Sue Bernhauser

1
Sue 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.  

4
(No Transcript)
5
(No Transcript)
6
Part 1 Introduction
7
Introduction

• The Commission was a year-long process
• Why was it needed?
• Who was involved?
• What did we do?

8
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

9
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

10
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 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

11
Part 2 Context, policy and vision
12
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

13
Our 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
14
Our 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
15
Our 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

16
Part 3 Meeting the challenge
17
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

18
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 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

19
Part 4 The way forward
20
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
21
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

22
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

23
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

24
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 roles
• Regulating support workers
• Government and stakeholders to review and
  recommend type and level of regulation of
  non-registered staff

25
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
  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

26
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

27
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.

28
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

29
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

30
Part 5 What next?
31
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!

32
What 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

33
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