“If the NHS is going to become more productive, we need to put the nursing and midwifery workforce at the heart of it,” Natasha Phillips, founder of Future Nurse, told the Highland Marketing advisory board.
To raise productivity, the NHS needs to streamline its workflows and handovers, to make every touchpoint with the patient as efficient and effective as possible. And it is nurses and midwives who drive that, because: “a large part of their role is to co-ordinate care around the patient.”
Over the past quarter of a century, considerable investment has been put into IT systems to try and capture data and drive care co-ordination. Yet the results, in terms of productivity, or releasing time to care, have been disappointing.
One reason, Natasha argued, is that there hasn’t been anything like enough investment in equipping nurses and midwives with digital skills. True, there has been some progress. As chief nursing information officer for England, Natasha saw the number of trusts with chief nursing information officers increase from 20% to 80%.
“However, that’s still a tiny percentage of the nursing and midwifery workforce,” she said, “and all of them need digital skills centred around their practice, which is to help people to live their best life, or to have the best possible death.”
The question of how to make sure the nursing and midwifery workforce has the digital education and skills it needs is particularly pressing with the arrival of new technologies, such as genomics and AI.
Sam Neville, who modestly describes herself as “a jobbing CNIO” in the East of England, pointed out that nurses and midwives are already being asked to use genomic tests, clinical decision support systems (such as NEWS2), and AI-driven rostering and flow tools as part of their practice.
So, it’s important they understand them – and can communicate about them with patients. She outlined a “persona” developed for the Phillips-Ives review that outlines the skills a future midwife, Jax, will need throughout her career, as she gains experience and moves into leadership roles.
The Phillips-Ives review was commissioned by NHS England and led by Natasha and Jeanette Ives Erickson, who works in the US. It’s never been published, but it was leaked over the summer [‘Severe shortage’ of digital nurses, warns Phillips Ives review | Nursing Times].
Chris Tack, a digital health consultant and former physiotherapist and AHP information officer, who, like Sam, contributed to the review, told the advisory board it developed a model to address the current shortage of digital specialists and skills, and to create the nurses and midwives of the future, built around four strands.
Broadly, these are: revamped education for nursing and midwifery students; competency-based training for working professionals; more support for digital nurses and midwives; and a career track for the leaders of the future, so “they can feed back into academia and training and create a positive feedback loop.”
The model would need to be underpinned by a regulatory and competency framework and practical support, such as a digital passport for staff to carry around the system. So, getting something like it in place would be a big job. Around 730,000 of the NHS’ 1.3 billion employees are nurses and midwives; and another 185,000 are AHPs.
Even so, Nicola Haywood-Cleverly, a non-executive director at several public bodies, said there was a need to reach even more people – including administrative staff. Natasha agreed. “We need to push for a national plan, but it does not have to be for nursing and midwifery,” she said.
“Neil Perry, a consultant who used to lead IT at Dartford and Gravesham NHS Foundation Trust, argued that just getting Phillips Ives formally published would be a start.
“That way, it would become mandated reading for NHS organisations’ leadership teams, receive a formal response, and be discussed alongside the new government’s health plans.”
Like Nicola, Neil argued the whole workforce needs digital skills if transformation projects are going to work. “There is a difference between innovation and adoption,” he said. “You need a small group of enthusiasts to work on innovation, but you need everybody to enable the change to be adopted.
“And where I think that really matters is sorting out upfront data entry and quality, because without that, you will never get the good quality algorithms, or data to train machine learning models that we were talking about earlier.” Sam agreed, arguing it is essential that people understand why they are being asked to collect data in the way they are.
“If people think: ‘Oh, I have to do this now’ they will find reasons not to do it,” she said. “They’ll say: ‘The computer logs me out’ or: ‘There are too many screens and it will take too much time’.” Chris said France spotted exactly this problem.
Which is why, when it launched its latest, five-year Digital Health Roadmap in 2023, it chose to put £100 million into competency-based training, before trying to create an “ecosystem” for care, research and innovation, or progress big telehealth and personal health record projects.
Still, James Norman, a former NHS chief information officer who now works in industry, argued it would help if the NHS had more user-friendly IT. Over the past decade, a lot of IT policy and marketing has been conducted on the basis of slogans: create “a paperless NHS”; “go cloud-first”.
When the real need has been to focus on the infrastructure, devices, logins, interfaces, and data exchanges that staff have to use – or try to use – to do their jobs. Unless that is sorted, James said: “Even with a strategy, and education, and training, staff will be hamstrung by the technology, because nobody has joined the dots.”
Ian Hogan, the chief information officer at a mental health trust, pointed out that the companies that build or commission technology out in the consumer world spend a lot of time on user interfaces. “There’s something called the ‘three click’ rule, that says that if people cannot get to where they want to get within three clicks, they will give up,” he said.
“Amazon, the BBC iPlayer etc, have got it down to a fine art, but it’s not like that in the NHS, where EPR systems are too big and too old.” David Hancock, a consultant who used to work in industry, said that even where EPR vendors are looking to improve things, they “tend to think about doctors rather than nurses.”
He argued they need to involve more staff groups so they can input on “how to collect data at the point of care” as part of their roles. This triggered a debate about whether nurses, midwives and AHPs are getting involved with IT systems and developments early enough.
Nicola said she’d been to a virtual wards conference recently, and while there were lots of nurses in the audience, there weren’t many working with vendors. Natasha agreed that: “We have made progress in getting CNIOs and nurses involved in implementations” but “there’s a way to go in the ideation space.”
One of the things that Future Nurse wants to do is to create a community of practice, to bring suppliers, digital nurses and midwives together.
Andy Kinnear, a consultant who used to run an NHS commissioning support unit, felt nurses and others need to be involved even earlier, in debates about emerging technology. “I have been to conferences in Munich and Amsterdam this summer, and there was AI everywhere,” he said.
“It’s a whole new world, but I wondered who is talking about the ethics of it. We need to get nurses, midwives and AHPs involved, because it feels like there’s a danger of adopting some things before we’ve really thought about whether we should be doing them.”
Sam said CNIOs and nurses may be involved in AI deployments. But Natasha agreed there is a need for policy and guiderails at a national level. Perhaps, she suggested, this is one area in which the Royal Colleges could be active, “as keepers of professional standards.”
Getting involved in debates about the future of technology, working with suppliers to make systems fit for use, supporting implementations and adoption, just using IT as part of the job. There’s a lot for nurses, midwives and AHPs to do in the health tech space.
Advisory board chair Jeremy Nettle argued there’s a need to prioritise. “It’s interesting looking forward, but we need to sort out the basics first,” he suggested. “We need to get in place the things that let staff deliver holistic care for people because, at the end of the day, that is what they are all about.”
Longer term, Natasha argued that what is needed is focused, joined-up thinking and joined-up working across the system to deliver it. “We need programmes that are connected to do the things we really want to do,” she said. “Tech is all: go paperless, go to the cloud. It’s not: make people better, sort out prevention. Or: do it efficiently, do it well.
“If we keep focusing on the technology, things will only get worse. That’s why we need to put the focus on people. France got it the right way round.”
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