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 a Deputy Chief Nursing Officer to Ruth May, Chief Nursing Officer for England and supports CNO on matters linked to professional regulation, education, research, and collective leadership. This is in addition to the work with ministers, government officials, professional regulators, royal colleges, professional bodies and the Devolved Administrations to help shape policy and decision making.

Susan was previously a Director of Nursing at NHS England leading on a range 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 within healthcare across a variety of settings; and provider and commissioning executive and non-executive Board roles within both the UK and overseas.

She has also worked in a variety of other national 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 across the UK at the Nursing and Midwifery Council.

Twitter: @SAitke

Leave a Reply

Your email address will not be published. Required fields are marked *