Clinical update

Policy update: Leading Change, Adding Value

New NHS England nursing and midwifery framework sets out how to transform the health and care sectors
Leading change, adding value book cover

Essential facts

Leading Change, Adding Value is NHS Englands new nursing and midwifery framework. It is designed to build on Compassion in Practice (CiP), which was published 3 years ago and set out the 6Cs compassion, care, commitment, courage, competence and communication. CiP established the values at the heart of nursing and midwifery, while the new framework sets out how staff can help transform the health and care sectors to meet the aims set out by NHS Englands Five Year Forward View.

Main arguments

The NHS, like the rest of society, is changing, the document says. The 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 peoples homes and in the community. The result is that more is being asked of nurses, midwives and

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Leading change, adding value book cover

Essential facts

Leading Change, Adding Value is NHS England’s new nursing and midwifery framework. It is designed to build on Compassion in Practice (CiP), which was published 3 years ago and set out the 6Cs – compassion, care, commitment, courage, competence and communication. CiP established the values at the heart of nursing and midwifery, while the new framework sets out how staff can help transform the health and care sectors to meet the aims set out by NHS England’s Five Year Forward View.

Main arguments

The NHS, like the rest of society, is changing, the document says. The 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’. This was originally coined by the Five Year Forward View and involves creating better outcomes, better experiences for people and better use of resources. The strategy says this will require the profession to focus on ‘high value’, while having the courage to phase out ‘low value’, activities. To help staff achieve this, it sets out ten commitments.

The ten commitments
  • Promote a culture where improving the population’s health is core.

  • Increase the visibility of leadership and input in prevention.

  • Work with individuals, families and communities to equip them to make informed choices and manage their health.

  • Focus on individuals experiencing high value care.

  • Work in partnership with individuals, their families and others important to them.

  • Actively respond to what matters most to our staff and colleagues.

  • Lead and drive research to evidence the impact of what we do.

  • Have the right education, training and development.

  • Have the right staff in the right places at the right time.

  • 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 that the ‘lack of resources’ remains the biggest challenge.

The Royal College of Midwives says the aims are ‘very 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 each and every nurse and midwife to embrace the strategy and help ‘shape the future’. 

‘This framework encourages us all to reach further both individually and collectively. 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.’

She believes if that is done the impact could be immense across the health and social care sector.

‘The role that 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, which underpin it, 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.'

 

Expert comment

Expert Susan Osborne

Susan Osborne, chair of the Safe Staffing Alliance, London

‘I was disappointed with this document as it reads like 'motherhood and apple pie' issues – a lot of words and little action, silent on statistical or research evidence and no mandate to provide funding for the initiatives mentioned. It makes no reference of the severe problems the NHS is experiencing, including the shortage of registered nurses and midwives and nothing about the shortage of children's nurses in the NHS, social care and local authorities.

‘It acknowledges variation in the health service, but this could be remedied if there were mandated safe staffing levels across all sectors including children's services. There is already a recognition that on children's wards there should be a ratio of 1:3 or 1:4 depending on the speciality.'

 

Find out more 

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

Compassion in Practice resources

The Five Year Forward View

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