Interview: the CNO's message to nursing after Francis report
The nursing profession needs to “rebuild the trust of the public”, according to chief nursing officer for England Jane Cummings.
In an interview with Nursing Times last week, Ms Cummings gave her initial reaction to the publication of the Mid Staffordshire Foundation Trust public inquiry report.
She described the report as “harrowing” and “hard to read”. “We have clearly failed people in the past – some terribly in Mid Staffordshire – but we still hear about poor practice and bad patient experience, so I don’t think we can say, that was then and this now,” she said.
But Ms Cummings highlighted that the “vast majority of care is good”. “Many staff I speak to are just brilliant, doing fantastically good jobs and absolutely dedicated and committed – I see it all the time,” she told Nursing Times.
Message for nurses
Asked what her message to nurses was in the wake of the report, she called on the profession to read the document and “understand why Robert Francis has been as direct as he has been”.
“I don’t think we can be complacent and we need to rebuild the trust of the public really,” she said.
“Many patients I speak to when I’m visiting hospitals and healthcare settings are incredibly positive about the nursing care they’ve received. But we also hear stories where patients didn’t get the care they want or deserve.”
She added: “We’ve got a good opportunity to use the recommendations that Robert Francis has made to really concentrate on building an NHS that we as nurses… can be proud of and one that our patients deserve.
“We don’t go into these jobs for glory, we go into them because we want to make a difference for the people that we care for, and I feel as strongly about that in my role,” she said.
Ms Cummings told Nursing Times she was supportive of the “overall direction” of the recommendations made by inquiry chair Robert Francis QC in his report, but wanted to avoid making an “immediate kneejerk reaction to any of them”.
“All 290 recommendations need to be reviewed in detail with and we need to give it the consideration it deserves – and the public deserves – to make sure we can move on and continue to improve,” she said.
“The direction was one that we would support and it gives us an opportunity to really concentrate on things that will make a difference and I think it gives us an opportunity to build on the work that’s already been done over the last couple of years,” she added.
The direction for nursing
Describing how the nursing profession should move forward, she said: “It’s a careful balance between acknowledging there are things we need to do differently and things we need to improve, but at the same time not giving the impression that nursing has completely lost its way or is completely uncompassionate or uncaring – because that’s frankly not true.”
Pressed on whether she welcomed any specific recommendations in the report, Ms Cummings said she was “very positive” about Francis’s “very strong emphasis on culture” and “putting patients really at the heart of everything we do”.
“There’s been lots of improvements made across the board, but we still have a long way to go in order to really get it right.”
She added that she was also pleased to see that the new national nursing strategy, Compassion in Practice, was acknowledged in the report.
“The point he made was the proposals that were in Compassion in Practice were entirely consistent with what he was putting in the report…I was pleased about that because it reinforced the work we have done over the past months with nurses, midwives and care staff across England.”
Keeping the new CNO role under review
Part of the report focused directly on Ms Cummings herself, recommending that that the government’s recent splitting of the CNO role in England into two positions should be “kept under review”.
Under the coalition’s reforms, the post of the CNO for England was restructured, with a CNO appointed to the new NHS Commissioning Board – the post currently held by Ms Cummings – and a director of nursing appointed at the Department of Health.
Concerns were raised by some that splitting the role might dilute the nursing voice at senior NHS levels, though others argued that having two senior voices was better than one.
Mr Francis said the inquiry had been told that the commissioning board’s CNO would act as the “head of the nursing profession in England” and would “have the greatest opportunity to lead and directly influence nursing in the NHS”.
“The CNO will also be the principal adviser to the government on NHS nursing matters. The Board also intends to have four regional chief nurses.”
But Mr Francis said the “effectiveness of the newly positioned office of CNO should be kept under review”.
This was in order to ensure the maintenance of a “recognised leading representative of the nursing profession as a whole, able and empowered to give independent professional advice to the government on nursing issues” with equivalent authority to that provided by the chief medical officer.
“It would be unfortunate at a time of such challenge to the nursing profession if its voice were to be diminished just when it’s standing and self-regard need to be enhanced for the good of the patients it serves,” Mr Francis said in his report.
“Clearly, it is not the intention of the changes described to do that, but the effectiveness of the new arrangements should be kept under review,” it added.
Asked about her opinion on this point, Ms Cummings described it as “fair enough” and that she had “no problems” with Mr Francis recommending the role be kept under review.
She said she had “every intention” of the role remaining effective as a provider of independent professional advice to the government. “Because we have changed under the reforms, it is entirely reasonable to say we just need to make sure that remains the practice,” Ms Cummings said.
“I have a significantly large responsibility to lead the nursing profession across England to make sure we get the changes implemented that we need to,” she added.