1. Chair of the Council of Deans of Health
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. 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. 

6. Part 1: Introduction

7. 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

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
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

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 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

11. Part 2: Context, policy and vision

12. The context Socioeconomic, health and demographic trends
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
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

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!
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

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 All available at cnm.independent.gov.uk
Full report and recommendations
Executive summary
Leaflet for service users
DVD of the report launch
Promotional DVD
All available at
cnm.independent.gov.uk