Sue Bernhauser

Dean of the School of Human & Health Sciences, University of Huddersfield,

Chair of the Council of Deans of Health

and Commissioner

•Sometimes I think I understand everything, then I regain consciousness.

STRESS • The following picture has 2 identical dolphins in it.

• It was used in a case study on stress levels at an NHS hospital.  

• Look at both dolphins jumping out of the water.

• The dolphins are identical. A closely monitored, scientific study

revealed that, in spite of the fact that the dolphins are identical, a

person under stress would find differences in the two dolphins.

• The more differences a person finds between the dolphins,

the more stress that person is experiencing.  

Part 1: Introduction

Introduction

The Commission was a year-long process…

• Why was it needed?• Who was involved?• What did we do?

Nurses and midwives are responsible for so much of what we have achieved over the last 10 years. They are experts who know best how the service can meet the needs of patients and their local communities. We must be bold in putting them in control and at the heart of our plans for a world-class NHS.

Prime Minister Gordon Brown, launching the Commission on 10 March 2009

Why was the Commission needed?

• First overarching review of nursing and midwifery since 1972• Changing health needs• Major advances in treatment and care• Rising public expectations• Nursing and midwifery needs to be better understood,

developed and supported• Changes need to go further, faster

Who led the work?

• Chaired by nurse MP Ann Keen, Parliamentary Under Secretary for Health Services

• 20 Commissioners – expert nurses and midwives from practice, management, education, research and policy-making

• Support Office hosted by Department of Health

The debate exposed many myths and misunderstandings about nursing, perhaps above all the mistaken idea that compassion can be separated from competence. Compassion is vital, but it is not enough: nurses and midwives must also be well educated to deliver safe, effective care.

Ann Keen MP, Chair of the Commission

What the Commission did

• Extensive engagement with the public, service users, nursing and midwifery staff, other professionals and stakeholder organizations. Activities included:

• National listening events in London and Manchester • Events in all 10 NHS strategic health authorities• Stakeholder events including a students’ day• Debate via the media and the Commission’s website• Round table discussions, one hosted by the Prime Minister.

• We received over 2500 submissions, representing the views of many thousands of people, and supporting evidence

Part 2: Context, policy and vision

The context

The Commission analysed nursing and midwifery today in the context of:

• Socioeconomic, health and demographic trends• The education, continuing professional development and

supervision needed to meet future needs• Management and workplace cultures

We then developed:• A value-based vision of the future that sees nurses and

midwives in the mainstream of service planning, development and delivery

• 20 high-level recommendations

Our vision: six dimensions

1 High quality, compassionate careNurses and midwives will champion, deliver and coordinate physical and psychosocial care for every service user, family and carer, throughout the care pathway, and be supported in doing so2 Health and wellbeingNurses and midwives play important roles in health promotion, disease prevention and maintaining health and wellbeing. They champion health and wellbeing at work and elsewhere

Our vision: six dimensions

3 Caring for people with long-term conditionsNurses’ central role in the care and support of people with

long-term conditions and the complex health needs of ageing will be recognised and enhanced

4 Promoting innovation in nursing and midwiferyNurses and midwives will work in new ways and sometimes

new roles in response to service users’ needs

Our vision: six dimensions

5 Nurses and midwives leading servicesNurses and midwives will be confident and effective leaders and champions of care, with a powerful voice at all levels of the health system

6 Careers in nursing and midwiferyNursing and midwifery offer worthwhile, appealing careers with high levels of responsibility and autonomy, plus opportunities for personal and professional development and fulfilment

Part 3: Meeting the challenge

Meeting the challenge…

• Considerable investment is made in developing nursing and midwifery capital – but its potential is underdeveloped

• Basic and continuing education need further investment and improvement, especially with the move to degree level

• Workplace cultures and teams need to be more supportive• The public image needs updating

Meeting the challenge…

The impact of nursing and midwifery on health and health care should be better evaluated. The Commission made two specific recommendations:

1 Evaluate nursing and midwiferyGaps in evidence-based evaluation of nursing and midwifery must be identified to see what further research is needed

2 Measure progress and outcomesThe development of a framework of explicit, nationally agreed indicators and outcomes for nursing and midwifery must be accelerated

Part 4: The way forward

The nursing and midwifery pledge

Nurses and midwives must declare their commitment to society and service users in a pledge to give high quality care to all and tackle unacceptable variations in standards

The pledge complements the NMC Code, the NHS Constitution and other professional codes and regulatory standards. Nurses and midwives must use it to guide their practice, adapting it to their work settings, and regulators and employers must ensure that their codes, policies and guidance on nursing and midwifery support it.

The Commission

The pledge…

The pledge asks every nurse and midwife to:• Uphold the NMC Code and the NHS Constitution• Take personal responsibility for delivering effective,

evidence-based, high quality care• Acknowledge that service users are partners in their care• Live up to the responsibility of being seen as role models

for healthy living• Engage with policy-making and decision-making

Recommendations

In addition to the pledge, we make• 19 further recommendations that reflect the outcomes

of our engagement process and provide a Call to Action• They cover the six key themes outlined above

Theme 1: high quality, compassionate care

Senior nurses and midwives’ responsibility for care• Uphold the pledge• Accept full individual accountability for care• Maintain clinical credibility• Champion high quality care from point of care to board

Corporate responsibility for care• Health boards must accept full accountability for commissioning

and delivering high quality care• Boards must appoint directors of nursing to champion care• Cultures and structures must recognise and support senior

nurses and midwives to deliver high quality care

More on Theme 1…

Protecting the title ‘nurse’• The title ‘nurse’ should only be used by those registered

by the Nursing & Midwifery Council Regulating advanced practice• NMC must regulate advanced nursing practice and define

required competencies• Consider advanced level regulation for those working in

specialist or consultant rolesRegulating support workers• Government and stakeholders to review and recommend

type and level of regulation of non-registered staff

Theme 2: health and wellbeing

Nurses and midwives’ contribution to health and wellbeing• Nurses and midwives should be supported to turn every

interaction into a health improvement opportunity• Active engagement in service design and monitoring A named midwife for every woman• To ensure coordination of care, reduction of inequalities

and provision of support and guidanceStaff health and wellbeing• Nurses and midwives must recognise they are role models,

and take personal responsibility for their health and wellbeing• Employers must care for the carers’ health and wellbeing

Theme 3: caring for people with long-term conditions

Nursing people with long-term conditions• Greater recognition for nurses’ lead role • Care pathways must maximise nursing contribution• All barriers to effective practice must be removed, for example

to enable direct referrals from nurses to other professionals and agencies

Flexible roles and career structures• Nurses must be competent and willing to work across the full

range of health and social care settings• Flexible career structures must be designed to support this

Theme 4: promoting innovation

Building capacity for innovation• Nursing and midwifery fellows should be appointed to promote

innovation in service design and delivery, as champions of change and leaders of transformational teams

• Develop entrepreneurial skills

Making best use of technology• Establish a high-level group to determine how to build nursing

and midwifery capacity to understand and influence the development and use of new technologies.

Theme 5: nurses and midwives leading services

Strengthening the role of the ward sister• Take immediate steps to strengthen this linchpin role in

hospital and equivalent in midwifery and community• Clearly defined authority and lines of accountability for clinical

lead roles, which must drive quality and safety • No more than two levels between sister and nursing director Fast-track leadership development• Regional schemes must be established to develop and support

potential nursing and midwifery leaders • Successful candidates who reflect the diversity of the workforce

must be fast-tracked to roles influencing care delivery

Theme 6: careers in nursing and midwifery

Educating to care• Fully implement degree-level registration of all new nurses• Effective revalidation • Greater investment in continuing professional development

Marketing nursing and midwifery• Tell a new story of nursing and midwifery • Position this career as a good choice • Recruit high-calibre candidates of all ages and backgrounds

Integrating practice, education and research• Facilitate sustainable clinical academic career pathways• Further develop research skills

Part 5: What next?

The next steps

• The 20 high-level recommendations provide an ambitious agenda and call to action

• Acting on this agenda would provide an excellent return on the public investment in nursing and midwifery

• It will require sustained effort and commitment from the Government, employers, educators and other stakeholders

• And from nurses and midwives!This will require nothing less than the renewal and revitalisation of nursing, and full recognition of the autonomy of midwifery. It will demand honesty about where things are going wrong, and commitment to making the systemic, social and cultural changes needed to put them right. We urge you to support us, and all nursing and midwifery staff, in our quest to deliver world-class health care to the people of England in the 21st century. Commendation from the Commissioners

• Encourage debate on the report• Hold meetings in your workplace, union, professional

organization• Discuss it with colleagues, managers, Chief Executives,

other professionals• Think about what needs to change in your workplace• Think about how it relates to your own work• Use the recommendations as a lever for change and a

platform for campaigning• Contact your SHA lead nurse to get involved in their strategies

What can I do?

Campaigning tools

• Full report and recommendations• Executive summary• Leaflet for service users• DVD of the report launch• Promotional DVD

All available at cnm.independent.gov.uk