Variations in healthcare: how you can help close the gap

Health Education England and NHS England have developed an e-learning tool to help staff identify variations in care and lead change

Health Education England and NHS England have developed an e-learning tool to help staff identify variations in care and lead change

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Raising the Bar: Shape of Caring, the Health Education England-commissioned review of education and training for nurses and care assistants, emphasised the vital role these staff play in enabling services to meet the complex challenges of today and tomorrow. They provide compassionate care and support in times of ill health, and also enable people to stay healthy and maintain their independence.

The work to deliver the key themes in Shape of Caring, and those in NHS England’s Leading Change, Adding Value, the national framework for nursing, midwifery and care staff, have many synergies, including addressing unwarranted variation.


Leading Change, Adding Value supports colleagues to demonstrate the contribution the professions make to narrowing the gaps set out in the Five Year Forward View and other national programmes and priorities.

Across the health and care system, staff at all levels are leading a significant programme of work to address inequities in health and well-being, care and quality, and the use of vital resources.

The priority for Health Education England is to develop a workforce with the right skills and values to deliver optimal care for patients. Nursing, midwifery and care staff are a central driving force in ensuring high quality, safe, patient-centred care within a wider multidisciplinary team.

Improving the quality and outcomes of care by reducing unwarranted variation requires, for many, a new way of working and, at times, a new language. To meet the triple aim of better outcomes, better experiences and better use of resources, colleagues across the system need to be equipped with the knowledge and capability to deliver the Leading Change, Adding Value framework within the context of their roles.

To support this, HEE and NHS England have, with e-Learning for HealthCare, co-developed a free-to-access Leading Change, Adding Value e-learning tool. This supports the partnership approach of implementing and embedding the framework across health and care.

The e-learning tool is available to all nursing, midwifery and care staff. A pdf version is also available.

Leading the change that is needed

Both the Shape of Caring and Leading Change, Adding Value position nursing, midwifery and care staff as leaders in managing the challenges of today and developing services for the future.

The aim of the e-learning tool is to provide an opportunity to develop and reinforce the knowledge and skills within the nursing, midwifery and care workforce to support understanding of the impact of unwarranted variation on individuals and populations, and help lead the change required to address it.

These staff form the largest proportion of the health and care workforce, and they work with individuals and communities of all ages and across all sectors.

Quantifying the value of nursing

Evidence from the World Health Organization (WHO) Health 2020 report shows that new models of care lead to cost-effective, people-centred services with better outcomes.

However, the report also warns that the work of nursing, midwifery and caring staff is still undervalued. It is vital that the professions do not assume that their work and the resulting outcomes are always understood and recognised.

Both the Shape of Caring and Leading Change, Adding Value, which we hope has been strengthened by the new e-learning tool, support nursing, midwifery and care staff to clearly quantify our positive contribution and the key leadership role we have in caring for individuals and populations for generations to come.

Access the e-learning tool here

Liz Fenton is deputy chief nurse, Health Education England

Kate Lievesley and Susan Aitkenhead are based in the nursing directorate, NHS England

Further information

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