Title: Sue Bernhauser
1Sue Bernhauser
- Dean of the School of Human Health Sciences,
University of Huddersfield, - Chair of the Council of Deans of Health
- and Commissioner
2- Sometimes I think I understand everything, then I
regain consciousness.
3- 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.
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6Part 1 Introduction
7Introduction
- The Commission was a year-long process
- Why was it needed?
- Who was involved?
- What did we do?
8Why 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
9Who 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
10What 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 Commissions
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
11Part 2 Context, policy and vision
12The 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
13Our vision six dimensions
1 High quality, compassionate care Nurses 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 so 2 Health
and wellbeing Nurses and midwives play important
roles in health promotion, disease prevention and
maintaining health and wellbeing. They champion
health and wellbeing at work and elsewhere
14Our vision six dimensions
3 Caring for people with long-term
conditions Nurses 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 midwifery Nurses and midwives will
work in new ways and sometimes new roles in
response to service users needs
15Our vision six dimensions
- 5 Nurses and midwives leading services
- Nurses 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 midwifery
- Nursing and midwifery offer worthwhile,
appealing careers with high levels of
responsibility and autonomy, plus opportunities
for personal and professional development and
fulfilment
16Part 3 Meeting the challenge
17Meeting 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
18Meeting 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 midwifery
- Gaps in evidence-based evaluation of nursing and
midwifery must be identified to see what further
research is needed - 2 Measure progress and outcomes
- The development of a framework of explicit,
nationally agreed indicators and outcomes for
nursing and midwifery must be accelerated
19Part 4 The way forward
20The 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
21The 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
22Recommendations
- 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
23Theme 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
24More 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 roles - Regulating support workers
- Government and stakeholders to review and
recommend type and level of regulation of
non-registered staff
25Theme 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
guidance - Staff 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
26Theme 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
27Theme 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.
28Theme 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
29Theme 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
30Part 5 What next?
31The 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!
32What can I do?
- 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
33Campaigning 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