Policy briefing: Leading Change, Adding Value

Ten commitments in new nursing and midwifery framework explain how staff can transform health and care sectors

Essential facts

Leading Change, Adding Value is NHS England’s new nursing and midwifery framework. It builds on Compassion in Practice (CiP), which set out the 6Cs. While CiP established the values of nursing and midwifery, the new framework explains how staff can help transform the health and care sectors to meet the aims of the NHS England’s Five Year Forward View.

Main arguments

The NHS, like the rest of society, is changing, the document says. As the population ages, the focus of services is shifting from curing illness to helping people manage their health. Technology allows self‑management to take place in people’s homes and the community, rather than hospitals and GPs. As a result, more is being asked of nurses, midwives and care staff in the work they do and the boundaries they cross. 

What are the aims

The framework describes a ‘triple aim’, a term coined by the Five Year Forward View. This involves creating better outcomes and experiences for people, and ensuring a better use of resources. The framework states that, to meet the triple aim, the profession must focus on ‘high value’ activities, while phasing out those of ‘low values’. To help staff achieve this, it sets out ten commitments.

The ten commitments

  1. Promote a culture in which improving the population’s health is core.
  2. Increase the visibility of leadership and input in prevention.
  3. Work with individuals, families and communities to equip them to make informed choices and manage their health.
  4. Focus on individuals experiencing high-value care.
  5. Work in partnership with individuals, their families and others important to them.
  6. Actively respond to what matters most to our staff and colleagues.
  7. Lead and drive research to evidence the impact of what we do.
  8. Have the right education, training and development. 
  9. Have the right staff in the right places at the right time.
  10. Champion the use of technology.

What others say

  • The RCN says the framework is right to acknowledge that nurses and midwives are the backbone of the NHS, but warns that ‘lack of resources’ remains the biggest challenge.
  • The Royal College of Midwives says the aims are laudable and if met will go a long way towards improving the nation’s health.

Implications for nurses

Chief nursing officer for England Jane Cummings wants nurses and midwives to embrace the framework and help ‘shape the future’.

‘This framework encourages us all to reach further individually and collectively. To do this we need to focus on what is important, and to connect with each other so we achieve more for patients and our professions.’ She believes that if this is done, the effect could be immense across the NHS, and the social care sector, where 50,000 nurses work.

‘The role played by nursing, midwifery and care staff should not be underestimated. We are on hospital wards caring for people, out in the community, care homes, academia, sitting on boards, developing policy and in the private sector.’

Ms Cummings says the framework and the 10 commitments that underpin it can help to make care more efficient, reduce unwarranted variation and prevent ill health.

‘The leadership potential in our workforce is boundless. From addressing differences in the incidence of pressure ulcers, to changing pathways of care and support in diagnosing diabetes, nursing, midwifery and care staff are ideally placed to be leading that change.’

Expert comment

Expert comment: Tricia Scott, Emergency Nurse consultant editor

Tricia Scott, principal lecturer and emergency care research lead at the Centre for Research in Primary and Community Care, University of Hertfordshire, and Emergency Nurse consultant editor

‘This framework builds on the compassion in care agenda by focusing on strengthened leadership capacity and announces 10 commitments to enhance care. Essentially, nurses will need to release their leadership potential, be courageous and empowered to make leadership decisions locally. To do this their argument for change needs to be evidence-based and strategically implemented, which may require further investment in pre-registration and continuous professional development programmes and in research. In the emergency setting, each and every practitioner and allied health worker needs to have a shared goal: to make every person’s health a priority. The public place immense trust in emergency practitioners when they are at their most vulnerable so emergency nurses should rise to this challenge to provide safe care for better patient outcomes.’


Leading Change, Adding Value and related resources are available to download at

Compassion in Practice resources are available at

The Five Year Forward View is at

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