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England’s CNO launches new nursing framework


The chief nursing officer for England has unveiled a new four-year plan for nurses, midwives and care workers focussed on how the profession can drive changes to services and help reduce unwarranted variation in health and care provision.

The new framework – called Leading Change, Adding Value – is the successor to the 2012 Compassion in Practice strategy.

“The key thing for me about the framework is recognition of the role that nurses, midwives and care staff play”

Jane Cummings

Called Leading Change, Adding Value, it is centred on 10 commitments, which include having the “right staff in the right places at the right time”, leading research to show the impact of practice, and increasing the visibility of nurse and midwife leadership and input in prevention (see box).

Speaking to Nursing Times ahead of the framework’s planned launch today, Jane Cummings said it was about demonstrating the impact nursing had and how it could help change the way services work.

The earlier Compassion in Practice strategy, she said, was aimed at restoring pride and respect in the profession in the wake of the Francis report into care failings at the former Mid Staffordshire NHS Foundation Trust.

However, she confirmed that the new framework would retain the previous strategy’s “6Cs” nursing values – care, compassion, competence, communication, courage and commitment.

Ms Cummings said the framework would support nurses in delivering the aims of the NHS England’s Five Year Forward View, especially reducing gaps between health and wellbeing, care and quality, and funding and efficiency.

“The best way of doing that is to focus on variation and in particular unwarranted variation,” she said, noting that the framework included tools and guidance to help achieve this aim.

“We’ve made a real effort to engage with social care, other care settings, academics and the whole system”

Jane Cummings

Asked how the framework would tackle staffing issues, she said it would be linked to the new care hours per patient day metric, which is due to be rolled out across NHS hospitals and combines the amount of care provided by both nurses and healthcare assistants per patient in a 24-hour period.

Ms Cumming said the 10 commitments were “generic enough to be adapted to whatever field you work in”, when asked how staff in different settings and sectors would be able to use the framework.

“The last strategy – although it was talking about the whole system – in reality it was predominantly picked up by the NHS,” she said. “This time we’ve made a real effort to engage with social care, other care settings, academics and the whole system.”

She later noted there were examples from across different sectors featured within the framework, including one which demonstrated reducing unwarranted variation in rates of pressure ulcers between care homes with similar types of patients, staffing and local populations.

Improving the visibility of nurse leaders, particularly for those working in prevention, was also a key part of the framework, said told Nursing Times.

“It’s about how can we work together and, importantly, how we can evidence the impact”

Jane Cummings

Asked how it would ensure leaders working in prevention continued to be developed when public health jobs were at risk from council cuts, Ms Cummings said she was “passionate” about ensuring the recent increase in health visitors was not lost.

She added that the framework was designed to “truly integrate the role and the work of nurse and midwives across traditional boundaries”.

“It’s about how can we work together and, importantly, how we can evidence the impact. If you’re working in a local authority or being commissioned by one, being able to demonstrate the impact of the work you’re doing is significant.”

The CNO also highlighted framework’s commitment to nurse-led research and the importance of using evidence in practice.

However, the CNO acknowledged the framework was not backed by funding, stating that “you don’t need lots of money make a big impact”.

She said its commitments could be achieved through programmes that were already funded, such as work on safe staffing and maternity services.

“The key thing for me about the framework is about a recognition of the role that nurses, midwives and care staff play. It’s about reminding them and everybody else what it is and the potential we’ve got. Secondly it’s about recognising that you can start small but have a big impact,” she said.

10 commitments in Leading Change, Adding Value framework

  1. We will promote a culture where improving the population’s health is a core component of the practice of all nursing, midwifery and care staff
  2. We will increase the visibility of nursing and midwifery leadership and input in prevention
  3. We will work with individuals, families and communities to equip them to make informed choices and manage their own health
  4. We will be centred on individuals experiencing high value care
  5. We will work in partnership with individuals, their families, carers and others important to them
  6. We will actively respond to what matters most to our staff and colleagues
  7. We will lead and drive research to evidence the impact of what we do
  8. We will have the right education, training and development to enhance our skills, knowledge and understanding
  9. We will have the right staff in the right places and at the right time
  10. We will champion the use of technology and informatics to improve practice, address unwarranted variations and enhance outcomes

Readers' comments (13)

  • Anthony Johnson

    What a useless waste of time this whole policy will be

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  • That`s just what we need, another "Framework" NOT!!!!!! Can anyone remember the 6 Cs? Wasn`t that a Framework? Who can remember all these meaningless doctrines passed down from on high, and do they make any difference?

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  • More than ever we need to educate nurses properly to see through this pseudo talk. I emplore nurses to understand you are being undermined by nonsense talk of value streams and false performance. The right people is nothing more than rheteric about dictating who as nurses fit into their management model this is fundamentally flawed and immoral . As nurses we came into nursing to help and support people not become a value stream or Carters hidden way of limiting staff numbers. This is the very model that is destroying nursing. There are those of us now existing proving how Cummings and other trusts are getting it seriously wrong under such nonsense approaches. The emphasis on culture is already outdated Cummings

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  • The last time 'Nurse Productivity' was 'measured' Mr Carter, was under Mrs Thatcher in the late 1980s, after she had introduced 'Internal Market Forces' into the NHS which were going to 1. Improve patient care 2. Improve efficiency. Of course, neither happened but it was the beginning of the end for the NHS. The net result of 'measuring nurse productivity' was one that reduced the knowledge, skills and expertise of nurses to nothing more than 'tasks', and which spectacularly failed to acknowledge the complexity of what nurses actually 'do'. Of course you can allocate 'tasks' to others to carry out but this flies in the face of holistic assessment, care planning and review, and often results in the fragmentation of 'care' and vital information which is often not understood and not passed on to other occupational groups. As nurses we are going to have to fight to have a 'voice'. We are advocates for those we care for. We cannot sit back and let governments tell us how to nurse. That is for us as a profession to define.

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  • 1) I have loads of time to promote health with 30 people waiting 6 1/2 hours.

    2) what the hell does that mean

    3,4,5 Fair enough but in the code anyway.

    6) Yer right! I want to be paid a fair wage and be given the time and space to do my job........if they pull this one off I will personally speak to the pope to apply for sainthood......although I think you need more than one miracle.

    7) Brilliant.......were is the money coming from?

    8) Ha ha ha. Think of all the "right training" we can get with a £2k cap on our whole devisions training......thats about £12/person. Time for basic training would be nice.

    9) Oh there is the second miracle.........lets just magic the staff up shall we.

    10) NHS IT is the worst I have ever used. I've seen more egg timers on the screen than anything else. It would take millions of £ to improve this.

    I really don't want to be negative but I feel my corporate bullshit detector kicking into overdrive. Meaningless words unless government backing. Clear that NHS England and the Tories will only support this in words........ansolutley no substance. Nursing has never been under more scrutany........I post anonymously for fear of loosing my job for expressing my feelings and speaking out at increasing corporate nonsence.

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  • I am quite looking forward to the You Tube launch of this strategy just like they did with the 6 Cs (tongue firmly in cheek )

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  • Well said Charlotte
    “It’s about how can we work together and, importantly, how we can evidence the impact. If you’re working in a local authority or being commissioned by one, being able to demonstrate the impact of the work you’re doing is significant.” JC from article above.
    - so much of what we do cannot be evidenced or measured or presented on a dashboard or scorecard or themometer or quality report or deep dive or performance report
    If our nurse leaders and the government will only support demonstratable impact in this format we are surely doomed!

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  • They are expecting us to revalidate but won't pay us for the time spent on the process. That is in addition to many of us working through breaks and going home late. These alone breach a fair number of the commandments ....sorry commitments ! or is giving our time for free the added value bit ?

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  • Oh my god, that 6C's video. The most undignified and embarrassing thing I think I've ever seen.

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  • Another document launched by nursing that will have no impact except take up space on the bookshelf or hard drive

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