with me in my role as Head of Excellence in Care at Healthcare Improvement Scotland. Excellence in Care is a national approach that recognises that caring for the most vulnerable people is most effective if patients, families and staff work together as a team.

The vision is primarily focused on nursing and midwifery teams ‘owning’ quality, and using data to deliver assurance and continuous improvements in care.

Excellence in Care was commissioned by the Scottish Government in response to the Vale of Leven Hospital Inquiry recommendations.

The inquiry into Clostridium difficile infection at the hospital in 2007 found that individual and systemic failings in quality and governance had contributed directly to the deaths of 34 people.

Crucially, the families who took part in the inquiry have been instrumental in shaping and developing the Excellence in Care vision, which very much focuses on giving ‘control’ of quality to frontline teams.

The approach also recognises the importance of enabling senior charge nurses, team leaders and the wider team to focus on what matters to them as professionals, whilst working in partnership with what patients and families, to foster meaningful improvements in care.

The plan for Excellence in Care is ambitious. There are more than 44,000 nurses and midwives throughout NHS Scotland – 43 per cent of the total NHS workforce and more than 80 per cent of those delivering direct care to patients. They can be found delivering care across every aspect of health and social care.

Nowadays, nursing has taken on new responsibilities and people will find care being managed exclusively by nurses working in multi-disciplinary and multi-agency teams that straddle health and social care, and which also include the voluntary and independent sectors.

The Excellence in Care approach is a world first. It is a multi-agency collaboration between the Scottish Government, Healthcare Improvement Scotland, NHS National Services Scotland, and NHS Education for Scotland.

It aims to provide the Scottish public with confidence and assurance that nursing and midwifery care is high quality, safe, effective and person-centred. An unique set of tools have been developed to support and empower local teams to access accurate data on quality of care to identify and prioritise improvements for practice.

This consistent Scotland-wide approach will help us to effectively monitor improvement and assist NHS Boards and Health & Social Care Partnerships to have consistent and robust processes for measuring, assuring and reporting on the quality of nursing and midwifery care and practice.

It stands to reason that everyone in Scotland will be cared for by a nurse and midwife at some point in their life.

In response to the many ways in which nurses and midwives can deliver care, the plan is to expand the approach across other professions to reflect multidisciplinary and multiagency working.

Excellence in Care will help to ensure that patients experience high quality care, delivered in a compassionate way by competent nurses and midwives, and will continue to help to foster trust in services provided, which is something that both I and my team are incredibly proud to be part of. Andrew Moore is Head of Excellence in Care for Healthcare Improvement Scotland