Impact case study database

Apollo Nursing Resource: support for specialist nurses

There are over 50,000 specialist nurses in the UK. They are experts in caring for people who have complex and diverse clinical needs. However, their ability to demonstrate and communicate the value they bring in a way that managers and those whose responsibility it is to pay for their services understand and value, tends to be less well-developed. In response to requests for help from the profession, recognising her research expertise, Professor Alison Leary developed Apollo Nursing Resource [S1] in partnership with a major global medical devices manufacturer and a UK university School of Nursing. The resource was launched in February 2014 and is free to access. Apollo Nursing Resource enables nurses to articulate their own value in terms of quality and efficiency to employers and commissioners of services.

Apollo Nursing Resource is used in several organisations across the UK, such as:

• The University Hospitals Birmingham NHS Foundation Trust: “ The Apollo Nursing Resource website is a practical and valuable tool. It captures the very essence of what we do and allows us to turn this into a meaningful dialogue which will assist with service provision and development” (Colorectal Nurse Specialist, University Hospitals Birmingham NHS Foundation Trust) [S1];

• The Royal College of Nursing’s Standards for infusion therapy include an example business case for a nurse-led service, prepared by Coventry and Warwickshire NHS Trust drawing on the Apollo Nursing Resource [S1]; and

• The resource was used in a study to demonstrate the value of haemophilia nurse specialists in the NHS. The study estimated that the work of each nurse was associated with an estimated minimum saving of GBP83,000 (£83k) in emergency visits avoided, and GBP50,000‐GBP100,000 (£50-100k) annually in clinic appointments in which nurses had replaced consultant physicians [S1].

Professor Leary also developed two workload tools, available on the Apollo Nursing Resource: Alexa Caseload and Cassandra. These are both included in an NHS Quality Board review of workforce tools [S1]. When Cassandra was used at Canterbury Christ Church University and Health Education Kent Surrey and Sussex, it was found that the “tool provides a robust mechanism for collecting complex multidimensional workload activity data that represents an accurate picture of what care is being delivered, to whom, in a range of settings for different bands of practitioners” [S1].

Impacts on Policy and Organisational Change

Professor Leary’s work has had wide-ranging influence on national policy and influenced organisational change.

Nursing job titles are now the subject of more scrutiny

Professor Leary’s finding that some employers were asking or allowing unregistered staff to use titles that indicated a more complex level of practice and education – for example, associate advanced nurse practitioner – prompted the Chief Nursing Officer for England to write to directors of nursing at NHS Trusts to ensure unqualified staff were not being referred to as nurses. “ This [study] has raised a lot of discussion within the profession and from those commenting on the profession… our preferred position is that only a [registered nurse] should have the word ‘nurse’ in their job title or in their job description.” [S2]

Staffing levels are now determined on the basis of need, and funded appropriately

Professor Leary’s research influenced a key policy document on safe staffing in the NHS: Developing Workforce Safeguards [S3]. The Chief Nurse for Health Education England confirms that “ The work of Professor Leary was influential in this second policy document entitled Developing Workforce Safeguards which was published in 2018 and now forms the basis on which NHS Improvement measures and assesses NHS provider organisations in relation to safe staffing.” [S3]

The Scottish Chief Nursing Officer invited Professor Leary to present evidence to inform the 2019 “Health and Care (Staffing) (Scotland) Bill” [S3]. Professor Leary’s research into safety also underpins the Royal College of Nursing’s policy on their Safe Staffing campaign, which is lobbying for similar regulation in England and Wales [S3].

Professor Leary worked with the Queen’s Nursing Institute (QNI) to produce their first general review of the District Nursing workforce since 2014. The report ‘ District Nursing Today: The View of District Nurse Team Leaders in the UK’ [S4] resulted in an investment of GBP18,500,000 (£18.5m) to train 500 district nurses. The CEO of the QNI notes that:

“A very welcome decision was made by Health Education England to reverse a situation where there was to be no more funding of the District Nurse programmes after the September 2019 intake. Funding of £18.5 million [GBP18,500,000] was identified for the education and training of 500 District Nurses in September 2020. This is a huge success, and it is in direct response to the research data and evidence produced by Professor Alison Leary in this report. The individuals, carers and families in receipt of District Nursing services in England will benefit from this decision – and it is likely to impact on HEE education funding decisions around District Nursing in future years, beyond this decision for 2020.” [S4].

Specialist nurse workforces are now evidence-based

Access to a specialist nurse service improves patient experience and outcome in Crohn’s disease and ulcerative colitis. These are the most common forms of inflammatory bowel disease (IBD), affecting 1 in 250 of the population in the UK, i.e., approximately 300,000 people. Professor Leary’s research on IBD directly informed the latest national workforce standard in the CCUK/Royal College of Physicians Gastroenterology standards, known as the IBD Strategy Partnership (2019). Her recommendation that there should be 2.5 FTE nurses per 250,000 population – an increase from 1.5 FTE in the previous standard – was accepted. It also informs the ECCO IBD (European Crohns and Colitis Organisation) standards, where Leary’s research is included in the context of the Advanced IBD nurse’s role and the benefits this brings [S5].

A nurse consultant and national nursing leader at the Royal Free Hospital (London) explains the significance of the work for national standards of IBD care: *“The enormous impact the modelling had is that the results are now embedded in the new national standards for IBD care. These were launched summer 2019, and now every acute Trust in the UK is benchmarking and action planning against them. Also, in England the standards are now of Trusts Quality accounts. We have also re-audited nursing roles nationally, and numbers are continuing to increase. The caseload modelling is a big driver in that.*” [S5].

Gender status inequalities are more visible and debated

Leary’s work has been cited in several reports, including:

1. Closing the Gap, a joint report by The Kings Fund, Nuffield Trust and the Health Foundation, which sets out a series of recommended policy actions that should be at the heart of the workforce implementation plan [S6];

2. Gender and Nursing as a Profession: this Royal College of Nursing (RCN) report explores and critiques the gendered construction of value within the nursing profession and evaluates how value is attributed to nursing, the value placed on individuals and the status of the profession [S6]; and

3. The Courage of Compassion: a review from the King’s Fund commissioned by the RCN Foundation, investigated how to transform nurses’ and midwives’ workplaces so that they can thrive and flourish and are better able to provide the compassionate, high-quality care that they wish to offer. [S6].

This work also gained the attention of the Secretary of State for Health, Matt Hancock. In a speech at the Chief Nursing Officer’s summit in March 2019, Hancock said he wants more nurses leading NHS trusts, and mentioned Professor Leary, referencing her analysis of gender gaps in the profession: “ As Professor Alison Leary puts it: The compassion and caring are really important, but it isn’t generally compassion that will save somebody’s life. If we can help society to understand that nursing is a “knowledge intensive occupation”, she believes it would help nursing to be more valued and attract more men and women into the profession. I wholeheartedly agree with her.” [S7]

Sports Ground Safety

Professor Leary’s work has been incorporated into in Chapter 18 of the sixth edition Guide to Safety at Sports Grounds ‘Green Guide’ by the Sports Ground Safety Authority, published in 2019 [S8]. The Green Guide helps sports grounds owners and operators calculate a safe capacity for their venue. Professor Leary contributed to the development and evaluation of the role of medical co-ordinator, a key addition to the latest edition of this guide. Its use is mandatory for all 92 English Football League Clubs.

The Green Guide is used around the world by architects and designers as a best practice guide for the development and refurbishment of stadiums. The sixth edition, containing Professor Leary’s work, has sales figures of 2,500 and has been sent to 49 countries. The Secretary of State for Digital, Culture, Media and Sport noted that, “ *Fan safety at sports grounds is paramount. The world looks to us as an example of how to manage risks and improve safety records and this guide will continue to contribute to that legacy.*” [S8]