Adapt or perish

Fiona Barr

Barbara Stuttle is a self-confessed technophobe. She is also community nursing lead for Connecting for Health.

While these two labels might seem mutually exclusive, Stuttle says it should make her conversion to the cause of the National Programme for IT all the more credible.

"When I was asked by Connecting for Health to get involved as one of the clinical leads for nursing I told them that I don’t do IT," she told EHI Primary Care.

What Connecting for Health sought from Stuttle, however, was not her keyboard skills but her understanding of the NHS and the issues around community nursing. After a career that began as a district nurse and has seen her hold a variety of management positions within the NHS, Stuttle is currently director of primary care and modernisation at Thurrock PCT.

Stuttle believes that the harsh reality is that community nurses must adopt new ways of working, aided by technology. Otherwise, there will no longer be a community nursing service as numbers of recruits to the profession dwindle every year and large numbers near retirement.

She says: “Unless we do really embrace this and take it on we will not deliver healthcare in the future. We need to do things differently and I’ve seen how the technology can change what’s happening and improve safety for patients while enabling professional staff to use their skills in a much more focused and directed way."

Crossing the generations

The ageing workforce poses particular challenges for those like Stuttle seeking to muster enthusiasm for technical solutions. Stuttle, however, has the advantage that she starts from the same point as many of those she wants to win over.

“I can type with one finger but I can’t type with two. Technology slows me down and I’m sure a lot of community nurses feel the same. We have to nurture them and work with them so that we see how we can use the technology without freaking them out.”

Conversely Stuttle also describes a younger breed of community nurses, brought up on technology. She says: "Young community nurses are frustrated. They see the advantages that they could gain by having access to IT and how it can make their lives easier."

In a previous incarnation she played a lead part in the rollout of nurse prescribing in London and the southeast and is also currently chair of the Association of Nurse Prescribing.

That is experience she can bring to her key role at Connecting for Health which is to lead the project to provide the IT necessary to support nurse prescribing by community nurses as well as engaging community nurses in the entire Connecting for Health programme.

Stuttle acknowledges that community nursing has been something of a Cinderella service as far as IT is concerned, with community nurses left to take on 25-mile round trips to check their email and share one computer between six while acute units are targeted for substantial investment in IT.

However she believes that it is time nursing clinicians in the community get the IT they need to do their job effectively. It is an argument that has been made many times before. But will it now happen?

"Yes it will," she says. "It isn’t going to be in the next two months but in the next ten years we will see some real benefits. This is the hard bit."

Care records in the community

Next year the first shoots of Connecting for Health’s plans for community nursing should be seen when Stuttle’s project to provide IT solutions for nurse prescribing in the community gets going. Stuttle says she has been inundated by community nurses wanting to get involved with the project’s development.

District nurses and health visitors at pilot sites will use laptops and handheld computers to prescribe electronically with the eventual aim that such technology will be linked to the spine and the NHS Care Records Service (NCRS).

Stuttle believes the NCRS will bring ‘phenomenal’ benefits to community nurses.

"The ability to relay information between clinical staff is brilliant. A community nurse will have immediate access to the information they need to have access to and be a clear member of the team and not an add-on."

Stuttle argues that community nursing input into the development of the NCRS and the whole of the Connecting for Health programme is vital but acknowledges that community nurses currently face other preoccupations with the wholesale reorganisation of the NHS.

She says: "There’s no doubt people are anxious about their jobs and I did think people would take their bats and balls home but that’s not happened. It’s a credit to community nursing that they have remained involved to try and influence what’s going to happen.”

Building nurses’ influence

Stuttle argues that the Connecting for Health programme has become even more important with the reconfiguration of the NHS since the potential for there to be a much greater number of potential provider organisations will mean electronic links and systems will be essential.

She urges community nurses to keep raising the issues they are facing and to get involved whenever they can.

She adds: "My experience from nurse prescribing in years past is if you’re not around the table you don’t get noticed and you don’t get heard."

Indeed community nurses might point out that while the GP community has argued vociferously about its right to system choice, no one is offering the same choice to community nurses. However Stuttle believes the desire to have this kind of influence will grow over time.

She adds: "The more community nurses get involved the more they will know what suits them. To me the most important thing is that any system is integrated with GP systems because without that it’s a farce."

Links with social services will also be vital for community nurses, says Stuttle. She says the SAP pilots across the country are paying dividends despite teething problems.

She adds: “In my previous job, I was in charge of the SAP pilot for south east Essex and I really saw the benefits of what this will be for the future."

Her vision of that future is one in which patients hold their own records and where the technological potential of telecare is harnessed to allow community teams to provide high quality care to their patients.

Stuttle has been involved with Connecting for Health since April but was one of the last of the clinical leads to be appointed. Was community nursing once again an afterthought?

"I don’t know. But I think they took a big risk having me because I could have been a real pain. I have been turned around though," she says. “And it’s not the case that I have been brainwashed.”