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CNO urges nurses to ‘lead service changes’, despite ‘relentless’ pressures

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The chief nursing officer for England has urged nurses to get involved more in redesigning local and regional services, while recognising that pressure on staff at the frontline has been “relentless”.

Jane Cummings noted that concerns had been raised in some parts of the country about a lack of engagement from nurses in the 44 sustainability and transformation plans (STPs) that are being developed.

“People are under so much pressure at the moment that, sometimes, it’s hard to step back”

Jane Cummings

Speaking to Nursing Times ahead of her annual summit with leaders from the profession this week, she said there was a need for nurses from both commissioning bodies and provider organisations to be involved in the plans.

It was particularly important for nurses to be “actively engaged” in the workforce side of STPs, she suggested, following revelations that some of the draft plans involved staffing cuts.

In January last year, NHS England gathered together local health and social care organisations into groups to cover geographical population “footprints” around England.

They were told to look at how they could make services more efficient and also move away from acute models in favour of more community provision.

The 44 plans, or STPs, have now been published in draft form, but some have drawn criticism for setting out ambitions to cut nurse staffing levels, while others have been accompanied by negative media coverage and public opposition at shutting or downgrading hospitals.

Professor Cummings said: “There’s been quite a lot of concern raised in certain places around nursing – or nurses – not being as engaged in STPs as they might want, or as others might want them to be.”

She said she thought such concerns were “not unreasonable”, though she added that levels of nurse engagement with STPs had “been very varied across the country”.

“I do generally think there’s not, perhaps, been as much as we would have expected or wanted,” she told Nursing Times.

In response to such concerns, the CNO said the summit would include several presentations that were designed to encourage the profession to become more engaged with the STP process.

“We’ve got a session on the realities and opportunities for collaboration within STPs,” she said, adding: “We’ve got a couple of nurses who are really talking about what they have done, how they have done it and what are the opportunities.”

“That’s really important for me, let’s celebrate the good and the possible”

Jane Cummings

She said she wanted senior members of the profession at the event in Birmingham to “think about how we can really get nurses to drive those changes and to work on the plans as they are developed”.

“If you get [nurses] involved in the plans as they develop, part of that will about be engaging in developing what the workforce plans for STPs look like,” said the CNO.

“We need to have nurses actively engaged in that – both in terms of commissioning new services and from a provider point of view, in terms of how can we provide those and what plans do we need to do it,” she said.

The CNO also re-emphasised her desire, generally, for nurses to be involved in service innovation, highlighting the theme of the national nursing framework – Leading Change, Adding Value.

“Fundamentally, we want to give people a real opportunity to think through how nurses and midwives at every level can lead by example and recognise their really crucial role in innovating and influencing,” she said, when asked what she wanted delegates to take away from the summit.

“That’s really important,” she said. “People are under so much pressure at the moment that, sometimes, it’s hard to step back and think through what it is that you could do as an individual – or your organisation – to really make the changes that we all know need to be made, and actually most people want to make.

“The conference has got some great examples of people talking about what they’ve done and what is possible,” she said. “Hopefully, this will give people time to reflect and think through what they can do differently when they go back, or what they can build on from what they were already doing.”

“Pressures have been relentless, they are tired. They will have had an incredibly busy winter”

Jane Cummings

Professor Cummings added that some clinical commissioning group nurses would be talking at the event about the importance of practice nurse leadership in terms of primary care.

“That’s an area that I really want to focus a lot of attention on – primary care nursing and community nursing as we move forward,” she said.

Similar to the aims of STPs, she highlighted the role of nurses in the need for greater integration between traditional settings, such as between community and hospital-based clinics.

“We talk about integration, quite a lot, but delivering it is often a different matter and a different issue,” she said.

However, she said that “some really practical examples about how we can work differently” would be featured at the summit, citing the example of nurses in Manchester.

She added: “There are some very good opportunities at the event to really concentrate on some of the things that actually are really important, which is about leadership, personalisation, integration and workforce.”

Asked what her keynote speech would focus on, the CNO said she wanted to focus on “really recognising the power that the nursing profession can have” for positive change.

“I want to do something that, while recognising the pressures, also really talks up the good stuff,” she said, noting that it “can be a self-fulfilling prophecy if all we ever do is talk about the negatives”.

“That’s really important for me, let’s celebrate the good and the possible, as well as recognising the realities of about the environment in which people are working,” said Professor Cummings.

However, she acknowledged that “inevitably” nurses were tired due to the “relentless” pressures facing frontline staff, especially over the colder months.

“Pressures have been relentless, they are tired. They will have had an incredibly busy winter, in fact, it’s probably been very busy for a very long time,” she said.

Despite such pressures, Professor Cummings said she wanted nurses to “recognise the contribution they can make to making the changes that they need to make”, and for national organisations to “help and support people to make those changes”.

Bodies, like NHS England and NHS Improvement, needed to ask they could “really encourage people and support them to do the things that they need to do”, she said, adding: “It’s important for me.”

NHS England

Bursary removal is ‘uncharted territory’, says CNO

Jane Cummings at Expo 2016

“I want people to come away from this summit feeling that they can go back and can continue to do some really good work, and they can learn from each other and lead that change,” she said.

Professor Cummings acknowledged that some key topics currently affecting nursing, such as the introduction of nursing associates and apprenticeships, were not on the summit agenda.

Asked why this was the case, she told Nursing Times that such topics had been discussed at several pre-summit events by directors of nursing from both provider organisations and commissioners.

“We covered a lot of those items in those meetings,” she said, adding that she had asked directors what they wanted to concentrate on at the summit and that there would be a session on workforce.

“We covered nursing associates and nurse apprenticeships at those pre-summit events… in those environments and that’s what they wanted. They didn’t particularly want it in the summit,” she said.

She added: “When you look around the agenda, it is quite based around the 10 commitments from Leading Change, adding Vale. We’ve been very clear that we want to support people around those.”

A series of blogs have also been written ahead of the summit by the CNO and other speakers at the event, covering a range of topics that are set to be discussed:

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Readers' comments (1)

  • It is important to get the point of view of nurses heard. It's obvious that the changes to government advisory channels is sidelining nurses and bringing more and more doctors - who are cavalry to the rescue, don't get heavily involved with patients at a personal level and do not understand long term care but do know how to make abrupt decisions on life or death matters - and accountants - who haven't a clue how to deliver cost-effective humane care - but do know how to slash costs for the short term which unfortunately has the outcome of harming patients, nurses and anyone else who cares. It cannot be left to NHS senior managers who are unregulated and unchecked, unlike nurses and co. Some senior managers have no obvious nursing or medical background. Does town planning count as experience for designing a health service? I find that a bit of a worry, especially observing the results.

    Please even though you are worn out, make an effort to get into the STPs either in person or if shifts etc prevent, have a group with spokesperson(s) and feedback sessions or however it suits you. But don't leave it up to those who know damn all about your lives or the real lives of your patients.

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