Using Health Policy in Nursing Practice

Georgina Taylor

• Publisher: Learning Matters
• Year: 2013
• ISBN:
  9781446281383
• Edition: 1
• Topic: Medizin
• Subtopic: Pflegefähigkeiten

This book is part of the Transforming Nursing Practice series, written specifically to support nursing students on the new degree programme.

Health policy can appear complex and remote from nursing practice. This book demystifies health policy and helps you understand how policy decisions relate to your daily practice. Through the exploration of selected hot topics, such as patient involvement and dignity, the book helps you to consider how not only to use policy in practice, but also how to use practice to influence policy. Patient narratives and case studies are followed through each chapter to show how policy issues can impact on real life care. The book also shows how you can use an understanding of policy to develop your career.

Key Features:

- Shows how policy impacts on the real world and how you can use it to improve care or change practice

- Regular activities help you to engage with policy issues

- Enables you to see how to use policy in practice yourself

- Supports you in meeting the NMC requirements for registration

About the series

Transforming Nursing Practice is the first series of books designed to help students meet the requirements of the NMC Standards and Essential Skills Clusters for the new degree programmes. Each book addresses a core topic, and together they cover the generic knowledge required for all fields of practice. Accessible and challenging, Transforming Nursing Practice helps nursing students prepare for the demands of future healthcare delivery.

Series editor: Proffesor Shirley Bach, Head of the School of Nursing and Midwifery at the University of Brighton. Co-series editor for learning skills titles: Dr Mooi Standing, Independent Academic Consultant at national and international level, and an accredited Nursing and Midwifery Council (NMC) reviewer.

Georgina Taylor was a Principal Lecturer in the School of Health and Social Sciences at Middlesex University for many years, and has recently retired. She taught research methods to a range of healthcare professionals and aspects of health policy and interprofessional working to third year nursing students. Research interests include the health of refugees and asylum seekers, health inequalities, intercultural care, and patient safety.

Chapter 1
What does health policy
mean for nursing practice?

NMC Standards for Pre-registration Nursing Education

This chapter will address the following competencies:

Domain 1: Professional values

1. All nurses must practise with confidence according to The code: Standards of conduct, performance and ethics for nurses and midwives (NMC, 2008), and within other recognised ethical and legal frameworks. They must be able to recognise and address ethical challenges relating to people’s choices and decision-making about their care, and act within the law to help them and their families and carers find acceptable solutions.

Domain 4: Leadership, management and team working

1. All nurses must act as change agents and provide leadership through quality improvement and service development to enhance people’s wellbeing and experiences of healthcare.

2. All nurses must be able to systematically evaluate care and ensure that they and others use the findings to help improve people’s experience and care outcomes and to shape future services.

3. All nurses must be able to identify priorities and manage time and resources effectively to ensure the quality of care is maintained or enhanced.

NMC Essential Skills Clusters

This chapter will address the following ESCs:

Cluster: Organisational aspects of care

16. People can trust the newly registered graduate nurse to safely lead, co-ordinate and manage care.

18. People can trust a newly registered graduate nurse to enhance the safety of service users and identify and actively manage risk and uncertainty in relation to people, the environment, self and others.

By entry to the register:

xiii. Works within legal and ethical frameworks to promote safety and positive risk taking.

xiv. Works within policies to protect self and others in all care settings including in the home care setting.

Chapter aims

After reading this chapter, you will be able to:

• understand the importance of policy awareness for nurses;
• outline the policy-making process;
• recall key stakeholders in the making and shaping of health policy;
• outline how nurses can become involved in shaping health policy.

Introduction

Patient safety, quality of care and improving the health of the population are all high on the government’s agenda for health policy. In 2012, the Department of Health (DH) in England announced plans to introduce a safety tool to measure basic aspects of patient care – the NHS Safety Thermometer (DH, 2012a). However, these plans have raised questions among nurses and patient groups, because there are financial incentives for acute trusts that choose to use the safety tool (Kendall-Raynor, 2012). The tool requires nurses to record harmful events, such as pressure ulcers and falls, in order to identify areas where improvement is required. Some nurses will question the necessity of these requirements and see this as yet another policy initiative to add to their already heavy workload, but many trusts are already keeping records of this type of information (Kendall-Raynor, 2012). It is an example of policy that has an impact on day-to-day nursing practice. In order to understand policies it is important to be aware of why policies are initiated.

This chapter will introduce you to health policy in general, explaining why policy awareness is important to nursing practice at both micro-level and macro-level. It will outline different levels of policy-making – international, national and local – and relate them to the National Health Service (NHS), outlining the founding principles of the NHS, how these have been maintained over the years and the relevance for current debates. The Coalition government’s White Paper Equity and excellence: liberating the NHS (DH, 2010a) and subsequent 2012 Health and Social Care Act will be used as a case study to identify the stages at which various stakeholders have the opportunity to comment and thus potentially influence policy development. This will also provide an opportunity to consider key issues that have been raised by stakeholders in relation to the legislation. An overarching policy theme will be that of quality improvement.

Nurses are key professionals in improving the quality of care. The National Nursing Research Unit (NNRU) at the Florence Nightingale School of Nursing & Midwifery at King’s College London perceives nurses as:

Confident and effective leaders and champions of care quality with a powerful voice at all levels of the healthcare system, from policy-making to the frontline.
(Maben and Griffiths, 2008, p6)

Indeed, in recognition of the nursing contribution to improving the quality of healthcare services, the Prime Minister, David Cameron, set up the Nursing and Care Quality Forum in 2012, with the aim of improving the quality of care. The forum consists of nurses from a range of settings as well as patient representatives. You can look at the sort of work that the Nursing Forum is doing in relation to health policy by visiting the DH website (www.dh.gov.uk) and searching for the Nursing and Care Quality Forum. There are numerous other places where you can find information about health policy, for example, the King’s Fund, the Royal College of Nursing (RCN), the NNRU and professional nursing journals. You will find some suggested useful websites at the end of the chapter. You can now engage in the following activity to identify a policy initiative.

Activity 1.1 Evidence-based practice and research

Search through professional nursing journals, or visit one of the websites listed at the end of the chapter, and look for one example of health policy that might be applicable for your current or recent placement or that is of interest to you.

There is a brief outline answer at the end of the chapter.

Policy in everyday nursing practice

Policy can originate at international, national and/or local levels. Whatever the origin, many policies shape everyday nursing practice. A key overarching and enduring policy theme over recent years, and one that has spanned changes in governments, is that of improving the quality of healthcare. While the emphasis on quality did not originate with the Labour government that came to power in 1997, it became a driving force for the ‘new NHS’ to be addressed through a comprehensive quality improvement framework (DH, 1997) that remains in place. The concept of clinical governance is central to the quality framework and is defined as:

A framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.
(NHSE, 1999, p3)

Clinical governance integrates clinical audit, research, continuing professional development and reflective practice into a systematic framework (Braine, 2006), within which national quality standards are implemented. These standards are set by the National Institute for Health and Clinical Excellence (NICE) and are replacing National Service Frameworks (NSFs) in the reorganised NHS. NSFs have formed a good example of how nurses can be involved in shaping policy, as they were developed by groups of experts in the relevant field, including health professionals, service users and carers, and other appropriate agencies (Currie, 2000). Clinical governance imposes responsibilities on all healthcare practitioners and organisations to ensure that these standards are met at local level, and also to identify and work to resolve lapses in quality. The delivery of the quality standards is monitored essentially by the Care Quality Commission (CQC), so standards are set (by NICE) and monitored (by CQC) centrally and implemented locally by NHS Trusts. Importantly, the ultimate responsibility for the quality of care lies with the Chief Executives of NHS Trusts.

The impetus to improve quality was maintained by the Darzi Report High quality care for all: NHS next stage review final report (DH, 2008a), which identified three key domains of quality.

• Patient safety: first of all, do no harm.
• Patient experience: including the quality of caring.
• Effectiveness of care: success rates for treatments and patient-reported outcomes measures (PROMs). (DH, 2008a, p47)

The quest for quality improvement has been maintained by the Coalition government, pledging to build on the ongoing good work in the NHS through the retention of Lord Darzi’s strategy for quality. Spanning the three domains of quality, the National Health Service Outcomes Framework provides a set of national outcome goals to direct the NHS. The National Health Service Commissioning Board is to be held to account against these goals (DH, 2010a). Echoing clinical governance, the White Paper states:

we will create an environment where staff and organisations enjoy greater freedom and clearer incentives to flourish, but also know the consequences of failing the patients they serve and the tax payers who fund them.
(DH, 2010a, p9)

Activity 1.2 Reflection

Can you identify a quality improvement initiative that is in place in your clinical placement?

Did the policy driver for this initiative originate at international, national or local level?

What factors determine success?

There is a brief outline answer at the end of the chapter.

You might have identified a range of initiatives depending on the nature of your placement, but one aspect of quality improvement, which also concerns safety, is in the area of infection control. This area of practice has attracted policy attention at international levels, for example at the World Health Organization (WHO) and European Union (EU), as well as at national government level and most crucially at local levels where policies are implemented. The NMC (2010) identifies Infection prevention and control in its Essential Skills Clusters, requiring nurses to take effective measures to prevent and control infection in accordance with local and national policy. So every time nurses wash their hands, use a hand gel or wear a uniform, they are implementing policy.

What is health policy?

Health policy is the term used to describe government decisions and actions aimed at maintaining and improving people’s health.
(Blakemore, 2003, p196)

Major changes in health policy might require a programme of legislation at national level, but policy can also result from a statement by the Secretary of State for Health or a speech made by a government minister (Blakemore, 2003). In this chapter we look at policy arising from a programme of legislation that culminated in the 2012 Health and Social Care Act. However, in January 2012 the Prime Minister, David Cameron, made an important statement in relation to nursing policy when he announced that nurses must undertake hourly ward rounds (Triggle, 2012) following a report by the CQC that expressed concern about dignity and respect in hospitals throughout the country. National Health policies need to be interpreted and implemented locally, but local NHS organisations – for example, NHS Trusts – also formulate their own policies. It is important to point out that, as well as decisions to act on a health issue or problem, policy includes decisions not to take action. Health policy also includes decisions and non-decisions by health managers and professionals who make up the wider policy community (Green and Thorogood, 1998).

Various models and theories exist concerning the process of policy making, but Buse et al., (2005, pp13–14) propose a simple framework.

• Problem identification and issue recognition.
• Policy formulation.
• Policy implementation.
• Policy evaluation.

This process is, of course, similar to the nursing process of assessing, planning, implementing and evaluating, which will prompt you to suspect that the policy process is not necessarily linear but cyclical, as policy evaluation might result in further problem identification. In this book you will consider examples of opportunities for nurses to influence policy development at each of the above stages.

A distinction can be made between ‘health’ policy and ‘healthcare’ policy. The former relates to policy aimed at improving health, i.e. working ‘upstream’ (this will be addressed in Chapter 7), while the latter relates to policy that concerns healthcare delivery, i.e. working ‘downstream’, and essentially concerning the NHS (Hunter, 2003).

The National Health Service

NHS services in England, Northern Ireland, Scotland and Wales are managed separately as a consequence of devolved governance arrangements. The services are similar in many respects, and the core principles of the NHS apply across all four countries of the United Kingdom (UK), but there are some differences and notable divergences (Baggott, 2007). Examples include: the decision in Scotland to make long-term...