Your browser is no longer supported

For the best possible experience using our website we recommend you upgrade to a newer version or another browser.

Your browser appears to have cookies disabled. For the best experience of this website, please enable cookies in your browser

We'll assume we have your consent to use cookies, for example so you won't need to log in each time you visit our site.
Learn more


'6Cs must end the years of make do and mend'


One of the major criticisms of the new nursing strategy Compassion in Practice, aka the 6Cs, is that it’s too vague. People are concerned that it’s just words on a PowerPoint slide, with no real meaning behind them.

There was a fear that trusts would go off and interpret them individually, and that nursing would end up with nothing being spread from one organisation to another. The concern was we would arrive at something of a patchwork quilt of good ideas, as so often happens in the NHS - some duplicate work, some differing takes, some reinventions of the wheel.

But that’s not the case according to Jane Cummings, the chief nursing officer for England.

At last week’s Health Innovation Expo, she announced that there is detail behind the plans, and that she would be revealing exactly how all the elements will be rolled out.

The only way to improve standards in the profession is to listen to it, understand what has gone wrong from the nurse’s perspective and put this right

While unable to set out her vision fully until after the government has issued its response to the Francis report - expected next week - she did give some hints about its focus.

The safety thermometer, the cultural barometer and the connection between patient experience and staff experience all got a mention and are set to be part of the new plans to boost nursing.

I am delighted that someone is recognising the importance of happy staff. Nurses spend their time making sure their patients are content, comfortable and cared for. But the duties of the job and looking after really sick people takes its toll. Much has been written about emotional labour but, in some trusts, very little is done to identify and mitigate its effects on nurses.

Ms Cummings talked about the brilliant standard of care in organisations she had visited since taking up the post of CNO a year ago. But she also conceded that standards do vary.

Of course, some of that is down to poor practitioners. These exist in every profession. But far more is down to resourcing, lack of leadership and lack of competence. And a lack of compassion - or rather compassion that was once there but has been beaten out of nurses through years of being ignored or ridden roughshod over.

So the focus of the 6Cs is right. The only way to improve standards in the profession is to listen to it, understand what has gone wrong from the nurse’s perspective and put this right.

The years of make do and mend in nursing need to end. It is time to resource properly, listen carefully and act sensibly. Let’s hope that, with the response to Francis and the full version of 6Cs, we get all of that.

If you haven’t signed our petition, please do so now at Your signature will make all the difference.

Visit our Speak out Safely page to find out more.

Jenni Middleton, editor Follow me on Twitter @nursingtimesed



Readers' comments (14)

  • "One of the major criticisms of the new nursing strategy Compassion in Practice, aka the 6Cs, is that it’s too vague. People are concerned that it’s just words on a PowerPoint slide, with no real meaning behind them".

    Right on the nail there. Also, as it does not take staffing levels into account, it bears no reality to actual life on the wards where nurses are struggling with chronic under staffing. The 6 "C" are suitable for a la la fantacy world where wards are adequately staffed and nurses have all the time in the world to attend to patients needs. If only it existed.

    Unsuitable or offensive? Report this comment

  • I heard Jane Cummings being interviewed on Radio 4 on 15th March 13. She was asked for her opinion on what lay behind poor care in general. Not once did she mention inadequate staffing levels as a possible cause. This was a disgraceful response, especially since The Nursing Times and RCN have highlighted this so often in recent months. But no doubt this would not go down well with Jane's political masters. It is disgraceful that this woman continues to ignore under-staffing and resultant nurse burnout as a cause of poor care.

    Unsuitable or offensive? Report this comment

  • Anonymous | 19-Mar-2013 3:08 pm

    I imagine she is well aware of this but is answerable to as you say, her 'political masters'. she probably puts her job on the line if she speaks out and says what she thinks. Imagine what could happen and the financial implications if she admitted more staff were needed. that is just my guess, otherwise why else would she fail to affirm this blatantly obvious fact. it cannot possibly be because she is unaware of it unless she is totally cut off from the rest of the world in her ivory tower which cannot be the case.

    Unsuitable or offensive? Report this comment

  • Anonymous | 19-Mar-2013 3:17 pm

    Not being facetious, but do you really think so? I'm a manager, and honestly, sometimes some of the things discussed in meetings bear such little resemblance to reality. Few if any people in my trust leave their office areas and see it for themselves, and the media make it convenient to blame lazy nurses with a bad attitude rather than not enough of them. And I do think that the heart of your comment (which I took to mean we can't admit we need more staff because that would cost money and that would never do) is exactly what's wrong with the NHS. Money over quality.
    And if I look at finance data across my health economy, there actually IS enough money. It just sits in the wrong places, like stupid PFI deals.
    I wish Jane would be a passionate campaigner for nursing but maybe I've had too many happy pills.....

    Unsuitable or offensive? Report this comment

  • The Nobody

    "I wish Jane would be a passionate campaigner for nursing..."

    doesn't she also need the six Cs to be a campaigner, as well as large open eyes, ears and preferably a mobile pair of legs?

    I do not wish to to be facetious either but surely this also goes for the CEO.

    (clinician and healthcare manager) -Anonymous | 19-Mar-2013 3:17 pm

    Unsuitable or offensive? Report this comment

  • 'mobile pair of legs' - that is funny.

    Unsuitable or offensive? Report this comment

  • Proper staffing ratios operate in Australia and some parts of the states. Though on paper it may look like a large expense, I,m sure the reduction in post operative complications. prolonged stays due to HAI and pressure sores/poor nutrition and a reduction in litigation would possibly offset that cost.
    But as usual the NHS only responds with short term ism and knee jerk reactions.

    Unsuitable or offensive? Report this comment

  • michael stone

    The Nobody | 20-Mar-2013 1:53 am

    I think that is the issue with people like Jane Cummings - if they speak up, and really kick up a fuss, they get booted out.

    This is the reason that angry relatives are much more vocal than are serving clinicians, and why retired clinicians are usually willing to be more critical than those still trying to stay in a job, I suspect ?

    If J C isn't aware of the complaints from frontline nurses re inadequate staffing numbers, then she does need firing !

    Unsuitable or offensive? Report this comment

  • DH Agent - as if ! | 22-Mar-2013 3:17 pm

    this seems correct. diplomacy is probably one of the prerequisites of the job but far more heavily biased towards the senior side than the front line workers who appear to be insignificant and not worth considering in their books. I expect she has been warned to give priority to the budgets.

    I tried unsuccessfully to find her job description on the DH site, site and from a Google search in general as I am not at all clear what her role is other than to inform the government about nursing and ensure the quality of care for the public which I assume means listening to nurses and their needs and ensuring adequate resources for them to work effectively and safely. DH just give one brief and unexplicit paragraph which does nothing to inform the public.

    Unsuitable or offensive? Report this comment

  • I have not heard one positive comment from nurses about the work Jane Cummins has done so far. It is clear that the expert views of highly trained frontline staff are not wanted or listened to. Staff are not valued.
    The entire medical/nursing process and interface are simply not understood by those making pronouncements on how it should go forwards. The insistence on "pathways" which patients deviate from at their peril, rather than expert individualised care in response to patient need is dangerous.
    Would these people be telling Honda engineers how to design a car? Or telling your local solicitor that they are going to have to type all their own letters? And that they will have to do it all for more hours and less money? I won't even mention the average 10 hours per week unpaid overtime I do simply to keep on top of my job...with no thanks or acknowledgement.
    Please, will somebody at the top listen and act on what is beiong said in all these posts.

    Unsuitable or offensive? Report this comment

  • Those who do not understand the many faceted role of nursing seem to think of it as a type of bedside maid/secretary/administrator, etc. and job that anyone can do with a little basic training. no wonder on this premise, politicians believe it is too costly and salaries and staff can be reduced - it must be all part of their reductionist scheme. Once this is in full swing there will be a huge outcry to bring back qualified and specialised nurses as the consequences on patient care are far too grave and a false economy, but setting up a new system and finding and recruiting suitable nurses from the pool of redundancies, the de skilled or those who have gone into other careers or abroad, and setting up a new training scheme for entrants to the profession to match real needs will be far too costly.

    Unsuitable or offensive? Report this comment

  • Jenni Middleton, I think you need to accept that the "6C's" are like Monty Python's famous parrot- well and truly dead, beyond resurrection, expired, deceased, is no more.

    Unsuitable or offensive? Report this comment

  • michael stone

    Anonymous | 23-Mar-2013 3:54 pm

    The 6Cs are fine as a description of a good 'mindset', but they do not address implementation: they do not explain how to deal with 'bullying of whistleblowers', etc.

    I do not want to kill the 6Cs - I want to see the necessary enviromental changes, to 'power structures, etc', that would allow clinicians to act ethically and to put the 6Cs into practice, ALSO described by Jane et al, and effected.

    Unsuitable or offensive? Report this comment

  • I think the 6 cs have existed in one format or another for many years.Albeit not formally recognized.
    In order to fully implement these recommendations more staff are needed and more compassion for the staff trying their hard pressed best to implement these findings properly!!
    The 6cs should NOT be dead as I think they form the basis of good old fashioned nursing care. Enabling a person and not a condition to be seen??

    Unsuitable or offensive? Report this comment

Have your say

You must sign in to make a comment

Please remember that the submission of any material is governed by our Terms and Conditions and by submitting material you confirm your agreement to these Terms and Conditions. Links may be included in your comments but HTML is not permitted.

Related Jobs