Leading Change, Adding Value: a framework for nursing, midwifery and care staff

Transformation, as set out within the Five Year Forward View (FYFV) is being delivered so we have health and care services that can adapt to the future. There is recognition that we cannot rely on what might be regarded as the more ‘traditional’ solutions to some of our major pressures and that we need to think somewhat differently as we move forwards.

Leading Change, Adding Value (LCAV) is the national framework for nursing, midwifery and care staff within England and specifically highlights the huge capability and contribution to transformation work that this key part of the health and care workforce bring to the table.

Nursing, midwifery and care staff already examine and understand what needs to change, or could be changed to improve services, experiences and outcomes for patients, individuals and populations as part of their everyday practice. However, much of this essential work can often remain hidden or misunderstood, as some of it is not easily measured or captured, or shared.

Consequently LCAV was developed to help nursing, midwifery and care colleagues truly consider the outcomes of their work and question whether their actions always make a measurable difference to experience, outcomes and the use of resources. By bringing this focus to achieving the ‘triple aim’ of improving experience, outcomes and use of resources, we are able to clearly demonstrate the vitally important contributions of the professions to the FYFV and the wider system going forwards.

LCAV supports nursing, midwifery and care staff in considering their practice and outcomes, wherever they work and whatever role they undertake. It specifically looks at reducing ‘unwarranted variation’, where standards of care are not equal and how we can make sure that by seeing where inequalities exist and changing them, that everyone can receive the same highest standards.

The end product of the formal three year programme of LCAV will be the bringing together of an ‘Atlas of Shared Learning’. The Atlas will clearly demonstrate how nursing, midwifery and care staff across the system have led and contributed in narrowing the gaps that exist in health and well-being, care and quality, and funding and efficiency and their essential input to the FYFV and other national programmes.

The document will enable national and international colleagues to source and implement learning on where unwarranted variation in care was identified and addressed through nursing, midwifery and care staff leadership and the resulting improvement of outcomes, experiences and use of resources.

It goes without saying that a key enabler to leading transformation within the framework is the use of technology and informatics to improve practice, address unwarranted variations and enhance outcomes. We are therefore particularly keen as we build the Atlas to identify further exemplars of where digital technology is being harnessed to improve and support the delivery of health and care practice. We are already aware of many areas of excellent practice and innovation but are keen to receive more case studies of where nursing, midwifery and care staff are leading both large and small scale digital work across the system whether in the design stage or implementation, or ideally both.

We would welcome any such studies being forwarded via our website which can be accessed at or via the LCAV email address at:

Susan Aitkenhead

Susan Aitkenhead is Director of Nursing, Professional Development at NHS England and leads on a variety of work aligned to system and service transformation at national, regional and local levels.

Susan is a registered nurse with extensive clinical, operational and strategic experience in delivering healthcare across a variety of settings; and provider and commissioning Board roles based within both the UK and overseas.

She has also worked in a variety of national policy roles such as at the Department of Health providing advice and support to ministers and policy officials across central government departments, and in professional regulation at the Nursing and Midwifery Council.

As part of her role Susan also works one day a week as a non-executive Director for Manchester Health and Care Commissioning, as their Board Nurse. This is a partnership between Manchester City Council and NHS Manchester Clinical Commissioning Group (previously NHS North, Central and South Manchester Clinical Commissioning Groups). These organisations came together to ensure a more joined up and effective approach to commissioning health and social care services for the people of Manchester; and the Board Nurse role adds scrutiny with particular regard to guardianship of the patient experience across all care settings including safeguarding, quality and experience.

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