Increase Ward Management Pay to Improve Patient Care

Sisters and charge nurses must be given higher status and more pay if the NHS’s current problems surrounding the care of older patients are to be successfully addressed, according to senior clinicians.

Speakers at two high profile inquiries into NHS quality standards last week both identified the loss of good ward managers as a key area in need of improvement, highlighting an ongoing problem in nursing.

The ongoing Mid Staffordshire Foundation Trust public inquiry and the newly established Dignity Commission were told that good ward managers should be paid more and encouraged to stay at the bedside rather than move into more senior care management jobs in order to raise standards of care.

Last week also saw two more reports expose shocking examples of poor care of the older patients, this time in the community. The reports, from the Queen’s Nursing Institute and the Equality and Human Rights Commission, follow the cases highlighted over the past 12 months by the Care Quality Commission, health service ombudsman and the Patients Association.

In his closing submissions to the Mid Staffs public inquiry, the FT’s chair Sir Stephen Moss said junior nursing staff needed role models on the wards.

“Ward sisters who’ll not accept anything less than the best standards of care should be rewarded and encouraged to stay at that level, without moving into more senior or managerial roles,” he said.

Sir Stephen, who was director of nursing at Queen’s Medical Centre in Nottingham for more than 20 years, told Nursing Times that staying at the bedside should be seen as an “attractive career choice”, and nurses should not feel they had to move into management or education to progress.

Sisters and charge nurses are usually paid an Agenda for Change band seven salary – ranging from £30,460 to £40,157 – although in some places they can be on a band six, which starts at just £25,528 per year.

Meanwhile, at the Dignity Commission’s third evidence session last Thursday, Royal College of Physicians clinical vice president Linda Patterson said a sister or a charge nurse working with a senior doctor could be a “very powerful” team.

“The ward manager is the leader for quality on a ward. They need to have higher status, they need to be higher paid and be seen as an absolutely key role,” said Dr Patterson.

The Commission, which is examining why some organisations fail to treat older people with dignity, was set up by Age UK, the NHS Confederation and the Local Government Association, and began hearing evidence earlier this month.

Royal College of Nursing director of nursing and service delivery Janet Davies told the hearing it was also important that ward managers were only responsible for one ward. Additionally, she said there was a need to recognise nursing older people as a specialist area, and “not something you do because you can’t get a job elsewhere”.

Both the commission and the inquiry will produce reports including recommendations for improving standards of care next year.

Adviser to the commission Dame Elisabeth Fradd told Nursing Times nurses on the frontline had been “blamed enough” for the problems surrounding older patients.

“It’s a much bigger issue. It’s about the culture inside the organisation that either does or doesn’t support nurses,” she said.

Dame Elizabeth is a member of an informal group of senior nurses, which also includes Sir Stephen Moss, that have come together to call for a change in the culture of the NHS. All of whom are acting as advisers to the Dignity Commission.

She said it was “not surprising” people came into healthcare with poor attitudes towards older people, as it reflected in society’s tendency to marginalise them.

She added: “When that’s coupled with an organisation that isn’t compassionate [towards staff] how can you expect people to be compassionate when they’re delivering care?”

* The Royal College of Nursing in Wales last week launched a campaign, “Time to Care”, to highlight the importance of nurses having enough time to carry out their work duties to the highest possible standard.

RCN Wales director Tina Donnelly said: “Nurses need time to provide a high standard of nursing in the health care, and this is vital to ensure that the fundamentals of care; such as nutrition and hydration, privacy, dignity, respect and meeting hygiene and toilet needs are fully met.”