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Nursing debate questions long-term impact of '6Cs' values


The set of national nursing values known as the “6Cs” have “sold the profession short” and will have faded out of use in a few years’ time, claimed delegates at an event last week.

The 6Cs, the best known part of the national nursing strategy for England Compassion in Practice, were introduced in 2012 following the Francis report and have subsequently been rolled out to other professions in the NHS.  

They were the subject of a formal debate last Thursday, which was organised by academics and titled “We need to talk about the 6Cs”.

“We need to be held to account by more things than the 6Cs”

Tony Butterworth

The organisers of the debate at London South Bank University claimed the 6Cs had “received mixed responses in the healthcare community”, and that many commentators had challenged their focus on individual nurses rather than the environments and constraints within which they work.


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“There have been numerous informal discussions, particularly on social media, [about the 6Cs] but until now there has not been a formal debate,” they said. “We want that to change.”

Some present at the event said that, while the values the 6Cs stand for – care, compassion, competence, communication, courage and commitment – were to be “applauded”, they did not ensure standards of care were being met.

Professor Tony Butterworth claimed that the Nursing and Midwifery Council’s new code of conduct would prove to be a more powerful tool for change.

Speaking during the debate on whether the 6Cs improved care, he said: “We need to be held to account by more things than the 6Cs. I applaud them, but it will be the code of practice that holds us to account – not the 6Cs.”

When later asked what the future of the 6Cs would be, he said: “They will decline, as they should. They will go to a place where they will not become less important, [but] they will decline in their prominence.”

“I’m not so sure the 6Cs have a life beyond this next year or two,” he added.

Professor Butterworth said he was not aware of any evidence to suggest the 6Cs had improved patient outcomes or the working lives of staff, but said he would like to see some commissioned.

“We need to big up our academic credentials and let the world know educated nurses are caring nurses”

Stella Backhouse

Meanwhile, Stella Backhouse, who writes the Grumbling Appendix nursing blog, said that while the values behind the 6Cs were important, it was difficult for nurses to maintain them because of the “highly challenging” working environment they were often in.

Ms Backhouse said systemic problems within the NHS should be addressed to ensure standards of care are being met, rather than “simply repeating this [6C] mantra over and over again”.

She also said the 6Cs failed to describe the complexity of the [nurse] role, claiming they “sold [the profession] short”, because they did not highlight the critical thinking required for nursing.

“We need to big up our academic credentials and let the world know educated nurses are caring nurses,” she told the audience of nurses and academics.

But Professor Juliet Beal, NHS England’s director of nursing quality improvement and care, spoke out in support of the 6Cs.

She said she believed there was “quite a bit of qualitative evidence” available to support their impact on care, but noted that it needed to be collated. She also acknowledged that quantitative evidence would be harder to gather.

Professor Beal said the 6C should be viewed as part of a whole range of tools that should be used to address problems within failing trusts. “The 6Cs is about having a value set,” she said.


Readers' comments (13)

  • michael stone

    The '6 Cs' always did seem to be only one part of a complex analysis: the 6 Cs cover 'the mindset of nurses' but they largely ignore the question of adequate staffing levels.

    And at the moment, there is probably a 7th 'C' - consent. The Montgomery case, which for some reason seems not yet to have made it onto the pages of NT, has got significant implications for patient-clinician interactions:

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  • 6C's Compassion in Care

    As you work through the day
    Listen please to what we say,
    There’s not much for us to do
    But sit around and wait for you.
    The day is long when we’re alone
    No one to talk too, but I can hear the drone
    My saving grace is the smile you give
    And the care provided so I may live
    The look in your eyes to show you care
    Means just as much as the doctor there.
    Dignity, respect, compassion alike
    I can see the 6 C’s will delight
    My time in hospital here with you
    And the courage; shown when others had no clue
    Gave me confidence in your care
    To keep me focused and getting there!

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  • how about another "C" common sense, not enough staff , over worked undervalued, mps need to be more compassionate as well

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  • I cannot believe that any nurse who did not already demonstrate the 'six c's' in her professional life is likely to change because she is told to! The same goes for the new code (that we paid for of course, and is basically the same as before but with a couple of extras). Having read it through I cannot see how it will change anything I already do, and I suspect that will be true of most nurses who strive to excel anyway. It is just another demonstration of raising patients expectations without tackling any of the real issues affecting the health service!

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  • I believe the 6Cs is a valuable tool alongside the NHS Constitution, NMC Code of Conduct and CQC domains which can all be used together to underpin the vision, values and principles of expert nursing care in practice.

    It may be helpful rather than academics and those not in nursing practice denigrating the 6Cs that they produce their own vision and strategy for education and academia and articulate it in a way everyone can understand and implement which can be used alongside the 6Csto to cover the gaps they have identified.

    I have heard and seen several examples from patients, users of the service and nurses that demonstrate the 6Cs is effective and is of benefit when utilised in its entirety.

    Let's all work together and support and celebrate the many that use the 6Cs for the benefit of patients and others we care, after all the 6Cs is not an academic exercise but it is evidenced-based.

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  • Sorry Joan, can't let that go. Lots of people at the debate were wholly clinical. The debate was respectful and considered but illustrated the folly of making a distinction between academia and practice- neither works without the other.

    The very definition of expertise is experience informed by theory. Its surprising how common sense (i.e. One's personal assumptions) varies between people, academia and theory remove that bias and enable sustainable improvement to flourish.

    Dismissing people who disagree with you as 'academic and not in nursing practice' won't help the patient experience which is why Juliet Beal and Jane Cummings supported the debate

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  • We need more leaders and less managers. Leadership means to inspire, to motivate to support, managers just seem to pile on the pressure without offering any encouragement. Let's see the managers performing the 6cs before they demand that we take them on board. As if haven't been demonstrating them since we qualified!

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  • That might be because the managers don't have any "people skills" or "leadership skills".
    As for waiting for managers to perform the 6cs - they aren't paid to do that or employed to do that, they are there to make sure that you do!

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  • michael stone

    ***You are correct in drawing attention to the Montgomery Judgment which has major implications for all HCP's including Nurses.***

    Back to the 6C topic !

    It is time for the 6"C" nonsense to be buried, it is a load of twaddle "invented" by a non-practicing "nurse" who would not be able to function in a busy clinical environment.

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  • I have just experienced the 6Cs in action, when my grandmother was admitted to Scarborough General Hospital Coronary Care Unit. The team there had the 6Cs on a huge board in the centre of their ward- with considered interpretation of what that meant for them as a whole team- for all patients and relatives to read and understand.
    The culture of this ward embodied the 6Cs and the whole team were absolutely fantastic! I found that every member of staff were proud of their 6Cs and I think, influenced by how it related to them and their role. Most importantly-they lived the values.
    My grandmother had excellent care, all staff were compassionate at all times. As family, we were included in challenging decision making and doctors and nurses were open to full discussions with us and with each other. Commitment to care was evident throughout and as a family we were confident in the care and competence of the team.
    Sadly my grandmother passed away but my family and I will never forget the care and compassion, the courage, confidence, competence of that very challenging time.
    I welcome the debate on the 6Cs- hopefully it will encourage patients, practitioners and services to get involved and inform the evidence base- a lack of evidence does not mean a concept/idea/intervention is not effective.

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