A strategy to put nurses in the driving seat

Key aspects of the new strategy for nursing and midwifery will be revealed at the chief nursing officer for England’s summit. CNO Jane Cummings reveals how the strategy is a response to national policies aimed at improving services in an NHS living within its means. The current strategy, Compassion in Practice, attempted to restore nursing’s reputation. Its successor will help nurses to think differently and drive change.

In early November I met Jane Cummings at her London office to discuss the new strategy for nursing and midwifery. The chief nursing officer for England would, I suspect, object if I called it ‘her’ strategy; several times she points out it is not a top-down initiative. The strategy owes its existence – not just its content – to the nurses and midwives who have contributed ideas to it, a process that began back in May.

‘One of the questions we asked, right at the beginning, was do we need a strategy?’ says Ms Cummings.

The answer was resoundingly positive. In one questionnaire, completed by 2,800 nurses, 93% said ‘yes’. ‘They wanted an overview to support the development of the profession.’

The discussion process will end next week when the draft strategy is revealed at the CNO’s annual summit in Birmingham, a gathering of around 500 senior nurses. Ms Cummings will explain the strategy and those in attendance will be able to comment. Feedback may well give the strategy a final polish, but fundamental change is unlikely. ‘We’ve had a lot of engagement already,’ she says. ‘I’d be surprised if the strategy changed a lot but we are open to debate.’

We asked right at the beginning whether we needed a strategy, and nurses answered ‘yes’

Since early in the process, discussion has focused on five themes: population health and prevention; the personalisation agenda – ensuring individuals have choice and control over their care; productivity, safety and effective staffing; service transformation, innovation and improvement; and building and sustaining the future workforce.

Jane Cummings wants to ‘enable people to work and act differently’

Picture credit: Barney Newman

The emphasis in these themes has been changed slightly, reveals Ms Cummings, to cut down on the jargon and improve clarity. Take population health and prevention: ‘This is about “our health” – making it meaningful to the individual. When we are writing a vision for the future what is the nursing contribution? Let’s talk about it in a way that the public can understand.’

Similarly, the personalisation agenda will be presented as ‘my health’; ensuring productivity and safe staffing becomes ‘keeping me safe – having the right staff’.

The need to look after NHS staff was always going to be a theme, but it will now be central to developing and sustaining the workforce.

One of the six action areas in the current nursing strategy, Compassion in Practice, is of course ‘supporting positive staff experience’, which points to the evidence about staff experience and quality of care, and states that staff need to be supported and nurtured to do their job well. Ms Cummings suggests the new strategy will go further: ‘It has to be built on – the evidence is clear.’

Compassion in Practice was developed under the long shadow of the Mid Staffs scandal. ‘It was right for the time and we delivered an awful lot of good things.’

Perhaps its most notable achievement was to re-assert the core principles of nursing at a time when the public – and a minority in the profession – had lost sight of them. The 6Cs – care, compassion, competence, communication, courage and commitment – underpinned the strategic plan of Compassion in Practice.

The feedback says people want the 6Cs to continue as an organising principle

Ms Cummings says research by Middlesex University found that of 2,200 staff, 91% of respondents were aware of the 6Cs, compared with 80% who knew about Compassion in Practice. Indeed, she comes close to suggesting that the 6Cs may have been a little too successful: ‘The 6Cs were the thing that really took off and they may have overshadowed some of the detail of the strategy.’

So what will happen to the 6Cs now? Will they expire when the new strategy arrives in the spring? ‘The overwhelming feedback is people want the 6Cs to continue as an organising principle. We won’t spend a lot of time talking about them because they are well known, but they will definitely carry on,’ says Ms Cummings.

Arguably, Compassion in Practice is a definition and a defence of nursing. The new strategy will look outwards, be more ambitious. The principle of compassionate care will continue, but ‘we have moved on a long way,’ says Ms Cummings. ‘There’s an understanding that we do deliver the values of the 6Cs.’

The challenge now, she says, is to ensure nurses take the lead in implementing national health policy and in solving longstanding problems such as variation in the quality of services.

The new strategy will attempt to respond to the big issues facing the health service. ‘What is the nursing and midwifery contribution to the Five Year Forward View, the new models of care and supporting the vanguards? What is the nursing contribution to improving variation and ensuring the right care is delivered all the time? How can we put ourselves in a position where we drive change?’ says Ms Cummings.

I ask her if the strategy will resemble a set of commitments – things nurses should do – or a wish list aimed at government and employers, setting out the conditions needed for nurses to achieve their potential. ‘I don’t think it will be one or the other,’ replies Ms Cummings. ‘There will be a set of principles, a framework that will be developed nationally but can be implemented locally.’ It will include, ‘things that can be done by the individual’.

Compassion in Practice has been criticised for being too hospital-focused. Ms Cummings wants the new strategy to be relevant to nurses across boundaries: ‘What you do is much more important than which organisation you work for’. She adds the aim is to ‘create a lot more energy’ and connections via patient and professional networks and social media.

This needs to be meaningful to an individual member of staff – not just a load of words

The CNO is developing in the strategy a vision for nursing, but she wants it to be grounded in today’s reality. ‘It needs to be tangible and meaningful to an individual member of staff – it can’t just be a load of words.

‘What I don’t want is a document that is beautifully written and sits on a shelf, or on a website, and is not really used. We want something that will enable people to work and act differently.’

Ms Cummings also emphasises that the strategy’s impact will be measured: ‘We are aiming to build in evaluation from the beginning. With the benefit of hindsight, we could have done that better last time’.

The new nursing strategy and the CNO summit: part of a movement for change

The CNO sees the new nursing strategy as part of a movement for change that includes the models of care being ushered in by the Five Year Forward View and the ideas being generated by the vanguard sites.

But given that the Forward View already exists – setting the direction of travel for everyone working in health – do we even need a nursing strategy? In a recent article in the RCNi journal Primary Health Care, independent consultant Deborah Sturdy, a former adviser for older people at the Department for Health, said having a nursing strategy separate to the Forward View was ‘unhelpful… particularly when you think of the cost, time and effort involved’.

But Ms Cummings insists the nursing strategy adds detail to the Forward View. ‘I think there is something valuable about articulating what the nursing and midwifery contribution is – and it is certainly what people have asked for.’

The strategy arrives at a time when nurses and midwives are getting to grips with revalidation, which requires them to reflect on their practice against the requirements of the new code of conduct; and then there are the 6Cs.

But where a sceptic might see the strategy landing in a crowded field, Ms Cummings sees a helpful alignment of positive influences for change. ‘The strategy will be very positive, very constructive. It will give people a clear sense of the five key areas where we have the biggest contribution. The point of it is providing something that nurses can use.

‘The principles in the strategy are not something I would expect nurses and midwives to reel off. It is about how we can use a new vision to make changes locally, it’s about thinking differently.’

Part of that thinking has to be about making the best use of NHS resources in a tough funding climate. The theme of the CNO’s summit next week is ‘leading change and creating value’, and the programme emphasises efficiency and productivity, as well as quality. ‘There are opportunities to be more productive and more efficient – but that has to be done alongside improving outcomes, ‘It’s not one or the other,’ says the CNO.

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