Professor Jane Cummings, the Chief Nursing Officer for England, sets the record straight on the future of nursing

Nursing and midwifery have changed dramatically since the days of Florence Nightingale and I am proud of what we as professions have achieved and continue to achieve.

Today there are more than half a million registered nurses and midwives in England with 50,000 working out of hospital in care homes and the care sector. Alongside them are more than a million care assistants providing support to our most vulnerable.

The number of nurses and midwives continues to rise, but so does the need – we are living longer and that means many of us are living with long term conditions and for many this means more years with complex and serious illness.

The challenge for modern nursing and midwifery is to provide our patients and the people we support with competent, compassionate care that spans working with those we care for, carers and their families to promote physical and mental health and well-being, assess, diagnose and treat complex needs and have a workforce  better able to meet the growing demand on our services and expertise. We need new ways to meet the changing needs of the people we care for.

Equally, we also want to ensure that a career in nursing and midwifery remains attractive and appealing to our existing staff and prospective new recruits.

This year sees the introduction of a new role, the Nursing Associate, an important new addition to our team. Midwifery support workers have been in place for some time as have Associate Practitioners.

A Nursing Associate is not a registered nurse and will not replace them, but they will instead have the training and skills to bridge the gap between what a health care assistant can do and what a registered nurse is now needed to do.

Critics have suggested that this is a cheap replacement for nurses – this is not and must not be the case. This is an opportunity for thousands of talented people to gain the first step on the ladder not just to a job, but to a rewarding lifelong career.

For nurses, they will have additional support and more time freed up to perform the role they are trained to do, assessing, treating and caring for more complex patients.

For healthcare assistants and those who want a career in nursing it provides a new route to achieve this, giving them more skills and competencies with a structured education programme and the potential to go further and become a graduate nurse.

For those we care for this means that they will continue to receive the safe, high quality, compassionate care they deserve.

In practice it will mean that staffing will reflect patient need so in an emergency department or service with lots of patients who need intensive clinical care, there will be more registered nurses.

But in an area where less complex care is needed, there may be more Nursing Associates, freeing up registered nurses to be where they are needed most.

Nursing and midwifery are immensely rewarding vocations with an opportunity to undertake a huge variety of roles and I’m proud that an NHS nurse has a special place in the hearts of the British people. I believe this change will see many people have the chance to progress and for us to collectively lead the way in developing a workforce fit for the future.


  1. Janet Riddell-Heaney says:

    I’m disappointed this is such a political response to the present situation and the future of nursing. Today I watched Sky news to see a GP discussing nursing pay and the future of nursing. Where are the spokespersons for nurses to answer the questions on the profession. We are a profession in our own right not beholden to doctors. There is a crisis in nursing and bringing in yet more lower grades as outlined above does not support the senior grades who are struggling, it minimises what nurses do. This is a critical time for nurses to stand on their own two feet or forget Florence Nightingale and let’s have doctors assistants who are at their beck and call. I am sad at the demise of community nurses sold off by their seniors to local authorities, it is a profession that will disappear if someone doesn’t make sure that governments recognise the necessity of the work nurses do. make that change, stand up for nurses,

  2. Michele Booth says:

    I am also proud to be a nurse and including my training I have worked for 36 years in this profession, latterly in palliative care. Your article suggests there are more nurses than ever before but it doesn’t feel like that in practice. Good experienced nurses are exiting the profession at 55 and there seems to be a real deficit of community nurses nationally. The strain of increasing demand and fewer resources mean the leakage of experienced nurses leaving earlier is turning into a flood. I am very concerned for the stability of the NHS, charities and other sectors. Please can you look at the statistics and spend some days back at the coal face so you can raise these specific issues at the highest level in the DH. There needs to be a national debate in parliament.please contact me if there is anything I can do.

  3. Ranfurly says:

    More beds at home and fewer in hospitals.

    How much will it cost. What will it save? What happens to the saving. Need schedules of the items of care provided in hospital. Need same for a package of care at home. Then set side by side to see how each compares.
    How watertight will the system be when the carer doesn’t turn up. Do I starve? Do my vital pills get overlooked and I die? Do I lie in excrement for over 24 hours? Do I get infections from bed sores? Septic infections? How often does the consultant doctor see you. And not the junior doctor? What’s the difference between Care which I would need at home and the same but administered by a nurse in hospital? Who provides and who does the laundry?
    How much longer do I have to wait if my body suddenly does not function properly? But in a situation where ambulance services refuse to collect.
    Cummings should have checked the press release to avoid misinterpretation.
    I really dont want such an immature person running the NHS.

  4. joyce brand says:

    It is truly disheartening to see the NHS senior professionals lining up behind Hunt and co. How very convenient, just as the NHS is being starved of money the new gospel is ‘home is best’ and hospital actually damages the patient. Given that the NHS now seems to be about pushing out propaganda rather than concentrating on supporting staff and ensuring their on-going training it is not surprising that Prof. Jane Cummings should speak as she does, after all those in the NHS who speak out about the disastrous loss of money, the not even covert privatisation are unlikely to find themselves at the top of the career ladder.

  5. Kassander says:

    Oh dear. Oh dear.
    Censored again.
    Ms Cummings is the NHS England Board Exec. Director responsible for PPPI (Patient and Public Participation and Involvement), At September’s Board meeting she presented her proposals for the NEW Citizen-Gather online P&P discussion forum. The so-called replacement for the version unilaterally closed by Ms Anu Singh last Spring.
    This censoring and the astonishing overnight closing of a Digi-Voice for 3 000 members says little for the freedom of expression in the NEW G-G online.
    Mind you, that project was promised for Mid October (2016).
    Not a bit nor byte from it yet.

    • NHS England says:

      Hi Kassander,

      I can confirm that your comment has been posted. Apologies for the delay, we have been extremely busy during the run up to christmas.

      Kind regards
      NHS England

  6. KASSANDER says:

    This will not do Ms Cummings
    You are aware or should be that the critiques of Nursing Associates are focussed on professional matters Yet you have chosen to set up a straw nurse
    “Critics have suggested that this is a cheap replacement for nurses – this is not and must not be the case”
    Having done so you make a promise that you cannot possibly guarantee will be kept
    Might one suggest that you withdraw this article and issue a response which addresses head-on the concerns published widely?
    What your original article and this one does show is that NHSE for all its protestations of Consultation and Involvement is failing on those fronts Not for want of effort But listening only to your
    hand selected uncritical friends
    self-appointed Patient Leaders
    faux P&P reps from the multi£m VCS
    You proved it in the way you and your Dir PPPI Ms A Singh imposed your plans for the new P&P online Citizen-Gather Forum and you’ve done it again with Nursing Associates
    Break this uN-Heathy habit PLEASE

  7. Caroline says:

    Shame on the short-sighted administrators who suggested in the first place that 2 levels of nurse were not needed (when the SEN job was phased out). How long will it be before the ‘associate’ is deemed not good enough and will need to re-train to ‘diploma’ etc. level? Of course, in reality we already have a certain kind of associate nurse, because nurses from other countries won’t have been trained necessarily to the degree-standards expected now in the UK, so is this just formalising that intake of nurse?

  8. I survived NMC says:


    I don’t remember Florence Nightingale trying to gag hospitals, supporting dodgy payoffs or being a trade unionist, I know the lamp wasn’t for shining on (nursing competence) scandals – yes a lot has changed in nursing & midwifery, – are you planning to change it back??????

    “But in an area where less complex care is needed, there may be more Nursing Associates, freeing up registered nurses to be where they are needed most.” I shudder to think where you think this might be….. are there going to be even more scandals for nurses to be needed even more?

  9. Anonymous says:

    Well said – keep saying it!

  10. Anonymous says:

    In the 80,s many experienced and dedicated enrolled nurse were made to feel I inferior and in many cases forced to ‘re train as registered nurses ,Isn’t this the same ,under a different name ,why remove something to bring it back.Would agree it’s a career path but it also suggests if you have a degree you are too good to do basic care.

  11. Micro Doc says:

    Another person blabbering what has been fed into her ears by Jeremy hunt

  12. Mayo says:

    Applied for this position where worked for 9yrs same ward. Not even received not successful. Then hear Hca’s been accepted and only doing work for 2 yrs. Nhs all over
    Short cuts.

  13. mr k watson says:

    The NHS has a special place in the hearts of the British people but does the heart of the NHS have a special place for the nurses, if so why do some nurses feel that they are nobodies.

  14. Susie Taylor says:

    The problem with this is that often the older people who have more “care needs” also have long term complex health needs which require evolving assessment and nursing judgment. How will this work in practice with staffing ratios?