Policy briefing: Leading Change, Adding Value

An examination of NHE England's new nursing framework.
Leading Change Adding Value
Essential facts

Leading Change, Adding Value is NHS England’s new nursing and midwifery framework. It builds on Compassion in Practice (CiP), which three years ago introduced the 6Cs – compassion, care, commitment, courage, competence, communication. The new framework sets out how staff can help the health and care sectors to meet the aims in NHS England’s Five Year Forward View.

Main arguments

The NHS, like the rest of society, is changing, the document says. The longer ageing population means the focus has shifted from curing illness to helping people manage their health. Technology allows that to be done away from the traditional hospital and GP model, in people’s homes and in the community. The result is that more is being asked of nurses, midwives and care staff in terms of the jobs they do and the boundaries they work across. 

What are the aims?

The framework talks about the ‘triple aim’, originally coined by the Five Year Forward View, which involves creating better outcomes, better experiences for people and better use of resources. This requires the profession to focus on ‘high value’, while having the courage to phase out ‘low value’ activities.

It sets out ten commitments for staff.

The ten commitments
  1. Promote a culture where 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 and at the right time.
  10. Champion the use of technology.
What others say

The RCN says the framework is right to acknowledge that nursing and midwifery staff are the ‘NHS’s backbone’. It cites the role of prevention, tackling health inequalities and sharing excellent work as key factors in improving care, but warns ‘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.

Find out more

NHS England – Leading Change, Adding Value

NHS England – Compassion in Practice 

NHS England – Five Year Forward View 


Expert comment

‘I welcome the collaborative approach to the new nursing framework. It engages not only nurses and “people”, but important partners, in particular social care and housing. Public health must progress beyond health promotion, prevention, and protection, towards theories of health creation.

'This means breaking the nursing tradition from caring for communities to caring with them. Nurses and local people must share the control over public health approaches to create the conditions needed for the most disadvantaged communities to survive and thrive.

'Health inequality is the most significant challenge of our time. We need to get the focus right. I hope we can use this opportunity to significantly narrow the gap in life expectancy between advantaged and disadvantaged communities’

Heather Henry, co-chair of the New NHS Alliance


Implications for nurses

Chief nursing officer for England Jane Cummings wants every nurse and midwife to embrace the framework.

‘This framework encourages us all to reach further, individually and collectively,' she says. ‘To do this we need to focus on what is important and connect with each other so we achieve more for patients and also for our professions.’

Immense impact

She believes the impact could be immense across the health and social care sector, where 50,000 nurses work.

‘The role nursing, midwifery and care staff play 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.’

She says the strategy and the ten commitments can be used to transform care for the better, making it more efficient, reducing unwarranted variation and preventing ill-health.

‘The leadership potential in our workforce to manage the challenges of today and shape the future 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.’