“I THINK nursing punches above its weight here now,” says the Great Western Hospital’s outgoing chief nurse.

For Hilary Walker it’s one of her biggest achievements in more than five years at the Swindon hospital trust and a direct result of changes she's made.

When she arrived at GWH for her interview in 2012 it was the first time Cheshire-born Hilary had been to Swindon.

After working in sprawling and cramped Victorian hospitals in Birmingham and the Black Country for 25 years, purpose-built GWH was a revelation.

But she was there to solve a problem identified by new chief executive Nerissa Vaughan: “She felt that nursing was too quiet. We were the biggest chunk of the workforce but she heard very little from nurses or nursing.”

The structure within divisions at the hospital didn’t help, said Hilary. There was an associate medical director - a doctor - at the top, with a general manager overseeing the work and the matron working below him.

“All the decision making went on with the general manager and associate director, and matron was at the bottom of the pile,” said Hilary.

Excluding nurses from the decision-making had the potential to hurt patient care: “You only get part of the story. I’m not saying nurses have a bigger contribution to make than others, but they are the people who are there either at the bedside or the clinic 24/7. They have a lot of good understanding of what works what doesn’t, what’s risky.

“By not having them as part of the decision-making body is a real missed opportunity.”

With the agreement of the GWH board she put in place a new flock of divisional directors of nursing.

She said: “I think nursing punches above its weight now. The success is down to the development of nurse leaders, actually getting a structure in place that puts nursing at the table.”

“We’re in a fabulous position at the moment. I rate very highly our divisional directors of nursing; they’re very strong, very skilled, very influential.”

Securing the posts wasn’t exactly hard, Hilary says. But not everyone on the GWH board understood why they mattered.

She added “I know that if we turned round tomorrow and said we don’t think you need these anymore, there would be uproar.

“They’re so influential and they’re so valuable to the decision making of their division.”

Her goal was to encourage nurses to think for themselves: “It’s about creating space for people to be brilliant.”

Hilary shares that can-do attitude. As a specialist nurse she was worried about patients whose broken bones were being fixed with pins.

She said: “The nursing care of those pin sites to avoid infection in the organisation where I worked at the time was not exemplary and not very evidence based. As a nurse specialist, I wanted to improve it and I did.”

Her big regret, she says, was being in post when nurse recruitment nationally has been so challenging: “We are battling and competing with other healthcare providers. It’s not a level playing field.” International recruitment was helping plug some of the gap.

Now 55, Hilary has been a nurse since she was 18. Working her way up in Birmingham hospitals, she won the deputy chief nurse job in Wolverhampton.

From there, she joined Dudley Primary Care Trust as a director, before moving to GWH in 2012.

Nursing has changed hugely in her 37 years: “On the ground, with the patient what’s changed is the amount of technology that is available to support people in their work.What’s changed is the evidence base that nurse use to plan and deliver their care.

“What hasn’t changed one bit is the importance of connecting with your patients and their families. That empathy, that patience and compassion. Those human elements remain constant. They always will.”

Hilary on...the CQC

GWH was given a ‘requires improvement’ rating by the Care Quality Commission when inspectors visited last year. The Marlborough Road hospital was handed almost two dozen areas where improvements were demanded.

But Hilary believes it could be bumped-up to ‘good’ after the CQC’s next visit this summer.

She said: “In terms of progress since last March and the subsequent report we’re in a better place. 

“We’ve of course made progress against their recommendations. You would expect nothing else. 

“But I think the other thing for me is the level of ownership and determination at that local level.” 

She felt the next report would be ‘good’, adding: “I feel that would be a great testament to the work that the organisation has focussed on over the last couple of years. It’s not easy to do when our financial position is as it has been. It’s so much easier to fix stuff when you’ve got money.”

The CQC is expected to visit GWH this summer.

Hilary on...winter pressures

The hospital, in common with the wider NHS, faced one of its busiest winters this year.

Hilary said: "The biggest concern recently has been around our ability to manage all of the patients who are arriving in need of care.

"We’ve had queues in our emergency department, queues in our acute medical department, we’ve had no beds for people to be cared for in or moved into, so people have been cared for on trolleys.

"There have not been enough doctors, nurses, pharmacists, therapists, to provide the best care we can.

"Those are the things that you worry the most about, obviously because patients are recieving care that is not exemplary, but also because of the impact that that has on staff.

"All of our staff come to work to do a good job. It is soul destroying when you can’t deliver the care that you know patients need and the care that you are professionally motivated to give when there’s nothing you can do to achieve that today. It’s not every day.

There were too many days over this past winter where people will have gone home emotionally exhausted because they haven’t been able to deliver the best care."

What Hilary's old colleagues REALLY think of her...

Nerissa Vaughan, chief executive, said: “Hilary has given great service to the NHS and particularly to nursing. It's been a privilege to work with her at GWH, her wisdom and kindness have been a great asset for us at the hospital.

“I know she has no plans for a while, having planned all her life she's looking forward to not having to. Knowing Hilary though I'm sure she will keep herself very busy and wonder how she ever found time to work.

“On behalf of the trust I'd like to thank her for all her hard work and dedication. I wish her a long and happy retirement.” 

Medical director Dr Guy Rooney called the retiring chief nurse "a rare woman who has given her working life to the NHS": "She set the bar high for patient care and made us all jump to achieve it. She will be missed big time."