Workforce remains one of the biggest challenges for the nursing profession to overcome, England’s outgoing chief nursing officer Professor Jane Cummings has told Nursing Times.
The need for more nurses was an issue that she raised in her interview for the high-profile post back in 2012 and one Professor Cummings said she felt she was ending her tenure as CNO without having fully conquered.
“It has been an honour and privilege to be the professional lead for over 500,000 nurses and midwives”
But Professor Cummings, who qualified as a nurse in 1982, said much progress had been made – and after almost seven years of banging the drum, she believed people were finally listening.
“We’ve now got a recognition from pretty much everybody that workforce is a significant issue and a real challenge and, yes, it would have been nice for it to have been a bit earlier but we got there in the end,” she said.
At the end of 2012, Professor Cummings published the nursing and midwifery strategy Compassion in Practice, which set out six core values and behaviours that staff should uphold: care, compassion, competence, communication, courage and commitment – commonly known as the ‘6Cs’.
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Compassion in Practice included a section on workforce and Professor Cummings said this shone a light on the issue and inspired other organisations to take action.
She highlighted there were actually more nurses and midwives on the register today than there were when she started as CNO. However, which an 40,000 additional posts had been created to meet rising demand, many were vacant.
“Despite all the issues there are about workforce, and they are significant, we have got more nurses registered than we ever had, we have more midwives registered than we’ve ever had, but we have also created an additional 40,000 posts. So part of the gap is not that we have got a lot less nurses, it’s that we have more nurses but not as many as we need,” she told Nursing Times.
“That’s quite a subtle difference and it doesn’t feel like that when you are frontline nurses trying to cope with all the pressures you are under,” she said.
“But at least we have got hospitals and communities that are now saying: we know we need more nurses, we just now need to get them in post and keep the ones we have got,” she said.
“That’s been fundamental however frustrating it feels to people out there who are doing the job on a day to day basis,” she said.
Professor Cummings also helped to launch the biggest ever nurse recruitment drive to coincide with the 70th birthday of the NHS in 2018.
“Working in the most financially challenged times, probably since 1948, meant there wasn’t a lot of flexibility”
In addition, she noted that workforce was now recognised as a key priority nationally and is set to hold a leading role in the NHS long-term plan due to be released imminently.
However, Professor Cummings started her national leadership role during a period of major restructuring of the health service brought about by the Health and Social Care Act 2012.
Controversially, she was the first CNO to be based at NHS England rather than at the Department of Health – a move that has been criticised in the past by some including the Royal College of Nursing.
The change meant the CNO had to create a new team for herself while working out how her role would interact with a host of newly formed organisations such as Health Education England, Public Health England and NHS Improvement.
“Having had such a massive organisational change in 2012, with completely changing the way the health service worked and starting the CNO role with basically no staff, was quite a challenge,” she said.
“Not only was I new in post as the CNO, but I also had no staff, so I had to build a team and the massive reorganisation, and get used to working in different environments,” she added.
There has since been another organisational shake-up with the creation of a new joint leadership team between NHS England and NHS Improvement – called the NHS Executive Group, which the next CNO, Dr Ruth May, will be part of.
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Professor Cummings also put forward a proposal to create a new chief midwife post who would report to the CNO. A consultation on the plans finished in December.
The NHS Executive Group consists of seven regional teams and Professor Cummings said the plan was to have a chief nurse in place for each region.
Despite not technically being a civil servant like her predecessors, she was still an advisor to the government for nursing and midwifery and was subject to the same rules that meant she was not able to publicly reveal details of her private conversations with ministers.
Professor Cummings, who has a background in accident and emergency care, said: “That’s been tough at times particularly when people who don’t understand that have criticised me for not speaking up about X or Y – you can’t and that takes a bit of getting used to as a CNO.”
“That for me is about really walking the talk, it’s about really believing it, and really demonstrating it”
When asked what the hardest thing about being CNO was, Professor Cummings said: “Not being able to do everything as quickly as I wanted to do and not having any money to do it with.
“I think working in the most financially challenged times, probably since 1948, meant there wasn’t a lot of flexibility within NHS England to be able to do much extra, so most of what we have done we’ve done with very little money,” she said.
Despite having little cash support for the initiatives she led, Professor Cummings thought most of them had had a big impact.
She led on a national agenda to move care for people with learning disabilities out of institutions and into the community – with a target of shutting between 35-50% of inpatient beds by March 2019. But admitted that progress had not been fast enough, with the figure currently sitting at around 19%.
As part of this work, the CNO introduced “care and treatment reviews” and said these were proving successful in preventing people from being admitted to hospital when they did not need to be. She added that more people with learning disabilities were now being discharged from hospital than admitted, which had previously not been the case.
She said: “We’ve started to reverse the trend but at the end of the day we also need to recognise that some people do need to be in hospital.
Leading Change, Adding Value
“They should only be there the least amount of time and they should be there when that’s the only option for them, and creating the services in the community to support people to live in their own home has been quite complex, but we are making some significant progress – it’s just slower than we wanted it to be,” she said.
During her tenure, Professor Cummings has been a champion for diversity and she said one of her proudest achievement was overseeing the launch of the Workplace Race Equality Standard (WRES), which is used to ensure health services employees from black and minority ethnic backgrounds have equal access to career opportunities and receive fair treatment in the workplace.
“That has had quite a big impact and that for me is about really walking the talk, it’s about really believing it, and really demonstrating it, and not just doing it because it’s the latest fad… it’s about really fundamentally thinking that this is important,” she said.
While the Compassion in Practice strategy has finished – it was followed by the Leading Change, Adding Value framework in May 2016 – the 6Cs are still in use within the NHS and Professor Cummings said she believed they would form part of her “legacy” as CNO.
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She also noted that she had endeavoured to raise the profile of the profession through initiatives such as her Perceptions of Nursing scheme. Towards the end of last year, this work was combined with that of the international Nursing Now movement to create Nursing Now England.
The Nursing Now movement has now been adopted in more than 60 countries worldwide and aims to enable nurses to work at the top of their licence and expand their roles.
“I hope I have been part of improving the shift from what people were saying about nurses at the time of Francis report [into care failings at Mid Staffordshire Foundation Trust], to what they’re saying now,” said Professor Cummings, referencing the fact nurses have been voted as the most trusted profession in the Ipsos MORI survey for the past three years.
In a fitting end to her term as CNO, Professor Cummings was awarded a CBE in the Queen’s 2019 new year’s honours list for her services to nursing and the NHS.
She now plans to have some well-deserved time off but intends to stay involved with the health and care system on a part-time basis and continue her work with the charities Macmillan and Over The Wall.
When asked what the biggest challenges will be for Dr May when she takes on the role, Professor Cummings said: “There’s always the challenge of what the CNO role actually means and what it means you can and cannot do.
“The other thing will be the expectation that there will be around the long-term plan and how much will change and what we are able to do as a result of that and also increasing the work that we started around workforce changes and what we need to do around that,” she said.
She added: “There’s a long way to go and there’s lots more change to make, and there’s lots more improvements we can do. But despite all the pressures, we’ve got more nurses on the Nursing and Midwifery Council register now than when I started, and that is good.”
Jane Cummings: Biography
Jane Cummings is the executive lead for the nursing directorate at NHS England which includes maternity, learning disability, equality and diversity, patient participation and experience.
Jane was appointed as chief nursing officer for England in March 2012. She is the professional lead for nursing and midwifery in England and in September 2017 took up an interim role as regional director for London. She was previously chief nurse for the North of England region.
As CNO, she created the ‘6Cs’ and published Compassion in Practice in December 2012.
England’s chief nurse to oversee health service in the capital
This was followed by the Leading Change, Adding Value framework in May 2016 and recently launched the Perceptions of Nursing and midwifery programme to encourage recruitment and retention and support a national campaign.
She was awarded a doctorate by Edge Hill University, a doctorate by New Bucks University, and is a visiting professor at Kingston University and St George’s University, London.
She is also a trustee for Macmillan Cancer Support and a clinical ambassador for the Over the Wall Children’s Charity where she volunteers as a nurse, providing care for children affected by serious illnesses.