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Susan Aitkenhead: National framework for nursing, midwifery and care staff will ensure our contribution is recognised

Leading Change, Adding Value (LCAV) puts a new emphasis on measuring improvement. With the framework’s support, the ‘hidden’ achievements of nurses will be highlighted and unwarranted variation in care addressed, says NHS England’s Susan Aitkenhead

Leading Change, Adding Value (LCAV) puts a new emphasis on measuring improvement. With the framework’s support, the ‘hidden’ achievements of nurses will be highlighted and unwarranted variation in care addressed, says NHS England’s Susan Aitkenhead


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LCAV was launched as the national framework for all nursing, midwifery and care staff by England’s chief nursing officer Jane Cummings in May 2016.

Comprehensive stakeholder engagement had established strong support for a follow-up national framework to Compassion in Practice (2012) when it concluded.

It was agreed that there was an opportunity for a new framework to take a different approach and to clearly demonstrate the contribution that nursing, midwifery and care staff are bringing to the transformation work occurring across the health and care sectors in England.

Everyone can lead

‘Everyone can lead change, no matter what their role and wherever they work’ is the ethos of the framework. It goes without saying that nursing, midwifery and care staff are uniquely placed to understand what needs to change or could be changed to improve services, experiences and outcomes for patients, individuals and populations as part of their everyday practice.

However, much of this essential work often remains hidden or misunderstood, as some of it is not easily measured, captured or shared.

The framework aims to support us in truly considering the outcomes of our work. It helps us to question whether there is always a measurable positive difference achieved in experience, outcomes and the use of resources.

It also helps us look at where there is ‘unwarranted variation’ – inequalities –  and change them. This is an opportunity to make sure everyone can receive the same high standards of care.

LCAV emphasises the need for us to place the same importance on quantifying and measuring improvements as on the significance of always demonstrating quality at the centre of all that we do.

By achieving the triple aim of improving experience, outcomes and use of resources we can demonstrate the vitally important contributions of the professions to national, regional and local work, and their leadership in the wider system.

Atlas of learning

The end product of the formal three-year programme of LCAV will be the bringing together of an ‘Atlas of Shared Learning’. The atlas will clearly demonstrate how nursing, midwifery and care staff across the system have strongly led and contributed to the Five Year Forward View (NHS England 2014) and other national programmes such as All Our Health (Public Health England 2015), and the Shape of Caring (Health Education England 2015).

It will enable colleagues to source and implement learning on where unwarranted variation in care has been identified and addressed through nursing, midwifery and care staff leadership and the resulting improvement of outcomes, experiences and use of resources. Case studies are being collected and information on this can be accessed here.

LCAV was co-developed with colleagues from a wide range of national organisations, practitioners, people we care for, carers and the public. This ongoing and crucial partnership working across what can be a complex system ensures that the implementation of the framework is applicable for all nursing, midwifery and care staff in this time of change.


Susan AitkenheadSusan Aitkenhead is NHS England director of nursing, professional development, and the senior responsible officer for national implementation of Leading Change, Adding Value

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