Leadership and efficiency – chief nurse’s vision for better outcomes

Better patient outcomes and experience, as well as better use of resources for nurses and patients, are the aspirations of a new NHS England strategy.

Picture credit: Grant Humphreys

England’s chief nursing officer Jane Cummings, pictured, has just published a framework designed to help nurses achieve these aspirations. Launched at RCN headquarters in London, Leading Change, Adding Value is her vision for how nursing will evolve up until 2020.

It attempts to show how nurses can help close gaps in health and wellbeing, care and care quality, funding and efficiency. All this, while practising the 6Cs of care, compassion, communication, courage, commitment and competence.

The 133-page document highlights the need to focus on inconsistencies in outcomes, patient experiences and use of resources that cannot be explained away by factors beyond nurses’ control, such as geography, demography or infrastructure.

‘Nothing this recommends can happen without the right number of nurses’

The report, the successor to her 2012 Compassion in Practice strategy, which introduced the 6Cs, predicts greater teamwork across traditional care boundaries. It also expects nurses to work increasingly beyond hospitals to promote healthy lifestyles direct to the community.

‘This is about putting patients and their families first and health staff working together across organisational boundaries. Together we can create a sustainable, high quality service. We need to take this and look at how we can apply a national framework at a local level. I can’t see anything here other than a fantastic opportunity to drive care forward,’ says Professor Cummings.

The commitments

Jane Cummings has developed ten pledges for managers, nurses and trainers:

1 Promote a culture where improving the population’s health is a core component of the practice of all nursing, midwifery and care staff

2 Increase the visibility of nursing and midwifery leadership and input in illness prevention

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

4 Be centred on individuals experiencing high value care

5 Work in partnership with individuals, their families, carers and others important to them

6 Respond actively to what matters most to our staff and colleagues

7 Lead and drive research to provide evidence of the impact of what nurses do

8 Have the right education, training and professional development to enhance their skills, knowledge and understanding

9 Have the right staff in the right places and at the right time

10 Champion use of technology and informatics to improve practice, address variation in care and enhance outcomes

The framework has been welcomed by the RCN, whose general secretary Janet Davies was a member of the framework’s editorial board.

She says: ‘This highlights the potential of nursing to help shape the future of the health service. It also recognises the importance of public health and prevention, and sets an excellent example of how healthcare staff can make a difference.

‘They now need investment in their education, and support to get the best value from their skills.’

However, the new framework also recognises the pressures nurses face from lack of staff and money by stating that ‘the biggest threat to our capacity to deliver high quality care is shortage of resources’.

The issue of safe staffing is acknowledged: ‘Appropriate registered nurse staffing levels are associated with lower rates of serious incidents including medication errors, falls, poor nutrition and hydration and failure to rescue.’

However, the government refuses to countenance statutory minimum nurse staffing levels. Opponents are likely to feel that without this, the new framework cannot be brought to life as a practical way of improving nursing care.

Safe Staffing Alliance chair Susan Osborne is unimpressed by the framework’s lack of solutions to the staffing problem. ‘We have a severe shortage of nurses but like so many frameworks that have gone before, this fails to address the fact.

‘Nothing it recommends can be implemented without the right number of nurses in place,’ she says.

Established example of excellence

The chief nursing officer’s framework contains case studies to show how nurses are leading the fight against inconsistencies in quality.

Doncaster and Bassetlaw NHS Foundation Trust chief nurse and executive lead for quality and safety Denise Nightingale explains how audits and internal investigations took place in the area’s care homes.

They identified a clear infection prevention and control knowledge gap among staff so brought in a team of specialist nurses to create a communication forum.

This led to the creation of the Bassetlaw Quality Improvement Tool, which has led to improvements in all areas since it was introduced in September 2014.

Ms Nightingale explained how focusing her team ‘on having the right education, training and development to enhance skills, knowledge and understanding’ tied in with the ten commitments the chief nursing officer is asking nurses to make, especially number eight. The visibility and leadership shown by the infection prevention nurses had satisfied commitment two.

Professor Cummings remains proud of the nine months’ work that went into preparing the framework and has pledged to respond in person to as much feedback as possible.

She said her strategy will win back the public’s pride and respect, lost because of care scandals such as Mid Staffs. She adds: ‘I genuinely think this framework puts us in a strong position and allows us to articulate the good that our professions do day in, day out.’

Professor Cummings says every nurse can influence improvement and wants nurses to get involved online by sharing best practice on Twitter using #Lead2Add or by emailing questions and comments to

Go to

This article is for subscribers only