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11 March 2011: speech to the Florence Nightingale Foundation Conference

  • Last modified date:
    14 March 2011

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It’s a pleasure to join you today to discuss the future of nursing, and the key role of leadership in a modern NHS.

It is a theme that Florence Nightingale herself would warm to … [personal content excised]

Florence was a formidable and remarkable woman, whose strong views helped to shape the nursing profession as it stands today.

Passionate about evidence. Insistent on the highest professional standards. Wholly devoted to the patients’ best interests.

Famously, the first question Nightingale asked on arriving at the front line hospitals of the Crimea was ‘Who’s in charge?’

And that’s where I want to start today. It is, of course, a question carrying as much weight today as it did 150 years ago.

And it chimes with many of the concerns people have expressed to me.

Concerns about how we provide consistent, and consistently excellent, standards of care.

About whether nursing, and senior nurses, will have the influence they need within the new commissioning and management systems.

About whether we’ll be able to recruit and retain enough high quality nurses across the Service to improve standards of care.

Frankly, about whether the leadership and commitment is there – nationally, regionally and locally – to support the nursing profession through the changes that lie ahead.

It’s these very concerns I want to address today.

The value of nursing

For me, a modern NHS means nurses, midwives and allied health professionals having more opportunities to shape and improve how things work.

As David Cameron said: “nurses are the backbone of the NHS”. In truth: backbone, and muscle, and eyes and ears.

The single largest profession within the Health Service.

The people who spend most time with patients.

Who define the person’s experience of care, explaining, informing, comforting and supporting people through their treatment.

A group who, like GPs, are uniquely placed to understand and advocate on behalf of the patients and the families they support.

And it’s this ability, to see the whole care pathway for a patient, that we need to harness more effectively in the future.

Nurses, midwives and their colleagues in the allied health professions give us something extremely valuable.

They give us the human perspective.

They understand the ins and outs of the communities and populations they serve.

A health visitor’s value, for instance, doesn’t just lie in the support they provide – important as that may be.

It also lies in the insights they can bring, the connections they can draw, the relationships they can build with other parts of the system.

The same is true of district nurses, community nurses or ward sisters – all of them uniquely placed to identify trends, to spot problems and to suggest creative solutions.

And in a world where we’re increasingly in the business of managing complex long term conditions, the role of other professionals … speech and language therapists, podiatrists, physiotherapists, occupational therapists … all of them are crucial for delivering a full and effective programme of care.


So when we talk about quality, about outcomes, about continuous improvement, the role of the nursing profession is paramount.

At this point, let’s not for a second forget the High Impact Actions that were developed by the nursing and midwifery professions.

Eight actions that show the difference good nursing can make, in reducing both distress to patients, and cost to the NHS.

It is the kind of modern-day addendum to Notes on Nursing that Florence Nightingale would surely have championed.

She would have approved of the other aspect of quality: clear measurement and tracking of performance.

Something that is supported by the Quality Indicators – again developed in partnership with the profession – which will ensure higher standards across the board.

Nurse-led change

This demonstrates what happens when nurses and midwives have the freedom and responsibility to drive up standards and drive through change.

Leading improvements, as they have, for instance, in Newham.

Where nursing and support staff successfully reduced pressure ulcers in local nursing homes – saving money and reducing pain and distress for residents.

Or in my constituency of Cambridge, where children’s nurses now take responsibility for discharging patients.

We’re now seeing a much quicker discharge. Much  greater continuity of support for children and families treated there.


So we need a culture within the NHS that enables nurses and midwives to make their expertise and experience count. How do we achieve it?

Many in the room are concerned about General Practice-led consortia.

Well, my view on this is quite simple.

We know we will need nursing input in the new commissioning arrangements.

Frankly, we need lots of it.

We’d be mad to ignore it.

We do expect nurses, midwives and the allied health professions to be fully involved in how Consortia go about their task.

We want the Consortia to listen to them  To involve them. To engage them. To learn from them.

And, crucially, to apply this insight and knowledge in how they build and shape care pathways.

Why, then, don’t we insist on a formal nursing presence within GP consortia?

If this engagement is so important, you may ask, then why isn’t it mandatory?

Well, I think the danger with any mandatory arrangement is it can quickly become tokenistic.

Through the Health and Social Care Bill, we have put a clear duty on consortia to involve nurses, midwives and other professionals in decisions.

But I’m not going to prescribe precisely how they do this.

That’s exactly the sort of top-down direction we’re trying to get away from.

And in fact, if you look around, the appropriate structures are evolving naturally in the pathfinder areas.

In Warrington, for instance, they’ve formed a Clinical Cabinet that brings GPs, nurses and other clinicians together to discuss local commissioning strategy.

Other consortia will do things differently. But be in no doubt: all will be expected to involving nursing and midwifery expertise in their decisions.

National leadership

The same is true for the national and regional commissioning arrangements led by the NHS Commissioning Board.

Again, I’m very clear that there should be a senior nursing presence at the heart of national policy development.

I’m delighted Chris is staying with us as Chief Nursing Officer until October.

We will then be appointing a Chief Nursing Officer for the new NHS Commissioning Board, and a Director of Nursing for the Department of Public Health.

Why? Because nursing will be integral to decision-making at the highest levels within the new national structures.

A clear sign that we see nurse leadership as vital for developing and executing effective health policy.

Financial challenge

That leadership is even more necessary as we devote more of our resources to front-line care and, in order to meet rising demand, must use resources much better.

I know many are concerned about the financial environment and the implications for nursing capacity.

I’m afraid this is no time for sugar-coating.

We are entering the toughest period in the NHS’s history.

It is a time of unprecedented financial challenge.

It would have been whichever party was elected.

For whoever was standing here as Health Secretary, the same realities would exist.

To balance the demands and pressures of rising costs and an ageing population.

To make sure more money reaches the frontline, rather than being caught up in back office functions.

And to meet David Nicholson’s challenge, of finding an unprecedented total of £20 billion in savings over four years.

But knowing that resources will increase by £10.7 billion over that period; and all of the savings will be reinvested in the NHS, mean we can meet the challenge only if we focus on what really matters.

To promote innovation.

To prevent disease, not just seek to cure.

To raise productivity.

And to raise quality, by putting patients at the heart of care and making results for patients the driver of caring and care.

To achieve this we must have the resources at the front-line. And the team and staffing we need.

Workforce development

Our new workforce consultation set out how we will achieve this:

It’s about giving more direct power and responsibility to providers.

It’s about improving the co-ordination of training and continuous development through the new Health Education England body.

And it’s about making sure there’s consistent sector-wide leadership and oversight for workforce development.

Our modernisation plans give us a unique chance to step back.

To think about what the modern nursing workforce needs to look like.

To make sure decisions are made locally and based on local priorities.

In a tough financial environment, the challenge for senior nurses and midwives will be finding new ways of structuring teams, of matching levels of skill with levels of need.

And yes, that may mean using support staff in new ways to support patients and free up nurses and midwives to concentrate on more complex cases.

It’s what they’re doing in Derby, for instance, where assistant practitioners help patients regain their independence and confidence ahead of discharge.

Or in Lincolnshire where support staff act as a familiar face and a point of contact for patients between the hospital and home.

And in addition, the consultation allows us to think about the new skills and expertise that modern nursing entails.

We all know the business of nursing and midwifery is more complex today.

More multi-disciplinary working.

More complex, long term conditions.

More overlapping, complicated issues to unravel and resolve.

The new education standards will mean that more nurses, at point of registration, will have the knowledge and skills to bring services together for patients.

They will qualify with degrees, and be able to take on leadership and management roles within their organisations.

And it’s important that the best nurses and midwives don’t hide their light under a bushel.

We want to encourage a strong culture of mentoring and support, passing on knowledge to support the next generation and to ensure continuous improvement in standards.


Let me finish by going back to the theme I started with: the memory and legacy of Florence Nightingale.

Because if there’s one word that Nightingale has become synonymous with.

One word that sums up the essential, timeless quality of nursing …

It’s compassion.

Whatever the professional challenges and whatever the financial situation, we have to value, honour and protect the compassion and comfort that good nursing brings.

Yes, we need a modern NHS.

Yes, we need a more productive NHS.

But what matters more than anything is that we have a compassionate NHS.

This is not something you can measure, still less mandate from above.

It depends on all of us in this room, as leaders of the system, to instil and champion those values we hold dear.

No matter how tough things are.

We do need change in the NHS. And change will bring improvement.

But through your leadership, I know we can achieve it whilst preserving the fundamental principles that the Health Service depends upon.

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