That this meeting of Congress calls upon Council to lobby governments across the UK to decriminalise prostitution. Proposed by the RCN Greater Bristol Branch. (R)
World Health Organisation (2012) guidelines recommend that countries work towards the decriminalisation of sex work. There are two important things to note. Firstly, decriminalisation is not legalisation. And secondly, sexual exploitation and/or trafficking of persons will remain illegal.
There is no reliable evidence to suggest that the decriminalisation of sex work would encourage human trafficking; in fact, several international anti-trafficking organisations believe that decriminalisation of sex work would have a positive role to play in the fight against trafficking.
Currently in England, Wales and Scotland, prostitution itself (the exchange of sexual services for money between one seller and one buyer) is legal, but a number of related activities, including soliciting in a public place, kerb crawling, owning or managing a brothel, pimping and pandering, and more than one sex worker working together, are crimes. The law in Northern Ireland is different to the rest of the UK as it has conflated sex work and human trafficking into one issue. It is regulated primarily by the Human Trafficking and Exploitation (Criminal Justice and Support for Victims) Act (Northern Ireland) 2015, which makes it illegal to pay for sex in Northern Ireland.
Credible evidence shows that where sex workers are able to negotiate safer sex, HIV risk and other vulnerabilities can be better managed and greatly reduced. A recent systematic review, led by the London School of Hygiene and Tropical Medicine (Platt et al., 2018), found sex workers who had been subjected to recent arrests, prison or displacement from places of work had a three-times higher chance of experiencing sexual or physical violence and were twice as likely to have HIV and/or other sexually transmitted infections.
The review also noted that sex workers who had avoided repressive policing were 30% less likely to engage in sex with clients without a condom.
There have been proposals for a so-called Nordic Model (there are several types of Nordic Model but most approach this by criminalising the buyer and not the seller in order to reduce demand for sex workers). This model built on the assumption that sex work exists because of demand, but the reality is that the majority of sex workers enter the sex industry for socio-economic reasons and this will be unchanged by any reduction in demand.
Research in Sweden and Canada has also shown that criminalising sex workers’ clients did not improve sex workers’ safety or access to services and in some cases showed a detrimental impact. A 2017 Scottish Centre for Crime and Justice report highlighted both the limited and contested nature of existing evidence on the impacts of the criminalisation of the purchase of sex and the consensus for the need decriminalise individuals involved in prostitution.
This compared to New Zealand, where following decriminalisation, sex workers reported being better able to refuse clients and insist on condom use, in addition to improved relationships with police.
Amnesty International argues in favour of decriminalisation, arguing that the criminalisation of prostitution “threatens the rights to health, non-discrimination, equality, privacy, and security” of a sex worker. The World Health Organisation also condemns the criminalisation of sex work, and backs research by The Lancet which shows that decriminalising prostitution would help lower rates of sexually transmitted infections, particularly HIV/Aids.
As nursing staff, we have a responsibility to call for what is in the best interests of public health and the patients who entrust us with their care. Lending our voice to support a stigmatised and marginalised group is not only the right thing to do but will lead to improved health outcomes.
That this meeting of Congress asks RCN Council to review possible failures of healthcare staff to communicate fully Do Not Attempt Resuscitation (DNAR) orders with vulnerable groups. Proposed by the RCN Forth Valley Branch. (R)
Do Not Attempt Resuscitation (DNAR) orders (and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders in Scotland) are used to provide guidance to health care professionals on the action to take should the patient in their care suffer a cardiac arrest or stop breathing for any reason.
Effective communication – and recording of that communication – is fundamental to the work of health care professionals in the delivery of care to patients and their families and carers. Anecdotal evidence suggests that appropriately timed conversations about DNAR/DNACPR orders between health care staff and their patients do not always take place.
Consequently, these patients and their families and carers are not being fully consulted on decisions about cardiopulmonary resuscitation (CPR) intervention in advance. This area of concern was highlighted by the Parliamentary and Health Service Ombudsman (2015) report which noted that health care professionals do not always have open and honest conversations with patients and family members and carers.
The NHS Constitution for England (Department of Health, 2015) indicates that people have the right to be involved in discussions and decisions about their health and care and given the information to enable them to do so; this includes end-of-life care, and, where appropriate, this right extends to their family and carers.
The constitution also reflects the fact that all people can expect to be treated fairly And the NHS Scotland Charter of Patients’ Rights and Responsibilities, backed up in legislation, states: “you have the rights to be involved in decisions about your care”.
NICE guidelines on End of Life Care for Adults sets out the standard of good communication and shared decision making with patients, families and health care professionals.
Guidance published jointly and reviewed by the British Medical Association, Resuscitation Council (UK) and the Royal College of Nursing places a great emphasis on ensuring high-quality communication, decision making and recording in relation to decisions about CPR.
No matter how difficult the conversation, health care staff must discuss the issue of CPR interventions with their patients and/or their families or carers.
In Scotland, the national integrated policy guidance Decisions Relating to Cardiopulmonary Resuscitation (Scottish Government, 2016) clearly sets out the standards of communication for health care staff.
Similar to guidance in England and Wales, it indicates that if CPR is unlikely to be successful it is important that this is communicated sensitively to the patient, unless it is judged that the conversation would cause physical and psychological harm. If the patient lacks capacity, the relative or carer must be informed.
Conversations relating to DNAR/DNACPR orders should be part of a wider person-centred conversation about a patient. DNAR/DNACPR orders not only provide a platform for open communication about possible end of life interventions, but it also helps to demystify the dying process, empowers the patient and is at the heart of shared decision-making.
That this meeting of Congress debates whether the RCN would be more influential for nursing and health globally if we re-joined the International Council of Nurses (ICN). Proposed by the RCN Devon Branch. (MfD)ICN is a federation of 133 nursing organisations that represent 20 million nurses worldwide. ICN is operated by nurses and works to ensure quality nursing care for all, sound health policies globally, the advancement of nursing knowledge, the presence worldwide of a respected nursing profession and a competent and satisfied nursing workforce.
That this meeting of Congress asks RCN Council to challenge employers who impose clinical supervision on registered nurses by other professions. Proposed by the RCN Birmingham West and Sandwell Branch. (R)
Skills for Care defines supervision as “an accountable process which supports, assures and develops the knowledge skills and values of an individual, group or team”. Clinical supervision has benefits for nurses, nursing, patients and service users, carers and also the organisational culture, reflecting the values and behaviours of the organisation and its staff.
It is also linked to good clinical governance. Clinical supervision functions as an emotionally safe space that, in turn, promotes critical reflection and has a positive impact on nurses’ emotional well-being. Clinical supervision provides a strategy to mitigate nurses’ workplace stress and enhance retention.
Clinical supervision can help staff to manage the personal and professional demands created by the nature of their work. A variety of models for Clinical supervision have evolved in different work settings across the UK. Rarely is time for clinical supervision funded or included in the calculation of nurse staffing levels.
Clinical supervision provides an environment in which staff can: explore their own personal and emotional reactions to their work; reflect on and challenge their own practice in a safe and confidential environment as well as receive feedback on their skills; and engage in professional development, identify developmental needs and support revalidation.
A variety of models for clinical supervision have evolved in different work settings. Within mental health care environments, it is primarily through one-to-one engagement with another registered nurse. Clinical supervision can be carried out by another member of the same profession or group, providing staff with the opportunity to: review professional standards; keep up to date with developments in their profession; identify professional training and continuing development needs and ensure that they are working within professional codes of conduct and boundaries.
Consequently, it is agreed that clinical supervision is an important mechanism in the provision of high quality, safe and effective clinical care. However, anecdotal evidence from RCN members and CPN colleagues has shown that one-to-one clinical supervision in nursing is being eroded, especially in community mental health teams.
This is likely to increase as nurse staffing levels become more difficult to sustain. There is often insufficient time for nurses to have appropriate clinical supervision due to the demands of high caseloads and increased workloads. A major review by the Foundation of Nursing into Mental Health nursing showed that access to clinical supervision was insufficient in the UK.
Other professions such as midwifery and social work have successfully fought for supervision to be recognised as an essential element of their service.
Whilst some local policies encourage nurses to choose their own supervisor, and there are several models of supervision which encourage staff to seek supervision appropriate to their practice, there remain concerns about the support for meaningful clinical supervision opportunities. This includes evidence within community mental health teams of a move to group supervision which is being imposed and, even more worryingly, it is often led by a psychologist.
We are concerned that removal of 1:1 supervision denies a safe space for learning and undermines a nurse’s right to confidential supervision. Other health professionals, such as psychologists, bring a different perspective from nurses. This denies nurses positive role models, undermines professional development of nurses and can lead to resentment.
We are not arguing against a multi-professional approach to care giving and we value the expert intervention our health and care colleagues bring to the service users.
However we feel the role of supervisor in this important and valuable clinical supervision relationship should be a fellow registered nurse. A well-established system of clinical supervision has been proven to be effective in enhancing the normative, formative and restorative features so vital in the provision of high quality nursing care.
That this meeting of Congress discusses the impact on nursing, health care and our members when disputes about care decisions attain a high media profile. Proposed by the RCN Children and Young People: Acute Care Forum. (MfD)
There have been a number of high-profile cases recently – and in particular in the last couple of years – involving highly charged, emotive situations. At times such as these, nursing staff find themselves being torn in the roles of supporting families through difficult times and being the target of rage and abuse themselves.
Prioritising people so that they are treated with kindness, respect and compassion is enshrined in the NMC Code. As a workforce we endeavour to achieve this, however there are times when the people we care for, or their relatives, interpret our actions differently, and occasionally these differences can escalate.
There is an increasing emphasis on creating partnerships and empowering the people we care for, and while this is to be welcomed, it also has the potential to increase disputes about an individual’s care.
Some such disputes, when not resolved by local teams or arbitration, lead to legal action. This can attract the attention of both the media and the that of other interested parties such as campaign groups.
Recently, there have been some particularly high-profile cases relating to children. These attracted national and international attention, and saw the members involved – and the organisations they worked for – subjected to abuse.
There have been other cases where families have disagreed over the provision of dementia care, challenged the level of mental health care provided and the adoption of protocols used during end-of-life care.
The high-profile nature of these cases has led to RCN members being abused on social media, verbally abused as they went to work and, in some cases, threatened with physical harm. Despite the overt public hostility, there was little protection and no opportunity to respond. These situations place nursing staff in a very vulnerable position.
Our nursing workforce is already facing many pressures: poor pay, lack of staff, increases in workload, missed breaks, unpaid extra hours – the list is long and has a severe impact on the health and safety of nurses.
There is an obvious public interest high-profile cases, but the impact such cases have on staff is never told. Working in an environment where the appropriateness of care is questioned can lead to moral distress. The impacts and consequences of these situations can spiral and the risks are real: more highly trained and skilled nurses will leave the profession, and many will simply burn out.
At the moment nursing staff remain silent due to fear of professional misconduct, prosecution or of attracting further abuse. A one-sided debate will never be a true reflection of these issues, and allowing nurses and members to have a voice when important issues are considered by the media is a necessity.
While the RCN rightly cannot comment on such cases where it is representing and supporting individual members, as a profession we need to have the freedom and support from our employers and professional and regulatory bodies to engage in public debate.
We need to know that we will not be hounded by the bureaucracy for advocating for patients and their families or by the media for voicing an alternative view.
That this meeting of Congress discusses the lack of understanding of the abuse of nitrous oxide and its consequences on health and wellbeing. Proposed by the RCN Mental Health Forum. (MfD)
There is a significant lack of understanding of the impact that nitrous oxide has upon the health and wellbeing of individuals using it.
Commonly used as a recreational drug, nitrous oxide offers a euphoric effect to users but can cause chemical asphyxiation and is fatal. The body requires oxygen in order for life to be sustained – once it is starved of oxygen swelling can be caused to the brain. This occurs as there is not availability of a life-sustaining gas to replace the oxygen.
The lack of understanding of the effects of nitrous oxide extends to contemporary health services and to governments leading to a lack of legislation precluding sale and increasing numbers of deaths.
Nitrous Oxide (laughing gas) is now the fourth most used drug in the UK, according to the Global Drug Survey 2015. In the past year, only people in the Netherlands used it more. In 2013-14, some 470,000 people took nitrous oxide, according to the Home Office.
It’s especially popular with young people, with 7.6% of 16 to 24-year-olds using it that same year. This was a greater proportion than took cocaine (4.2%) and ecstasy (3.9%). The research suggests that there have been 17 fatalities related to the use of nitrous oxide in the UK between 2006 and 2012.
That this meeting of Congress directs RCN Council to instigate a review of the joint Chief Executive & General Secretary role with a view to introducing an elected General Secretary. Proposed by the RCN Greater Liverpool and Knowsley Branch. (R)
The question of an elected General Secretary was raised at the RCN Extraordinary General Meeting in September last year, which was called in response to the RCN’s communication of the 2018 NHS Pay Deal.
The General Secretary of most trades unions are required by law to be directly elected by all members.
This does not apply to the RCN or the other 12 Special Register Bodies which take part in collective bargaining on behalf of their members alongside other activities under the Industrial Relations Act 1971 unless they are voting members of the Trade Union Executive (our Council).
Of those 13 special register bodies all but the BMA appoint their General Secretary.
The Chief Executive & General Secretary of the RCN is the principal official and staff member of the organisation. The position holder must be a registered nurse and is appointed by RCN Council. They are not a member of RCN Council. It is the President who is the directly elected voice of the membership (as required under the trade union legislation) and an ex-officio voting member of Council.
The BMA also has an appointed Chief Executive. However it is the Chair of Council undertakes the role of General Secretary (although that title is not used). The BMA Chair of Council is not however directly elected by the membership but from within Council.
As well as considering an elected General Secretary, the review would also need to consider the subsequent organisational and governance impacts which may follow.These questions would include:
That this meeting of Congress discusses the health and well being impact on families and individuals without a secure, affordable home. Proposed by the RCN North Yorkshire Branch. (MfD)
A safe, settled home is the cornerstone on which individuals and families build a better quality of life, access services they need and gain greater independence (Guardian Society, 2014). There is extensive evidence that shows poor housing conditions have a significant impact on physical and mental health. For example, a warm and dry house can improve general health outcomes with a particular impact on respiratory conditions.
Housing also has a huge influence on mental health and wellbeing – children living in crowded homes are more likely be stressed, anxious and depressed, have poorer physical health, and do less well at school.
There is unequal distribution of good quality housing across the UK. In England, the effects of poor housing on the NHS were previously estimated to be at least £1.4bn per year and £2.5bn per year when considering all housing throughout the entirety of the UK.
Furthermore, one in five dwellings in England do not meet the Decent Homes standard; in Northern Ireland it is estimated the annual cost to society of inadequate housing is £401m; and in Wales, poor quality housing was estimated to cost the NHS more than £67m a year. According to Shelter Scotland, one in three Scottish homes don’t meet the Living Home Standard.
Lack of social housing means that many people on the lowest incomes are forced to find homes in the private rented sector where short-term tenancies, rent hikes and the threat of no-fault evictions all make long-term security difficult. This has been exacerbated by changes to housing benefit, which no longer covers the whole rent, and claimants can also go weeks without support. This can push vulnerable people into temporary – and in extreme cases full-time – homelessness.
In 2018, the Westminster Government recorded 4,677 people sleeping rough in England, 165% higher than in 2010. In Scotland, for the six-month period of 1 April to 30 September 2018 there were 18,486 applications for homelessness assistance, 2% more than in the same period in 2017. In Wales, 2,703 households were assessed as homeless during July to September 2018 while in Northern Ireland, there were 11,877 applications for homelessness during the 2017/18 financial year.
Health outcomes for those who are homeless are significantly worse than the general population. Homelessness and poor housing multiply inequalities and have a long-term impact on physical and mental health. The impact on children and young people can affect their long term physical and mental health. The rate of homeless children in Great Britain is one child in every 103 (England one in 96, Scotland one in 156, Wales one in 412).
Homeless families can suffer from a range of related health issues, including hunger and malnutrition, and they can struggle to access services such as GP surgeries. Rough sleepers risk assault and theft of personal items and are susceptible to extremes of weather throughout the year.
Without a safe, affordable home the severe health risks will continue.
That this meeting of Congress calls on RCN Council to lobby governments across the UK to provide adequate resources to deal with the rising levels of child poverty. Proposed by the RCN Cardiff and the Vale branch. (R)
Poverty can be measured in two ways. Relative poverty is a calculation of income available to a person or family. If their income is below 60% of the average income across the country, then they are determined to be living in relative poverty. This is called the poverty line.
Absolute poverty looks at the average income of a household today, and compares this to 60% of the average household income earned in 2010 to make a comparison across a number of years.
Research indicates that after housing costs, relative poverty equates to income less than: £248 a week for a couple with no children; £144 a week for a single person with no children; £401 a week for a couple with two children aged between five and 14; £297 a week for single parent with two children aged between five and 14 (Joseph Rowntree Foundation, 2018).
UK child poverty affects more than 4 million children (30%) or nine in a classroom of 30. They may experience poor physical and mental health and may not reach their full potential in school. Research shows links to family unemployment, poor housing, debt, homelessness and poor life chances (Children’s Society, UK Government, Full Fact).
Each country in the UK has introduced a Children’s (and Young People’s) Commissioner, responsible for promoting the rights and protections of children, and to advocate for their interests in policies and decisions that will affect their lives.
Wickham et al’s research from 2016 state that health care professionals need to act as advocates for more equitable welfare reform and provide services to reduce the health consequences of growing up in poverty.
The Westminster Government’s Child Poverty Act 2010 set UK-wide targets to end child poverty by 2020. It required each country to have Government-led strategies for eradicating child poverty, placing statutory duties on local authorities and regional bodies to cooperate to tackle child poverty, report on child poverty levels and prepare a local strategy in their areas.
For England, the Department for Work and Pensions jointly with the Department of Education published a strategy which set out ambitions to tackle the causes of disadvantage and transform families’ lives. This included moves to Universal Credit and ensuring fewer children grew up in workless households which were linked to lower educational attainment.
The Child Poverty (Scotland) Act 2017 places a duty on the Scottish Government to eradicate child poverty by 2030. The Scottish Government target followed a report from the Social Mobility and Child Poverty Commission, chaired by Alan Milburn which concluded that the 2020 child poverty target was likely to be missed by a considerable margin.
To accompany their devolved target, the Scottish Government (2018) also published Every Child, Every Chance: Tackling Child Poverty Delivery Plan 2018-22.
In Northern Ireland, the End Child Poverty campaign reported that around 25% of children in Northern Ireland were living in poverty last year (End Child Poverty, 2018). The Northern Ireland Commissioner for Children estimates that the majority (61%) live in households with at least one parent who is working. The Institute for Fiscal Studies warns that the level of child poverty in Northern Ireland will increase to more than 30% by 2020 without major interventions to support family income and opportunities for low income children (Hood and Waters, 2017).
The Welsh Government launched its Child Poverty Strategy in 2011, affirming its ambition to end child poverty by 2020. The strategy outlines objectives to reduce the number of families living in workless households; improve the skills of parents and young people living in low income households; and reduce inequalities that exist in health and education outcomes. Initiatives include the Healthy Child Wales Programme, seeking to deliver a universal health service to all children.
A 2016 report stated progress had been made against all priority areas, but clearly further progress is still required. The progress report is due to be published in 2019.
That this meeting of Congress condemns the failure by governments across the UK to introduce legislation to prevent bullying in the workplace and urges RCN Council to insist that this is addressed urgently. Proposed by the RCN Lancashire West Branch. (R)
A 2018 report put the cost of bullying and harassment in the NHS in England at over £2bn per year (Kline and Lewis, 2018). The economic analysis looked at the cost of staff being sick, leaving their jobs, being less productive, working even when they are sick (presenteeism), and employment relations. NHS staff surveys in all four countries of the UK show significant levels of bullying, by both managers and colleagues.
The RCN’s own employment survey in 2017 (Marangozov et al., 2017) found that one third of nursing staff across the NHS and independent sector said that they had experienced bullying or harassment from colleagues in the last 12 months, with Black African/Caribbean and disabled nursing staff more likely to report this.
The survey also identified that support for nursing staff is often lacking. Most nursing staff (70%) do not report bullying and harassment because they do not think that anything will change as a result but also because they do not think that they will get support from their manager or colleagues (50%).
Workplace bullying is described as complex, with multiple causes at individual, group, and organisational levels. At an organisational level empirical evidence suggests that there are higher levels of bullying in times of organisational change, in hierarchical organisations, in the presence of destructive leadership styles, and where bullying goes unchecked through lack of disciplinary action.
Bullying can have serious consequences for affected individuals and those they work with, causing psychological stress and creating a negative working environment which can lead to poorer patient care. Witnessing bullying has also been associated with negative outcomes which produces high levels of distress, increased job dissatisfaction and increased intentions to leave work. Bystander intervention has been identified as potentially unsafe in organisations that struggle to manage bullying.
There is no specific legislation on the prevention of bullying at work. Under the Management of Health and Safety at Work Regulations 1999, employers have a duty to assess psychosocial risks in the workplace, which the Health and Safety Executive recommend should include work-related stress and the impact on health of poor relationships at work. The Equality Act 2010 provides protection from harassment for employees with protected characteristics including race and disability.
Recommendations for tackling workplace bullying include establishing a culture in which employees have a heightened awareness of its signs, and where negative behaviours are challenged and positive behaviours endorsed.
The RCN has been involved in the development and implementation of national and local partnership approaches to tackling bullying at work from joint policy development to national tools to support local initiatives. More recent approaches have focussed on the promotion of positive cultures and tackling undermining behaviours.
In Northern Ireland, the HSC Collective Leadership Strategy, published in 2017 (Department of Health, Northern Ireland, 2017), includes a commitment to promote compassionate leadership as one of its four key components.
In Wales, the Minister for Health and Social Services has asked the NHS Wales Partnership Forum (WPF) – the RCN Wales Director is Staff-Side Chair – to work with the NHS and Welsh Assembly to oversee an all-Wales approach to this issue.
In Scotland, employment law remains a reserved matter where the ability to legislate remains with the UK Parliament. However, NHS Scotland plans to review its national policy on Bullying and Harassment in the workplace in 2019.
In England, the Social Partnership Forum launched a collective call to action on bullying and harassment. The call to action tasks employers and trade unions in all NHS organisations to work in partnership to create positive workplace cultures and tackle bullying.
That this meeting of Congress calls upon Council to lobby governments across the UK to end period poverty. Proposed by the RCN Women's Health Forum. (R)
Periods are a normal part of life. Over half the population will menstruate every month for over half of their life. It is increasingly recognised that good menstrual health is an essential component
Period poverty is the lack of access to sanitary products due to financial constraints. A survey conducted by Plan International UK reports that one in ten girls have been unable to afford sanitary products; one in seven have had to ask to borrow sanitary wear from a friend due to affordability issues; and one in ten have had to improvise sanitary wear. It is estimated that currently over 137,000 children across the UK have missed a day of school due to period poverty.
Across the UK, 5% VAT is added to sanitary products, including tampons, pads and towels.
In 2017, Nursing Standard reported the growing incidents of school nurses buying sanitary products to keep pupils in school. Foodbanks have also been relied upon to provide sanitary products for women and families.
In January this year, the NHS in England committed to providing free sanitary products to women and girls being cared for in hospitals. Menstrual hygiene is fundamental to providing dignified care. Local authorities across England have started to offer free sanitary products in their buildings for both staff and users. Stoke-on-Trent Council will be stocking free sanitary products in its buildings and a pilot scheme undertaken by Leeds City Council is currently trialling free products in some schools in their district.
Some national supermarkets have also chosen to cut prices, or pay the 5% tax themselves to increase affordability. In April 2019, the UK Government have announced their intention to provide sanitary products to schools in England but further reassurance is needed that this will include other places of study including universities.
Extra funding to help tackle period poverty by expanding the number of places where free sanitary products are available has been announced by the Scottish Government. A total of £4m is being made available to councils in Scotland to work in partnership with other organisations to meet local needs. This follows the Scottish Government’s commitment of £5.2m to make free sanitary products available to students in schools, colleges and universities across Scotland from August 2018.
North Ayrshire council in Scotland is the first local authority in the UK to provide free sanitary products in all public buildings.
The Scottish Government has committed to providing access to free sanitary products to staff and visitors in Scottish Government buildings to help ensure that lack of access to products does not impact on an individual’s ability to fully participate in Scottish Government business, and to set an example for other public sector bodies in Scotland.
Last September, Derry City and Strabane District Council became the first local authority in Northern Ireland to offer free sanitary products in some of its public buildings.
In Wales, the Welsh Government has pledged £1m to help address period poverty, and improve school facilities to ensure dignity for girls and young women. Local authorities are receiving funding to help tackle period poverty in areas where levels of deprivation are highest, whilst further funding is being invested to improve facilities and equipment in schools and to ensure access to good sanitary facilities for all children and young people who need them.
That this meeting of Congress asks RCN Council to lobby governments across the UK for better rural healthcare provision. Proposed by the RCN North Yorkshire Branch. (R)Rural health challenges are well documented. People living in rural communities have issues relating to accessing health and social care, general practice, domiciliary care, medicines, shopping and transport. The response times of health care staff are longer and domiciliary care may be limited.
This meeting of Congress discusses how we can further reduce avoidable harm and death from sepsis. Proposed by the RCN Children and Young People: Specialist Care Forum. (MfD)Improving the identification and care of sepsis in children and young adults is a vital area for discussion.
That this meeting of Congress discusses how role design and job flexibility will help the UK’s health service recruit and retain staff. Proposed by the RCN UK Stewards Committee. (MfD)
There is evidence to show that the adoption of flexible practices into nursing across the UK has been patchy, often ad hoc and reliant on the goodwill of individual managers. As 80% of nurses who work for agencies say that they do so because it gives them more control over when they work this suggests that flexible working is an important retention as well as recruitment tool.
Not all types of flexible work are suitable in all work environments, but with 100,000 job vacancies across the four countries it is time for all employers to seriously consider ways to design roles across their organisations that are flexible and carer-friendly. This needs to start from the top of the health service.
Some unions have cautioned that the adoption of flexible working practices has sometimes resulted in increased flexibility for employers, but reduced conditions and ability to control working hours
Flexible working is most successful when it is designed with the needs of both employers and employees in mind working in partnership. The benefits for both staff and employers will include improved health and well being as well as improved job satisfaction and organisational commitment. These factors can help to reduce absenteeism and staff turnover which in turn can improve staff morale
Role design and flexible working practice options may include:
That this meeting of Congress considers that national uniforms in England should be introduced to mirror that in the other three countries. Proposed by the RCN Plymouth Branch. (MfD)
Patients, families, staff and students in England can find it difficult to identify the different types of health care professionals they encounter, with nurses sometimes being confused with other hospital staff. Some patients with cognitive impairment find the variation in uniforms across NHS and independent health care providers particularly difficult, in both urban and rural communities.
In 2009, Congress debated nationalised uniforms. This passed with 76% in favour and was taken forward in Northern Ireland, Scotland and Wales, but not adopted in England.
Wales has a national nursing uniform that identifies by colour health care support workers, nursing students, staff nurses, ward sisters and nurse consultants. This was introduced in 2009 and the commissioning process for this uniform included frontline nursing focus groups. It was the first time an ethical approach to NHS uniform procurement was used in any of the four countries of the UK.
Since 2012, all staff working for NHS Scotland have been wearing the national uniform, with different levels of clinical staff wearing a dedicated shade of blue. More recently, a burgundy uniform for clinical nurse managers was introduced.
Regional uniforms for nursing staff within the Health and Social Care service in Northern Ireland were introduced in two phases from September 2011. Informed by public research conducted by the Patient and Client Council, the intention was to help patients and members of the public recognise health care staff. Staff also wear name badges stating their role and area of work, enabling patients and visitors to identify who is in charge and who to speak to if they have a concern. The uniforms were also designed to promote the identity of different professional staff groups within the Health and Social Care service across Northern Ireland.
In 2016, a fringe event asked how members would like to see nursing uniforms develop in the future. The majority wanted uniforms to be kept, and thought that a national uniform for England or even a UK-wide standard was needed. These uniforms should be easily identifiable by patients, families and colleagues.
The 2013 Francis Report recommended that: there should be a uniform description of health care support workers, with the relationship with currently registered nurses made clear by the title (recommendation 207); and that commissioning arrangements should require provider organisations to ensure by means of identity labels and uniforms that a health care support worker is easily distinguishable from that of a registered nurse (recommendation 208).
A 2016 study in Denver found increased levels of registered nurse recognition, perception of professionalism and perception of ability when standardised, colour-coded uniforms were introduced.
We do not want to suggest that we revert back to the stiff and impractical uniforms of days gone by, but why is it that we reject the notion of a consistent presentation of our professional image?
Other professions wear uniforms that clearly convey their role with nothing short of pride. Think about public reaction if other professions were to present themselves in non-standard outfits – police, military, airline pilots – would they be easily identifiable? Would they evoke the same public trust, confidence or respect?
That this meeting of Congress discusses if resilience is always a positive attribute and one to be aspired to in the modern health care workforce. Proposed by the RCN Norfolk Branch. (MfD)
The Oxford English dictionary defines resilience as “the capacity to recover quickly from difficulties” or “toughness”.
Resilience first emerged as a theory in the 1970s when child psychologists identified that some children had good outcomes despite being exposed to childhood trauma and adversity. Researchers focussed on protective factors that promote mental health and positive development in the face of risk. An ecological model of resilience evolved, which identifying three key factors that influence resilience, namely: individual factors such as personal attributes and temperament; familial factors including family cohesion and the presence of a caring adult; and the availability of external support factors such as teachers, social workers or community support. Theories of resilience have further evolved to include factors such as adaptability, humour and a sense of control.
Resilience theory is now widely applied in the workplace and the use of resilience at an individual level has gained traction within health care environments, in particular, as a means of supporting the nursing and wider clinical workforce with ever increasing pressures and to prevent burnout. The rate at which nurses are leaving the profession is a case for concern, related to being overstretched, demand and the impact of these on morale and standards of care. Developing resilient health care staff is seen by some as important in promoting wellbeing, workforce sustainability and the consistent delivery of quality care.
The 2017 NMC’s Future Nurse: Standards of Proficiency for Registered Nurses require nurses in all practice areas to demonstrate resilience alongside emotional intelligence.
Developing resilience for nursing staff within a workplace setting can take many guises including raising awareness on the importance of self–care, stress management training or peer support networks. A number of guides and toolkits including one for hospice nurses and the RCN’s Healthy You resources, have been developed to support the development of resilience in nursing staff.
Critics of resilience argue that its use within the nursing workforce is overwhelmingly submissive, with Traynor (2017) observing that it is dominated with phrases like ‘roll with the punches’ or ‘helping the nurse to survive at the bedside for longer’. Some academics, including Traynor also argue that asking individuals to improve their personal resilience without addressing the environments they are working in is self-defeating and could build resentment amongst the workforce.
RCN Wales has sponsored a PhD in collaboration with Cardiff University to explore resilience particularly from an organisational level. RCN Wales and Cardiff University will report on findings upon completion.
That this meeting of RCN Congress discusses the role of the NHS Staff Council in delivering fair and adequate pay. Proposed by the RCN Greater Liverpool and Knowsley Branch. (MfD)
The NHS Staff Council – in which the RCN plays a central role – is responsible for maintaining the Agenda for Change pay system. It has a UK-wide function and meets regularly, involving representatives from NHS employers and officers and lay representatives from trade unions, as well as government bodies from all four countries.
Agenda for Change covers more than 1 million staff across the UK. Staff Council’s remit includes maintaining the Agenda for Change pay system; negotiating changes in conditions for staff on Agenda for Change and reflecting these in the NHS terms and conditions of service handbook; and providing national support on interpreting the national agreement for employers and trade unions.
Until the Staff Council in 2004, responsibility for determining nurses’ pay and conditions rested with the Nursing and Midwives Whitley Council – one of several negotiating councils within the health sector.
However, it attracted criticism due the frequent inability to reach agreement and the absence of a governmental role within the negotiating machinery. As a result, nurses often received below-inflation pay increases. A series of one-off special reviews enabled nurses’ pay to ‘catch-up’, but overall the Whitley Council did not deliver improvements in pay and conditions for nurses in comparison with other occupations.
In 1983, the government established the Review Body to advise on the pay of nurses and midwives. However, the pay structure still focused only on pay for nurses and midwives and did not consider other roles. This gave rise to a raft of equal pay for equal value claims during the 1980s and 1990s which confirmed male dominated professions enjoyed better terms and conditions than those that were predominately female-dominated.
The RCN lobbied for equal pay with other professions and in 1997 the government, employers and trade unions all agreed that the situation was unsustainable and a better way for deciding pay for nursing and other health care staff was needed. Agenda for Change, as the new harmonised terms and conditions for all NHS staff (with the exception of Doctors, Dentists and very senior managers), was agreed and implemented in 2004 - as the mechanism ensure equal pay for equal work of equal value. Agenda for Change is also underpinned by a job evaluation scheme to ensure equity between similar roles in different roles across the UK.
The NHS Pay Review Body continues to make annual recommendations on pay as requested by governments in the four countries with the decision on any award made by the governments. The RCN, other unions, employers and UK governments submits evidence to the Pay Review Body.
This is usually an annual process. However, in 2010, the government imposed pay freezes and the 1% pay cap on public sector pay meaning that the latitude for the Pay Review to make recommendations on pay awards was restricted. Between 2010 and 2017 NHS nursing staff were up to 14% worse off in real terms as a result of the pay cap. In response, the RCN launched the ‘Scrap the Cap’ campaign. In October 2017 the government announced it would lift the 1% pay cap and signalled their intent to negotiate a pay award for NHS staff. Ministers committed £4.2 billion to fund a deal, on the condition that the pay deal increased productivity.
In 2018, three-year NHS pay deals were agreed in England, Scotland and Wales. A key part of the deals included a restructure of Agenda for Change, which reflected the trade union negotiating priorities of ensuring the deletion of pay points as part of a move to increase starting salaries and the reduction in the time it takes to reach the top of most pay bands. This year is the second year of the three-year deal. To date, a deal has not been agreed in Northern Ireland.
Despite the deal being one of the best public sector settlements, it has been argued that the three-year pay deal did not reward the nursing workforce equitably as there was a difference in the percentage increase in reward for nurses at higher and lower pay bands. Those that were lower paid received a greater level of reward in percentage terms.
This raises a question as to whether the focus on improving poor pay in lower pay bands will be at the expense of the rest of the workforce, and if so whether this creates a disadvantage for those within nursing. This discussion by members will inform the RCN’s future pay strategy.
That this meeting of Congress discusses the Code of Practice on Ethical Employment in Supply Chains. Proposed by the RCN Cardiff and the Vale branch. (MfD)
What is the Code? In 2018, the Welsh Government introduced a Code of Practice on Ethical Employment in Supply Chains. Its aim is for all NHS and public sector organisations to take action to eradicate unlawful and unethical employment practices, and that all workers at every stage of the supply chain are treated fairly and equally.
At present this Code only applies to public and third sector organisations in receipt of public funds operating in Wales. Employment law is devolved within UK countries.
When an organisation in Wales signs up to the Code, it agrees to comply with 12 commitments designed to eliminate modern slavery and support ethical employment practices. These include:
There are specific commitments for NHS staff, including a clear policy on whistleblowing, a mechanism for people outside the organisation to raise concerns of unlawful or unethical employment practices, and to consider the living wage as a minimum and encourage suppliers to do the same.
All Government-funded public sector services are expected (but as yet not mandated) to this Code of Practice. Other organisations in Wales are also encouraged to do so.
The Code sets out guidance and recommendations for tackling the following challenges:
1. Modern slavery and human rights abuses;
3. False self-employment;
4. Unfair use of umbrella schemes and zero hour contracts, and
5. Paying the living wage.
The Code is accompanied by a toolkit providing practical advice and guidance to help with implementation of the Code, and are supported by the RCN Welsh Board.
The NHS in England produces an annual statement to its governing Board detailing how it is tackling human trafficking and slavery, as mandated under the Modern Slavery Act of 2015. NHS England has confirmed plans to take additional measures to identify, assess and monitor potential risk areas in terms of modern slavery and human trafficking, particularly in its supply chains.
According to research published in 2017, Northern Ireland’s workplaces are among the least ethical in the UK. 17% of employees in Northern Ireland have encountered someone using their position of power to sexually harass another person, 22% never consider the ethical implications of their actions, and 11% of workers in Northern Ireland have been asked to carry out tasks which they believe to be unethical. Despite this, 100% of those surveyed in Northern Ireland claimed that they personally acted ethically in the workplace.
NHS Scotland produced a five-year procurement strategy in 2018, outlining an approach to procurement and supply chains which includes a specific objective to progress ethical and sustainable procurement. In this case, ethical employment has been integrated as a priority alongside other areas such as delivering value for money and improving governance structures.
Existing RCN work on this issue
In 2017 the RCN developed guidance aimed at overseas nursing staff and health care assistants (HCAs) who want to work in the UK, as well as their potential employers, signposting to information and comprehensive advice. The RCN has also developed an impact assessment tool. The RCN is also an active supporter of the Living Wage campaign.
That this meeting of Congress calls on RCN Council to lobby employers to set up systems to protect healthcare professionals from sexual harassment by patients or their families or friends. Proposed by the Outer North West London Branch. (R)The Equality Act 2010 (Parliament, 2010) defines sexual harassment as unwanted conduct of a sexual nature, which creates an intimidating, hostile, humiliating or offensive environment and violates a person’s dignity.
That this meeting of Congress calls on RCN Council to lobby the governments across the UK and all social care providers to recognise that personal care is nursing. Proposed by the RCN Suffolk Branch. (R)
The Care Quality Commission (CQC) in England defines personal care as “the provision of personal care for people who are unable to provide it for themselves, because of old age, illness or disability, and which is provided to them in the place where those people are living at the time when the care is provided”. For some people, this type of care will be delivered in their own home, for others it may be the care they receive whilst living in a residential home. This Resolution focusses on professional personal care, rather than personal care from unpaid friends or family members.
The types of personal care which an individual requires varies from person to person, but may include assistance with washing, dressing, personal hygiene, continence support and help with eating and drinking. This assistance may include prompting or supervising an individual to complete those activities, or providing more direct help.
In Scotland, the definition expands to include, for example, assistance with simple treatments such as eye drops or applying creams and dealing with the consequences of being immobile or substantially immobile. There are similarities with Virginia Henderson’s definition of nursing, and the RCN’s 2014 definition of nursing as “…provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death”. (Royal College of Nursing, 2014)
In Scotland, free personal care for over 65s has been available since 2002 to those who have been assessed by social work service staff and found to be in need of the service. (Scottish Government, 2018) This was extended to include everyone, regardless of age, from 1 April 2019 under what has been termed ‘Frank’s Law’.
In England, Northern Ireland and Wales, individuals or their families can request a needs assessment to identify what type of care is required, and then a means test to assess the financial contribution of the individual. The NHS continuing health care scheme pays for the personal care of some of those with significant ongoing health needs.
Personal care is increasingly delivered by carers working in care and nursing homes, or who may visit or live-in at the individual’s home. It should be planned and delivered in a way that involves the individual, and maximises choice, control, dignity and respect for the individual. Personal care is a regulated activity, meaning that agencies providing these services are assessed against national regulatory frameworks. Increasingly, national policies and guidance recognise the role of registered nurses within the management and coordination of personal care.
Carrying out personal care is not just a series of tasks – it forms part of the wider support which people with long-term health needs receive. Each personal care activity provides the opportunity for a health professional to observe a change in an individual’s condition, which may require further action. Record keeping is an important part of the carer’s role, and is essential for observing changes and trends. There is also a role to signpost the individual to other services or types of support. Registered nurses may be involved in assessment, in the creation of a care plan or package, and in coordinating its delivery. They may also be involved in training and supervising staff who carry out personal care.
That this meeting of Congress asks RCN Council to engage with governments across the UK on the National Strategy on Loneliness in order to improve the ability of nursing staff to recognise loneliness and its effects. Proposed by Outer North West London Branch. (R)
A General Practice Nurse Forum-hosted event at Congress 2018 highlighted how working in isolation can effect an individual’s emotional wellbeing and work performance. The event was attended by health care staff who work in isolation, such as care home staff, general practice nurses, community nurses, community mental health nurses and secondary care colleagues. Participants felt that workplace loneliness was prevalent and under recognised within the work environment, substantiating Relate’s 2014 survey which revealed that 42% of workers don’t have a single friend at the office. This is a serious cause for concern, considering that people in Britain work some of the longest hours in Europe.
Research shows that loneliness and social isolation are harmful to health. Lack of social connections can increase the likelihood of early death by 26%. That risk is comparable to smoking 15 cigarettes a day, and is higher than that caused by obesity and physical inactivity. Loneliness is one of the greatest public health challenges of our time.
The Westminster Government launched the Prime Minister’s Loneliness Commission and strategy in October 2018. As part of the long-term plan, funding will be provided to connect patients to a variety of activities which aim to reduce demand on the NHS and improve patients’ quality of life. It is also suggested that the public health outcomes framework should include loneliness outcome measures.
The Scottish Government’s first national strategy to tackle loneliness and isolation, A connected Scotland, was published in December.
The strategy includes examples of the important role nursing services can play in tackling loneliness and isolation. The RCN in Scotland responded to this consultation and the Minister for Mental Health is keen to continue working with the College on this issue.
According to the results of the Health Survey 2017-2018 in Northern Ireland, 20% of respondents showed signs of loneliness. The Public Health Agency is currently working on loneliness within the context of the regional dementia strategy.
The Welsh Assembly’s Programme for Government, Taking Wales Forward, includes the commitment to develop a nationwide and cross-government strategy to address the issue of loneliness. It focuses on early intervention to prevent chronic loneliness, given its wider effects on health and wellbeing, and resulting pressure on the NHS and social care services. Loneliness is a wide-ranging topic that impacts all nursing staff regardless of geographical or clinical area. Loneliness at work is likely to affect social interaction, relationships and potentially our clinical care as well as mental health.
It is possible that those who are lonely at work are more vulnerable to workforce pressures such as stress, ill health and potentially vulnerable to adverse behaviours.
This debate will consider how we can raise awareness of workplace loneliness and how we can positively impact our workplaces. Little has been discussed or researched around the impact of workforce loneliness amongst the nursing team and how this may potentially affect standards of care and patient safety. We propose that the RCN conducts further research in workplace loneliness.
That this meeting of Congress discusses the importance of raising awareness of safety culture and in doing so enhancing workplace culture. Proposed by the RCN UK Safety Representatives Committee. (MfD)
Safety culture and workplace or organisational culture are often intertwined but have distinct definitions. The Health and Safety Executive describe safety culture as a sub-set of an overall workplace or organisational culture.
Furthermore, the RCN describes a workplace culture as the product of the attitudes and behaviours that exist there. A safety culture, then, is the product of the attitudes towards safety issues and the way work hazards are managed. The Health Foundation describe a safety culture in health care as “one where staff have positive perceptions of psychological safety, teamwork, and leadership, and feel comfortable discussing errors. In addition, there is a ‘collective mindfulness’ about safety issues, where leadership and frontline staff take a shared responsibility for ensuring care is delivered safely.”
A fundamental requirement of a safe environment is adequate staffing levels. The RCN campaign for staffing for safe and effective care argues that legislation is a necessary requisite for ensuring there are adequate numbers of staff in any setting at any time to ensure that patients and staff are safe. This must be seen as an absolute requirement to establish a safety culture throughout organisations.
The RCN’s safe staffing campaign calls for clear legislation that ensures the right number of nurses with the right skills to ensure safe and effective patient care, in all publicly funded health and care settings across the UK. A positive safety culture would recognise the importance of staffing levels as a critical control measure that impacts significantly on individual performance and patient outcomes.
Historically, attempts to improve workplace safety concentrated on technical issues and individual human failures. Modern safety practices in high-risk industries have developed out of the analyses of major accidents (for example, Chernobyl, King’s Cross) which highlighted the role that organisational policies and procedures had in precipitating accidents.
While health and social care has been slow to adopt and adapt practices from high reliability organisations, such as nuclear power and aviation, it is now recognised that organisational values can impact and enhance risk and crisis management and safe performance.
A positive safety culture has three key elements: working practices and rules for effectively controlling hazards; a positive attitude towards risk management and compliance with the control processes; and the capacity to learn from accidents, near misses and safety performance indicators and bring about continual improvement.
An organisation can seek to enact these positive characteristics in a variety of ways. One key concern of frontline staff is how they anticipate and manage risk on a day-to-day basis, often termed situational awareness. Daily safety huddles are a tested method of embedding situation awareness and embody open communication of the current situation, including identification of the sickest patients as well as those whom staff are concerned about.
The adoption of interventions like safety huddles and other techniques is often associated with organisations which pursue a positive safety culture. However organisations are living systems that change and evolve continuously. The organisational learning that comes from safety initiatives such as these can be threatened by structural and environmental factors.
Therefore organisations often find they need to expand their safety management system with ways to monitor staff and patent perceptions of safety as well as other measures and indicators of quality and safety performance.
The Health and Care (Staffing) (Scotland) Bill, as at the time of writing, is intended to directly address issues of safety and the RCN has been instrumental in lobbying for a strengthened Bill. The RCN plans to support implementation of the legislation will include elements in relation to safety culture.
Within NHS Scotland, Healthcare Improvement Scotland (HIS) coordinates the Scottish Patient Safety Programme (SPSP) which is a unique national initiative that aims to improve the safety and reliability of health and social care and reduce harm, whenever care is delivered. It has a variety of work streams that coordinates campaign of activity to increase awareness of and support the provision of safe, high quality care, whatever the setting across health care in Scotland.
That this meeting of Congress urges RCN Council to review the functions and structures of RCN boards and branches to promote and encourage members to engage with the RCN. Proposed by the RCN Greater Liverpool and Knowsley Branch. (R)
The last branch review was carried out from 2005 to 2007. A new vision was agreed:
and a change programme to:
Following on from that review and the legal and governance review in 2010 the role of the country and regional boards was reviewed. The key change was for the boards to become part of the governance structure of the RCN and the size and composition of the boards was reviewed to reflect their new decision making role.
The 2010 review was evaluated in 2017 and found that the changes were seen by board members as being largely positive. However, the member consultation found that branch officers were not aware of the changes made to the role of country and regional boards; did not have a positive working relationship with their local board; and saw boards as a barrier to their activities.
As a result, RCN Council agreed to set up a task and finish group to review the current UK branch network and how it interacts with boards to see if it is fit for purpose and served the needs of the College and the UK membership locally.
This is included in the 2019-2021 Group Strategy.
The brief for the review is:
The review is to include consideration of the purpose of the branch; the existing structure and organisation; funding and support of branches and the branch experience; and how they work with their country or regional board. The first phase of the work is an information gathering and analysis phase and is part of the membership engagement research.
Page last updated - 05/09/2019