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Biggest challenge has been wanting to do more, says outgoing chief nurse

Chief nursing officer for England Jane Cummings hopes her legacy will be a more ‘balanced’ image of nursing as the NHS looks to the next 70 years

Chief nursing officer for England Jane Cummings hopes her legacy will be a more ‘balanced’ image of nursing as the NHS looks to the next 70 years


With five months left in post, England’s chief nurse aims to deliver two initiatives that
will boost the image of the profession. Picture: Grant Humphreys

After six years as chief nursing officer for England, Jane Cummings is stepping down. Her time in the post has coincided with arguably the most difficult period in the history of the NHS: escalating demand clashing with tightly controlled (many would say woefully inadequate) funding and unprecedented scrutiny of services in the wake of the Francis report into the Mid Staffordshire scandal.

Not a single bit of progress can have come easily to this CNO. Yet she insists there has been progress.

‘I haven’t been able to access lots of money to do all the nice things I wanted to do. Incentivising people to do things, without lots of money, has been quite a challenge’

‘The biggest challenge has been wanting to do more but not being able to because of significant financial pressures and increasing demand,’ she says. ‘I haven’t been able to access lots of money to do all the nice things I wanted to do. Incentivising people to do things, without lots of money, has been quite a challenge.

‘You have to think differently about how you make improvements. But when I look back at the six years, we have achieved quite a lot, despite that very difficult financial situation.’

Negative media coverage

When I ask her what the highlight has been, she doesn’t hesitate.

‘Compassion in Practice [the nursing strategy] and the 6Cs, which I developed in 2012, are the things most people associate with me. I wanted to be on the front foot before the Francis report came out. It was clear that nursing was going to be criticised and of course it was.

‘As a profession we could wait until someone told us what to do or we could come together, agree what was right and sort it out’

‘It was also clear that nurses felt quite got at, there was a lot of negative media coverage about nursing being uncaring.

‘I felt as a profession we could wait until someone told us what to do or we could come together, agree what was right and get on and sort it out. And that’s what led to Compassion in Practice being published.’

Pressured but not beleaguered

Despite the very real pressures on nurses in understaffed services, they are not, she believes, in the beleaguered state they were around the time the Francis report came out in early 2013. 

She says the latest NHS patient satisfaction survey was positive and nurses are the most trusted healthcare profession. The importance of the nursing workforce has been accepted and nursing shortages on hospital wards are highlighted, when not so long ago they would have been glossed over.

And she is adamant that the NHS, in its 70th anniversary year, is in better shape than it is often given credit for: ‘The NHS has been under huge pressure for quite a while now but despite that, it does deliver very good care. That’s not to say it can’t do better.’

‘The NHS has been under huge pressure for quite a while now but despite that, it does deliver very good care. That’s not to say it can’t do better’

We met just after the prime minister announced a funding deal for the NHS that will see its annual budget increase by an average of 3.4% over the next five years, £20.5 billion by 2023. This five-year commitment by the government will, she is confident, put the NHS on a surer footing. ‘It will help us look at the next five years with certainty – and help us develop a long-term plan for improvement,’ she says.


Professor Cummings: ‘If you have discussions with ministers you have a duty to keep
a level of detail confidential. It’s quite frustrating at times.’ Picture: Barney Newman

Picking up the challenge

Professor Cummings has announced her departure now because ‘it is time for someone else to pick up that challenge. In terms of the new strategy, having someone who can commit for two to three years is important’. Another factor is the alignment between NHS Improvement and NHS England, which will mean one chief nurse leading an integrated nursing team – a change she welcomes.

‘Some people expect me to behave like a trade union leader, but I’m a professional leader’

There has been criticism that the funding deal is not enough to rescue a health service in crisis, and scepticism about how the money will be found. Professor Cummings knows that when she welcomes a government announcement, or says something positive about the state of the NHS, she will be criticised on social media for being out of touch, but she insists that she is not being naïve. ‘It’s part of my job and the media’s job and all our jobs to reflect the reality – it’s about having a balanced approach.’

It is also part of the CNO’s role to be discreet and not alienate the people she hopes to influence. ‘Some people expect me to behave like a trade union leader, but I’m a professional leader. And of course, if you provide advice and have discussions with ministers you have a duty to keep a level of detail confidential. It’s quite frustrating at times because you can’t say things [publicly].’

‘Outcomes are pretty good’

She says the NHS treats one million people every 24 hours and the great majority of those receive good care. ‘This winter was very, very difficult but our outcomes are pretty good.’

She cites the Commonwealth Fund report last summer, a comparison of healthcare systems in 11 wealthy countries, which highlighted the NHS’s efficiency and gave it an overall top ranking. However, on outcomes the UK was rated second from last – only above the US.

‘The NHS needs to be a much more flexible employer. If you talk to newly qualified nurses they want to work much more flexibly’

Professor Cummings believes that there are risks in defending the NHS and nursing by constantly dwelling on crisis. ‘Yes, the pressures are huge, and we have a global shortage of nurses – when you look at the Nursing Now campaign it is very clear that this is not just happening in the UK or in England.

‘But we need to make sure that by talking about crisis all the time we do not put people off because they believe that things will never get better. We have to give hope because we want people to join the profession and we want people to stay in the profession.’

Focus on sharing solutions

Instead of a story of an overwhelmed NHS, which only demoralises staff, a more sophisticated narrative is needed that focuses on unwarranted variation and solution sharing, she says. ‘It’s about learning new ways of doing things and learning from the best.’

She gives the example of the PJ Paralysis campaign, which she launched in March, potentially having an impact on delayed discharge. ‘About 50% of the delays are down to the NHS, not local authorities, but there are things we can do.

‘Some of the anecdotal feedback [on PJ Paralysis] is that people’s length of stay is down because they are up and they are dressed. We have seen a recognition that patient time is important.’

Professor Cummings gives the impression that she is looking forward to her final five months in post, because she will be focusing on two things she feels passionately about – the first national recruitment campaign for nurses, to launch on 3 July, and a programme to improve the image or perception of nursing in the NHS. The launches have been timed to coincide with the NHS 70 celebrations.


Campaigns should present the reality of nursing, but also how rewarding it is, says the
chief nurse. Picture: John Houlihan

Telling a balanced story

She insists the initiatives will not ‘hide from reality’ but rather tell a ‘balanced’ story, one that shows how rewarding nursing in the NHS can be. ‘It is a busy job, it’s a hard job, but it’s a fantastic job – and the NHS is a fantastic place to work.’

The recruitment campaign – which will include TV ads and coverage in mainstream media and social media – will emphasise the breadth of nursing, that it is not just about working in a hospital.  It will also point out that pay and conditions are better than people often imagine to be the case.

‘The NHS is more than any government at any one time, it is something the British public wants and have said they are most proud of’

Six hundred ambassadors will work on the campaign, and Professor Cummings will also have the support of nurse author, and keynote speaker at this year’s RCN congress, Christie Watson.

Alongside the campaign will be work with employers. ‘The NHS needs to be a much more flexible employer. If you talk to newly qualified nurses they want to work much more flexibly.

‘When I qualified, working part-time or travelling the world for a bit wasn’t what you did. We need to recognise that there are quite a few people now who want to work differently.’

After nearly 40 years in the NHS, Professor Cummings’s own career is at a crossroads, not an end. ‘I’m not retiring – I’m retiring from this role. I’ll keep my options open.’

Passionate about the NHS

So we will hear from her again? ‘I’m sure you will, I’m too passionate about the NHS not to do something,’ she says.

But will the NHS still be around in another 70 years? She laughs at the question - the idea that the NHS is so vulnerable it is on the brink of collapse, or that this government is not committed to its future, strikes her as ludicrous.  Ultimately, however, she sees it as an institution beyond politics.

‘The NHS is more than any government at any one time, it is something the British public wants and have said they are most proud of. The British public will keep the NHS going. The people I speak to day in, day out want it to continue.’


Thelma Agnew is commissioning editor, Nursing Standard


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