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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)

  • So this clueless government poodle is still spouting her laughable nonsense. The best thing that nurses can do is to totally ignore her. She is a government appointee and although she has the grand title of Chief Nursing Officer, she was neither chosen by nurses, nor does she represent or speak for nurses. No doubt she was chosen by the DOH as someone who would carry out Jeremy Hunts dictates without thought or question. She publishes meaningless strategies every now and again to give the impression that she is actually doing something. As these are so full of jargon they are essentially meaningless to most nurses.

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  • Cummings your American approach is being attacked right under your nose. Porter we already prove our worth and I am not going to do my self out of a job by false performance measures based on a corrupt Bozo the Clown Lean Measures and Bell Curves bourballs based on it. BULL, BULL, BULL you're all losing the ability to lead up the top and so disconnected you flying in the clouds of delusion. The frontline is falling to bits, stress is every where and nurses in tears, whilst patients are dying or died. Cummings you should know better than anyone you can't force lean on people and guess work it's not working in your favour. Virginia Mason's reputation is being questioned and how embarrassing for you and trusts to be spending so much on QI experts and sending management to American Hospitals. How many millions is it, we all know it's about control and command because you're beginning to lose it. You are going to lose Cummings. In my view this framework is fake and its approach is mass fraud on a nation scale against the NHS. Disgusting.

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  • I am rarely lost for words, but now!!!

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