Prime Minister's Commission calls for nurses to take professional pledge

2 March, 2010 | By Steve Ford

The final report of the Prime Minister’s Commission on the Future of Nursing and Midwifery has called for all nurses and midwives to make a pledge to provide high quality, compassionate care.

The move confirms a recommendation made in a draft version of the report, as revealed by Nursing Times last month.

The commission hopes that such a pledge will help to restore public trust in the profession, following an increasing number of cases over recent years that have highlighted patients being treated with an apparent lack of dignity or compassion.

It is intended to complement the Nursing and Midwifery Council’s code and the NHS Constitution.

Health minister and commission chair Ann Keen said: “The Commission is clear that high quality, safe and compassionate care must rise to the top of the agenda for a 21st century world-class NHS. Nurses and midwives must renew their pledge to deliver this and employers must take responsibility for supporting them in this.

“If we are to build on the successes of the NHS and improve health and wellbeing, then we must ensure that nurses and midwives take their proper place as valued professionals at the heart of health care - delivering, leading and shaping care now and for future generations.”

The report, called Front Line Care, makes a total of 20 recommendations. Among these are the need to prepare nurses to meet the growing need for highly skilled care for people with long term conditions and the “complex needs of ageing”.

It also says that ward sisters, charge nurses and equivalent team leaders in the community and midwifery need “optimum support and training”. This is intended to help restore them to their “former traditional positions of authority as visible care champions”.

Additionally, it says the title “nurse” should be legally protected to reduce public confusion around roles and titles, that the Nursing and Midwifery Council should development regulation advanced nursing practice and that some form of regulation should be introduced for healthcare assistants and other non registered members of nursing teams.

The commission was set up by prime minster Gordon Brown in March 2009, with a mandate to advise him on how to build the future of health care, and give nurses and midwives a bigger say in service design and leadership as well as care delivery.

The nursing and midwifery pledge to deliver high quality care
1 Every nurse and midwife will uphold the Nursing and Midwifery Council Code and the values of the NHS Constitution, wherever they work, and will accept responsibility for and take charge of the quality of care, service and outcomes for every service user in their care. Each one of us will speak out and act wherever and whenever care falls below the agreed standard.
2 Every nurse and midwife, acknowledging the huge public investment in the provision of health care in the NHS and elsewhere, will act to ensure that these resources are used to optimum effect for the benefit of service users and society. This includes making best use of our own time and expertise, and developing and adopting practices, services and lifestyles that are health-promoting and sustainable.
3 Nurses and midwives, recognizing our important role in improving health and wellbeing and reducing inequalities, will engage actively in the design, monitoring and delivery of services to achieve this. We acknowledge that we are seen as role models of healthy living and will try to live up to this responsibility.
4 Nurses and midwives, acknowledging the public investment in our education, training and continuing professional development, will commit to delivering care that is evidence-based and effective, and evaluating and researching it to expand our knowledge of what works best.
5 Nurses and midwives, acknowledging that we are responsible for ensuring that health care decisions are informed by our expertise, will engage more directly with policy-making and decision-making. This includes decisions on funding priorities, health care technologies, and the development of innovative models of care.
6 Nurses and midwives will lead and manage the delivery of high quality, compassionate care. We will be at the leading edge of innovation, always challenging the status quo and taking responsibility for creating new solutions.

Readers' comments (30)

Anonymous | 2-Mar-2010 12:49 pm
What a load of crap! Absolute garbage. Brown to give nurses a bigger say in service design, leadership and delivery? Would this be the same primary care services he is in the process of selling off?

How much did this commission cost?

While you are at it Brown why don't you get the Dr's to sign a pledge? Or rename the hypocratic oath the hypocritic oath (far more accurate.....just ask the recipients of out of hours care or dodgy GP practice). If he thinks nurses have lost the publics trust it will be interesting to see how much of the publics trust he himself has lost very soon!!!
Unsuitable or offensive?
Anonymous | 2-Mar-2010 8:28 pm
All about the NHS as usual what about those of us working in the independent sector, will this not apply to us? Whenever I have contacted DEO Health or Chief Nursing officer relating to nursing issues it's only ever the NHS thay are referring to.
Unsuitable or offensive?
Doug Langdon | 3-Mar-2010 12:42 pm
What a political gimmic. Still l suppose it is what we should expect from Gordon Brown and his advisors at a time when he is clinging onto power.

In my view, it is not the nursing staff who are responsible for the majority of poor care that exists in our hospitals today, but the General Managers and economists who have been driving the NHS since 1982.

This recommendation, suggests to me that Gordon has no idea what has or is going on in the NHS, and if this is the case, what chance do we have of ever putting things right.

Only a small minority of Nurses fail to provide high standards of care, those that do are dealt with by the NMC, and l suspect that in a lot of reported cases, the nurses are found to be trying to cope with demands, that are unreasonable, given the resources available to them.

Going back in time to Hypocrates to find a solution is not the answer. Cutting out the beauracrat's is.
Unsuitable or offensive?
Anonymous | 3-Mar-2010 1:18 pm
I'm sorry but who does these idiots think we are? Let's get a civil servant to pledge that your benefit won't take 3 months to process, A banker to pledge that he won't take a million pound bonus.
Spineless civil servants and managers backed up by the RCN getting paid huge sums to come up with this rubbish, yet another reason to get out of nursing.
With numpties like this running the NHS God help us
Unsuitable or offensive?
Anonymous | 3-Mar-2010 5:33 pm
I agree with all the comments above but do you know what? NOTHING will change and quite frankly I almost wish that it would all fall apart and then there would be a real witch hunt to blame someone and that would certainly be all the mindless, spineless wastes of oxygen that are all NHS managers who don't give a crap about anyone but their sychophantic, lazy and useless selves
Unsuitable or offensive?
kathleen white | 3-Mar-2010 6:00 pm
Sorry to disagree Anonymous 3-March 5:33, but something will change if we are dumb enough to accept this insulting farce.

There will be more jobs for the pen pushers, and more NHS resources will be wasted.

I still don't know who will pay for the waste. Will it come from our NMC fees?

Why is the NMC Code of Conduct not protecting the puplic?

We all know why. The corrupt & incompetent managers, responsible for the current dysfunction are not governed by the NMC.

It would be more appropriate for Mr Brown's comission to ask these so called managers to sign a pledge to support front line staff and put an end to the bullying culture that they preside over.
Unsuitable or offensive?
Anonymous | 3-Mar-2010 6:02 pm
Sorry to disagree Anonymous 3-March 5:33, but something will change if we are dumb enough to accept this insulting farce.

There will be more jobs for the pen pushers, and more NHS resources will be wasted.

I still don't know who will pay for the waste. Will it come from our NMC fees?

Why is the NMC Code of Conduct not protecting the puplic?

We all know why. The corrupt & incompetent managers, responsible for the current dysfunction are not governed by the NMC.

It would be more appropriate for Mr Brown's comission to ask these so called managers to sign a pledge to support front line staff and put an end to the bullying culture that they preside over.
Unsuitable or offensive?
Anonymous | 3-Mar-2010 7:52 pm
i dont think we should have a gimmic like a pledge to try and improve care as trained nurses we should be doing that any way but we all know there are some who dont i.e. patients not being fed or given drinks when they can not do it themselves
patients left in dirty filthy clothes /beds
staff who treat patients and families with no respect
staff who do not adhere to infection control rules
you know you can complain as moan as long as you like but the truth is nursing has to change, patients want basic nursing care from nurses some one to listen and explain when they are worried about what is happening to them. i work in the community and i am throughly sick to the teeth of patients saying to me please dont send me back in there(hospital) because of the treatment they have received and this is just not the odd patients im talking 99 per cent. to hear a patient praise their care is a rarety they can t all be wrong !!!!!and also included are medical staff, they have acted like god for too long about time they came into the real world.perhaps if we took iniative ourselves and stopped complaining things might start to change and work with what weve got
Unsuitable or offensive?
helen britton | 3-Mar-2010 7:58 pm
What an utter pile of steaming crap it all is, the government have just slapped us all in the face yet again. What do they think our code of conduct is, a joke!!!. I already give 100% exellent service and work myself into the ground and what for, to be told yet again that I am no good and need to Improve my practice. What about you and your useless croneys Brown what about your pledge to improve things for our county, GET STUFFED!!!!!

Helen Britton
Community NUrse
South Yorkshire.
Unsuitable or offensive?
Anonymous | 3-Mar-2010 8:01 pm
further to comments above not all nurses that fail to give poor care are dealt with by the NMC and that it is very few, if that were true then our hospitals would not be receiving so many complaints from patients / families about the poor care they receive
Unsuitable or offensive?
Paul Killick | 4-Mar-2010 9:49 am
Isn't this another example of New Labour's confusion of fine words with something that might actually make a difference?
What should we expect next, an "apology" for Florence Nightingale's failure to have provided a "Diversity Policy"?
Unsuitable or offensive?
Martin Gray | 4-Mar-2010 12:34 pm
With regard to the pledge as detailed in the article:
Our code of conduct is already in place and should always be adhered to,making such a pledge unecessary. After all there has been no call for doctors to have to renew their oath.

Nurses are not given the opportunity to be actively involved in policymaking or decision making, except perhaps those that have been promoted to managerial positions because they have done some management course. How can we be expected to change things that being the case?

All too often such nurses are catapulted into positions of responsibility because of their academic qualifications rather than their hands-on experience and leadership qualities, or they are 'yes' people scared to stand up to management rather than fight for what is right. This happens in the community setting as much, if not more than, the hospital setting. Health visitors that are fairly new to the job and have little experience but have been 'pre-selected' and sent on management courses prior to new posts being set up, and the management qualification then being deemed an 'essential' rather than a 'desired' criteria thus ensuring the job only goes to that pre-selected candidate. Now that IS where the system does fall apart!

Before the older nurses retire don't you think it would be a good idea to give them the opportunity to pass on their skills and stop management from destroying nursing? In a recent article I read that the public needs to stop considering nurses to be dostors handmaidens and be recognised for their level of training. I wonder where such an idea came from - nurses are expected to provide care, and that is not being delivered for a variety of reasons but not one organised body has admitted this or why it has come about. Lots of accusations and buck passing though!!
Unsuitable or offensive?
kathleen white | 4-Mar-2010 10:41 pm
Yes Martin 4 March-2010- 12:34, you have summed it up in 4 paragraphs.
This "pledge" is an insult to good nurses and will make no difference to those who fall below acceptable standards.
If the NMC code of conduct does not protect the public from poor standards of care, it should be reviewed.
How regressive can things get. It does not require rocket science to show that it is NHS "so called" managers that need to sign a "pledge". Many of them concentrate on forcing hard working nurses to breach the NMC Code of Conduct.
I should know. I raised concerns about breaches in child protection and health and safety in 1999. This resulted in suspension from my specialist nurse practioner post. Naturally I took the situation to an Employment Tribunal.But two weeks before the hearing the Trust settled by offering a large pay out. I now know that this happens on a regular basis. Precious NHS resources used to cover up management corruption.
So, who should sign "the pledge"?

Kathleen White Edinburgh
Unsuitable or offensive?
Anonymous | 5-Mar-2010 1:57 am
Guess what, MP's to have a 1.5% pay rise as recommended by a pay body while we get either nothing or up to 1%.

'Doctors diagnose; Nurses Heal'
Nurse Jackie
Unsuitable or offensive?
john wilson | 5-Mar-2010 2:30 am
It still makes me glad that I left the UK. sittting here in Australia working in a well run public hospital with decent pay.
We, as nurses, have the public trust and respect overall, part of the reason for this is we dont do everything election hungry governments demand If you cant stand up for yourselves.
Do something about the despair i read in the comments on here then how can you stand up for your patients?

anon don't leave the profession come to Australia, we look after our patients and ourselves here

Maybe i'll see some of you soon
Unsuitable or offensive?
Martin Gray | 5-Mar-2010 12:10 pm
Unfortunately John some of us are near retiring age now and, attractive as your proposal sounds, it is just no an option to give up our NHS pensions; many of us may also be deemed 'too old' to be accepted for immigration or some other reason why we wouldn't be considered.
Enjoy your life in the sun, I expect many of us envy you greatly.
Unsuitable or offensive?
Karina Farrell | 5-Mar-2010 5:32 pm
I have been a student for 6 months, and all I ever seem to hear is negative comments from the powers that be about nurses. We are an easy target. So rather than just vent my frustration, I have written to my MP and asked him to send my correspondence to Andy Burnham. I told him that we do care, but we just don't have the time and resources to offer the care we would like to. And that a pledge is not going to suddenly make those nurses who don't suddenly pull their socks up! They are already failing to adhere to to NMC code.

I also told him it was time to stop the 'Nurse Bashing' and get behind us!

As a lone voice, I am sure I won't make much of a difference, but it was quite cathartic, and if enough of us tell them, perhaps they will have to listen.
Unsuitable or offensive?
kathleen white | 5-Mar-2010 11:52 pm
Well done Karina 05-March-2010- 5:32.
We need more nurses like you. I will write to Andy Burnham and I hope others will follow suit.

Successive enquiries have shown that poor healthcare is the result of understaffing, mismanagement and cultures of fear.

Surely it would make more sense to have a pledge signed by incompetent NHS managers and greedy,dishonest politicians.

Nurses have signed up to the NMC Code of Conduct, making a "pledge" unecessary.

Mr Brown and the Commission members should clean up corruption and greed.
Unsuitable or offensive?
Janet Edwards | 6-Mar-2010 1:47 pm
I am so glad that I am coming to the end of my career in nursing and not just starting out. For years the nurses have been blamed for everything that goes wrong in the NHS, I have worked under a labour gov, a conservative gov and again a labour gov and all I have seen is more money wasted in the NHS, and now they are trying to get us to sign a pledge to make everything right , They obviously cannot do it so they expect us to do it for them with no recompense, ( a lousy 1% pay rise if were lucky with no expenses for us) .
I agree that the management should be made to sign a pledge that they will not force us to break our professional code of conduct every time we bring a situation to their attention, I am fed up with hearing from management that you with have to cover the staff sickness yourselves, despite the fact that we already have 4 staff nurses off on maternity leave with not one of them having been replaced, all the other staff are alredy doing well over their contracted hours but no they want us to do more, and all they say is what do you expect us to do, well your job please, the job you are being payed a band 8a or 9 for, not expect me to do it for you.
I agree with the majority of the comments and say a pledge is not necessary only some decent managers running a very run down service, I dont even think a new government will help they never have before but again someone else wasting more money for a few more years thus allows them to pass the buck yet again. I stated at the beginning that I was coming to the end of my career, but I'm not too sure on that as the government keep raising the retirement age very soon I will be far far older than the patients I am looking after and then maybe they will offer to help me out.
Unsuitable or offensive?
Abel | 8-Mar-2010 5:58 am
You are right Phil. This is what I have found at Wikipedia:

“In 2007-2008 Keen had previously hit the headlines having the highest expenses claim of any MP excluding transport costs (which disproportionately affect MPs from remote constituencies), claiming a total of £167,306 for the financial year. In total the Keens have claimed almost £1.7million in expenses over seven years”.

To be honest! I am not surprised. Being an efficient politician consists of being reelected. Hence, they use all tricks as per their bible 'the Prince' of Machiavelli not only to deceive the people but also and most importantly to use power for their own benefit. Even if it is legal, do you think they will show any remorse or shame? Never!
Sophists killed Socrates long ago because they could not bear his virtues. Politicians kill hopes because they are not role models for rectitude.

"Since a politician never believes what he says, he is quite surprised to be taken at his word". Charles De Gaulle (1890 - 1970)
With more than 500.000 Nurses in UK, you may surprise them at the next election.

"It is the duty of every citizen according to his best capacities to give validity to his convictions in political affairs". Albert Einstein (1879 - 1955)
Using the ballot box with your ephemeral power, you can change great things for not only Nursing but also patients, their families and communities.

Abel Sidhoum(RN)
Unsuitable or offensive?