Nurses are central to a transformation in care

On International Nurses Day, England’s Chief Nursing Officer, Jane Cummings, reflects on changes to nursing and how the NHS needs an ‘adapt and change’ culture:

Nursing has changed dramatically in the 150 years since Florence Nightingale founded the first nursing school in London – undoubtedly for the better.

While compassionate care is still the guiding principle, advances in science and technology and changing health needs have seen nursing roles change dramatically.

Most nurses now either have a degree or are studying for one. This is testament to advances in nursing and the skills needed to be a nurse.

Nursing will never be an easy career option – we care for patients from birth to death, supporting them through the best and worst moments of their lives. It can be hard, emotionally draining but an enormous privilege.

In recent years the number of nurses continues to rise, although at the same time, demand is greater than ever. In the decade since 2002/03, emergency admissions staggeringly rose by almost a third. Nurses are seeing more patients, with more complex and serious conditions than ever before.

The modern nursing challenge is to deliver consistent and improving high quality care despite this growing demand.

I spend much of my time with nurses and I see the pressure they face. I am consistently overwhelmed by their determination to do the very best for their patients. I am as proud today to be a nurse as I was when I qualified over 30 years ago.

In the face of these pressures, it is clear that we need to change and transform the service. We need to up the pace of radical change if we are to truly respond to the lessons of Mid Staffordshire, Winterbourne View and the needs of our population.

The pressures are not insurmountable and NHS England is determined to meet the challenges and drive up the standard of patient care.

While nationally, we have a duty to provide guidance and leadership, the specific response needs to be locally determined in partnership with patients and the local population. We need to think and do things differently right across the health and care sector – each of us and every organisation needs to step up to the plate and be accountable.

It is unanimously agreed that we need better, integrated and preventative person-centred care – supporting patients in their communities and homes and reducing the need for hospital care.

What is less tangible is a need for widespread cultural change in the way we approach healthcare. Nurse staffing is a prime example. The public debate around staffing levels quite rightly continues.

This is a priority in the nursing and care strategy and at the end of last year, I published guidance on nurse staffing with the National Quality Board. With the Department of Health, we have also commissioned NICE to look at the evidence on adult hospital wards and make recommendations on determining nurse staffing. This will be published for consultation imminently.

This is part of the sophisticated, evolving approach to staffing that we need. Each ward in each hospital around the country is different in size, number of patients, the type of patients and acuity of condition. Likewise, each community is different – rural Cumbria is very different from inner city Birmingham.

We need a culture of using hard evidence and local professional judgement to determine the right team of staff with the right experience in each situation and a culture of support to speak out when something isn’t right. Evidence increasingly shows that this approach directly correlates with better care and a positive patient experience.

Public accountability will intensify – more Trusts are publishing actual versus planned nurse staffing levels shift by shift and are being publicly held to account. Together with the CQC we have asked all Trusts to ensure they are doing this by the end of June.

We also need an NHS that is truly representative of the communities it serves and Equality and Diversity week this week reinforces that we must step up the pace on this. Society is now more multi-layered and multicultural. Yet the NHS seriously lags behind in its BME representation, particularly in the most senior positions.

There is increasing evidence that diverse teams make better and safer decisions which leads to better patient outcomes and better staff experience. Why? Because these teams are more representative of the communities they serve when making decisions. The NHS must reflect and act on important works such as Roger Kline’s recent publication, ‘The snowy white peaks of the NHS: a survey of discrimination in governance and leadership and the potential impact on patient care in London and England’ (Kline 2014).

What comes through strongly is that widespread cultural change is needed. As NHS Leadership Academy Guidance underlines, it is not enough to simply change the membership or diversity of Trust Boards to make them more representative of local communities and the workforce they lead.

We must continually challenge ourselves. We need a culture of reflection and learning and of respect and understanding. While these may seem like woolly concepts, the most difficult transformation often isn’t easily tangible – which makes is so hard to grasp. We need an NHS that truly embraces equality and diversity and represents all demographics.

This is a priority for me and there needs to be continued challenge across the health and care sector, in the media and through academia and social commentary.

This week I had the privilege to celebrate International Nurses Day with qualified nurses, student nurses and military nurses from around the country at the Florence Nightingale Service in Westminster Abbey. It was a fabulous experience and truly recognised the significant role nurses play.

Over the years, healthcare demand has changed beyond recognition but the remarkable job that these inspiring individuals do remains. It would however be glib to ignore the real pressures nurses are under. Change is needed and central to this is having the right workforce, in the right place, not only with the right skills and time to deliver patient-centred care but one that is representative, from board to ward, of the patients we serve.

Jane Cummings

Professor Jane Cummings is the Chief Nursing Officer for England and Executive Director at NHS England.

Jane specialised in emergency care and has held a wide variety of roles across the NHS including Director of Commissioning, Director of Nursing and Deputy Chief Executive.

In February 2004, she became the national lead for emergency care agreeing and implementing the 98% operational standard. She has also worked as the nursing advisor for emergency care. In January 2005, she was appointed as the National Implementation Director for ‘Choice’ and ‘Choose and Book’.

Jane moved to NHS North West in November 2007 where she held executive responsibility for the professional leadership of nursing, quality, performance as well as QIPP, commissioning and for a time Deputy Chief Executive Officer. In October 2011, she was appointed to the role of Chief Nurse for the North of England SHA Cluster.

She was appointed as Chief Nursing Officer for England in March 2012 and started full time in June 2012. Jane is the professional lead for all nurses and midwives in England (with the exception of public health) and published the ‘6Cs’ and ‘Compassion in Practice’ in December 2012, followed by publishing the ‘Leading Change, Adding Value’ framework in May 2016.

Jane has executive oversight of maternity, patient experience, learning disability and, in January 2016, became executive lead for Patient and Public Participation.

She was awarded Doctorates by Edge Hill University and by Bucks New University, and she is a visiting professor at Kingston University and St George’s University, London.

She is also Director and trustee for Macmillan Cancer Support and a clinical Ambassador for the Over the Wall Children’s Charity where she volunteers as a nurse providing care for children affected by serious illnesses.

Follow Jane on Twitter: @JaneMCummings.

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  1. Harry Tomson says:

    Nurses are the key it is very true. Disasters like mid-staffs happen when nursing and medical standards are allowed to drop and clinical concerns ignored.

    Good health and care on the wards costs money and needs enough nurses to do it. The recent NICHE suggestion of a minimum of 1 nurse per 8 patients at night is a start.

    • Malcolm Richardson says:

      Nice stuff, no all we have to do is get the commissioners to listen to patients about where and how they want care from A&E to all the various clinics such as diabetic etc. Then they need to commission for nurse patient ratios and skill mixes and then you might begin to get what both you and patients are seeking.