In her first interview with Nursing Times since joining the Foundation of Nursing Studies (FoNS), Joanne Bosanquet said she was in the process of some “very delicate negotiations” with senior nursing leaders to make sure that the care sector was put at the “front and centre”.
“The more I’m realising just how challenging the care sector is for our nursing community”
The new head of the charity, which works to support nurse-led innovation, said moves to promote leadership for those working in the care sector was the right thing to do to help protect nurses who risked becoming isolated in the sector and to promote overall integration of health and care systems.
Ms Bosanquet signalled a need for a nursing lead specifically for the care sector, to sit underneath the UK’s four chief nursing officers. Having recently made the move to the charity from Public Health England (PHE), where she was deputy chief nurse for six years, she stressed the importance of having senior nurses sitting in on government discussions to help influence policy.
She said it was important for a nurse leader for the care sector to be situated within government so they could have those “all-important corridor conversations” that she had previously had when walking around PHE and the Department for Health and Social Care.
Ms Bosanquet, who took up her new post in May, proposed a deputy chief nursing officer position for the sector would be a “fantastic start” to help combat the challenges and “complex environment” nurses in care homes were working under.
She said: “The more experience that I have and the more time I spend with other colleagues, the more I’m realising just how challenging the care sector is for our nursing community and our nursing profession.
“We’ve got care homes that are closing, we’ve got care homes that are reverting from nursing homes to residential homes and so, potentially, our nurses are becoming more isolated in the care sector,” she said.
If the deputy chief nurse position did become a reality, Ms Bosanquet said was keen for her organisation to work alongside those in the post going forwards, while noting that the foundation’s presence in the care sector was itself a “recent venture”.
”Our nurses are becoming more isolated in the care sector”
Meanwhile, Ms Bosanquet said the foundation was also concerned about the career development opportunities for nurses working in the care sector. She noted that, despite mounting challenges on staff, government policy direction was expecting these nurses to become much more advanced.
“We’re wanting advanced nurse practice roles within the care sector, but funding is an issue and we don’t think that the policy makers are as aware as perhaps they could be about the level of academic attainment and expertise that these nurses have already got but may not be used,” she said.
When looking at advanced practice roles, she said there was increasingly an expectation that those in post would be educated to master’s degree level. However, she claimed that very often nurses would not have reached that level of academic attainment, despite having “many, many” years of experience. “We’ve got to consider how we tackle that,” she said.
In June, the Nursing and Midwifery Council pledged to look at introducing a system of regulation for advanced nurse practitioners in general, stating that “there is a patchwork of education of advanced and specialist practice across the UK”. It follows a high profile study, published in 2017 by researchers at London South Bank University, that found hundreds of unqualified staff were working under advanced nurse titles.
According to Ms Bosanquet, there needed to be recognition and a focus on levels of attainment, practice and expertise in order to help facilitate nurses in the care sector to become advanced nurse practitioners. “That’s our concern at the moment as an organisation,” she noted.
In addition, she warned that some smaller care home organisations did not have the money to invest in staff development. In contrast, many larger or independent companies had got directors of nursing and the infrastructure to support nurses continuing professional development. She noted examples of some care homes with just one registered nurse and a variety of care staff that made staff development more difficult.
Ms Bosanquet also flagged workforce concerns linked to the continuing delay with the publication of a government green paper on adult social care.
She said that, while NHS England continued to develop its workforce implementation plans to deliver the ambitions of the NHS Long Term Plan, the social care green paper was also needed to ensure that the two sectors were “linked closely together”.
“Our strong belief is that you cannot develop the workforce in the NHS without mirroring the same within social care – it just won’t work,” she told Nursing Times.
“If we’re not careful, we will be in a position where we will have more and more delayed discharges because, potentially, we won’t have the capacity within the community for the people to recuperate at home and to go home or closer to home and be cared for – we just won’t have it.”
“We’re in a superb position because we’re holistic and we have a really important place in the health and care system”
Regarding this issue more broadly, Ms Bosanquet said one of the main conversations the charity was having regularly was around how it could make its mark in striving towards truly integrating the health and social care systems.
She said she was interested in the recent introduction of a new nursing management role at Torbay and South Devon NHS Foundation Trust. The trust’s system director of nursing and professional practice is responsible for looking at workforce and population health and care needs, and will liaise with leaders from across the system.
Ms Bosanquet described the role as the “missing link” in the system. She said she would be watching its development closely with interest and that such overarching leadership roles had a “massive role to play” in collating evidence from different parts of the system and working to respond to population changes.
“I’m really interested in true integration and how we enable our nursing, midwifery and therapy leaders, to make sure that they are able to fulfil those roles properly,” she said.
Meanwhile, Ms Bosanquet highlighted the “enormous responsibility and leadership role” that nurses had to innovate as the largest health profession, while noting that it should not do it alone.
“We’re in a superb position because we’re holistic and we have a really important place in the health and care system, but we should not be the only ones innovating,” she said. “We’ll only be successful if we do it together and not in our silos.”
“We’ll only be successful if we do it together and not in our silos”
Ms Bosanquet stressed the importance of the foundation’s work in breaking down barriers for nurse innovation by focusing on “culture change”.
If the culture of an organisation is not ready for new nurse ideas, then innovations could “fall flat”, she noted. “The work we do is to support nurses and midwives to create the right context in order to change cultures,” she said.
A recent survey by Nursing Times and innovation charity Nesta suggested that most nurses had ideas for how to improve the service in which they worked but less than one in five felt their suggestions would be acted upon if they brought them forward.
The poll of more than 300 health staff also found understaffing and bureaucracy were among the key barriers stopping creativity on the frontline being harnessed.
Ms Bosanquet also emphasised the importance of person-centredness, noting that during her first few weeks as FoNS chief executive she had had a “real epiphany” over how deeply embedded person-centredness needs to be within the culture of an organisation for it to change.
“If people really understand the importance of person-centredness, then the innovation, which hopefully is person-centred, and the organisation will be aligned,” she said.
She suggested that really good organisations were those that saw failure as an opportunity to learn, improve and share with others their experience so that similar mistakes were not repeated.
“It feels very fresh, it’s responsive and it’s agile and it’s independent”
Speaking on her appointment at FoNS, Ms Bosanquet told Nursing Times she felt she brought a “completely different perspective” to the charity sector, while highlighting she still had a “huge amount to learn”. After her time as deputy chief nurse at PHE, she said she felt ready to “explore” a different sector.
In addition, as a Queen’s nurse and fellow of the Queen’s Nursing Institute, Ms Bosanquet said she felt she had a lot of prior experience in the charity world and was proud to have taken over as chief executive at the foundation.
“What is brilliant about FoNS is we can be quite agile and that’s what attracted me to the organisation,” she said. “It feels very fresh, it’s responsive and it’s agile and it’s independent.”
During her first 100 days as the new chief executive, she said she was taking time to listen, watch and experience as much as possible. As part of her direction going forwards, she said she was interested in bringing in a more “population level approach and system level approach to thinking”.
She said: “The main message for us is around person-centred cultures, creating caring cultures and compassionate leadership and working across the system – that’s the future and we are very well placed to support that.”
Biography: Joanne Bosanquet
Joanne Bosanquet is the new chief executive of the Foundation of Nursing Studies.
She joined the charity after six years as deputy chief nurse at Public Health England.
Ms Bosanquet was awarded an MBE for services to nursing and healthcare in June 2013 and is a fellow of the Queen’s Nursing Institute and a Queen’s nurse.
Between 2006-2013, she worked as a specialist nurse, then nurse consultant in health protection at the Health Protection Agency in England.
Ms Bosanquet became a registered nurse in 1992, later studying at postgraduate level to become a health visitor at King’s College London.
She is a visiting professor at the University of Surrey, and an honorary fellow at the University of Greenwich and London Metropolitan University.