Recommendation 243

Routine recording of observations

The recording of routine observations on the ward should, where possible, be done automatically as they are taken, with results being immediately accessible to all staff electronically in a form enabling progress to be monitored and interpreted. If this cannot be done, there needs to be a system whereby ward leaders and named nurses are responsible for ensuring that the observations are carried out and recorded.

In the initial government response to the inquiry, Patients First and Foremost, the Department of Health gave strong support to supervisory roles for ward managers (including sister, charge urse and team leader) in delivering oversight to all aspects of care on a ward and in a community, from cleanliness to allocation of staff.  Nurse leadership at ward level provided by a ward manager is also important to the delivery of safe, high-quality care to patients. However, we wish to allow for local flexibility in delivering nursing care and so the government is not mandating that ward nurse managers must operate in a supervisory capacity.

Having sufficient nurses trained and with the capacity to respond to ensure the delivery of safe, patient focused care is currently a core standard requirement of the Care Quality Commission. Compassion in Practice commits to ensuring we have the right staff, with the right skills in the right place. This includes supporting leaders to be supervisory, giving them time to lead action plans by December 2013.

The government’s Information Strategy, published in May 2012, outlines the use of routine observations  in improving the quality of data saying, ‘connected information can support safer, more integrated care for us and for the professionals providing our care – for example, through online access to GP records in hospitals, electronic prescriptions, barcode-scanning in care homes and hospitals to reduce medication errors, and electronic access to results, X-rays and scans. Many benefits and efficiencies can be achieved through information being recorded once, at first contact, and shared securely between those providing our care.’

In October 2012 the Prime Minister announced the Nursing Technology Fund, an investment fund of £100m spread over 2013/14 and 14/15. Three key technology types have been identified: digital pens, mobile technology and, of relevance to this recommendation, end of bed monitoring technologies. Full details of how NHS providers will be able apply for funding are to be announced shortly. The Nursing Technology Fund is available to support nurse or midwife led activity in all NHS Trusts and Foundation Trusts in England, including acute, community, mental health and ambulance trusts.

Local Healthwatch organisations are using their ‘enter and view’ powers to get a clear picture of how health and care services are meeting the needs of the public, and their place on every local health and wellbeing board will ensure that voices of people using services is at the heart of local planning and decision-making. Local Healthwatch will also enhance the new inspection regimes. They will make sure inspection teams get a comprehensive picture of local people’s opinions and concerns, and will maintain a focus on service quality issues after the inspection team has moved on.


In the first round of the Nursing Technology Fund, 74 Trusts were awarded funding totalling almost £30m for 85 projects.

The funded projects represent a good geographical spread and a range of care settings. The highest award to an individual project was £1 million, and to an individual organisation was £1.46 million (for two separate projects). All projects projected a Value For Money return greater than 2:1, with almost half projecting a return of at least 4:1. Of the successful projects, 90% will provide solutions for nurses, 23% for midwives, and 10% for health visitors. The majority of projects involve mobile technology, a quarter involve vital signs monitoring solutions, and eight projects involve digital pens.