Focus on culture of caring

Accepted.
Building on the actions set out in the Government’s initial response to the Inquiry, Patients First and Foremost, and Compassion in Practice, the nursing vision and strategy for England, various actions are underway to address this recommendation.
The Nursing and Midwifery Council has introduced new education standards. These require students to be tested for aptitude in literacy, numeracy and communication skills, and assessed as to health and good character on admission to programmes. Students must also pass all assessments at every progression point before they complete their programmes and be assessed for good health and good character as to their fitness for award and fitness to practice. Education programmes are half theory, half practice, and education and training takes place as a partnership between a university and practice environment. Students must meet all theory and all practice requirements to complete a programme, and there is no facility to compensate for poor performance in one area with strong performance in the other. The first nurses to have followed programmes approved against these new standards will commence practice in 2014.
The NHS Leadership Academy’s new leadership development programmes – underpinned by a revised leadership model – will focus on values, attitudes and behaviours and will see a range of NHS staff including doctors, allied health professionals, nurses, midwives, pharmacists and healthcare scientists learning in a multi-professional environment more conducive to prompting compassionate care. From preceptorship programmes through to programmes for those working at the most senior levels these high quality, accredited programmes put in place the training and development needed to address the challenges presented in this recommendation. Additionally successful completion of the programme and award will help in the recruitment and selection of suitably qualified nurses into more senior roles. NHS England is also working with Health Education England to embed the ‘6Cs’ set out in Compassion in Practice in all nursing and midwifery university education and training. The Government will invest up to £40 million in nurse leadership at all stages of the nursing career.
The Government’s Mandate to Health Education England contained a requirement to ensure that selection into all new NHS funded training posts incorporates testing of values. NHS England is working with Health Education England and NHS Employers to support the introduction of value-based recruitment and appraisal for all registered or unregistered staff.
We believe that placing a strong emphasis on values at the outset of training potential staff is vital to embed the principles of compassion and caring from the very beginning in those who will one day provide care to patients. It is essential that the staff of tomorrow are able to demonstrate not only academic and technical ability, but also that they have the values of kindness and compassion that are needed to care for patients in an emotionally demanding environment.
One of the most important things for securing compassionate care is making sure that the right staff, with the right capabilities, are recruited into posts involving direct care at the outset.
In Patients First and Foremost, the Government committed to a pilot programme, whereby every student who seeks NHS funding for nursing degrees will serve up to a year as a healthcare assistant.
The pilot is an opportunity for aspiring nurse students to get real, paid caring experience for up to one year as a healthcare assistant before entering undergraduate nursing education, to see if nursing is right for them and they are right for nursing.
In September 2013, Health Education England established the first set of pilots, and approximately 150 aspiring student nurses began working as healthcare assistants. Health Education England is looking to introduce further pilots in Spring 2014. On completion the pilot will be evaluated to see how pre-degree care experience could be rolled out in an affordable and cost-neutral way, so that everybody who wants to train to be a nurse is able to get caring experience before they start their studies. The evaluation results of the pilot scheme will need to be considered in the context of the Nursing and Midwifery Council’s 2010 pre-registration nursing standards and their application across the four countries of the United Kingdom.
We believe that students will enter their nursing degree course with increased confidence that this is the career for them, along with a genuine and demonstrated aptitude for caring. In addition, all nursing degree programmes last at least three years and require that 50 per cent of time is spent in practice learning and 50 per cent in academic study. The first progression point cannot be passed unless the student undertakes a period of practice learning and assessment, and so nursing students will continue to gain experience in care environments throughout their studies.
Alongside this, work is on-going to make a career in nursing more accessible for those staff who already give care, as set out in the Mandate to Health Education England.

NMC standards for competence for registered nurses sets out that all nurses must act first and foremost to care for and safeguard the public. They must practise autonomously and be responsible and accountable for safe, compassionate, person-centred, evidence-based nursing that respects and maintains dignity and human rights.

The NMC commissioned IFF Research to evaluate its pre-registration standards in July 2014 in direct response to this recommendation. This identified a particular call for a more explicit reference to compassion in the standards for midwifery pre-registration education. It also suggested that the NMC should consider adding to the standards a requirement that AEIs conduct values-based recruitment (in particular, ensuring that motivation and compassion are considered).

The NMC’s approach to education standards was transformed as a result of this report; from reviewing standards with a piecemeal approach to undertaking a whole scale review of all our education standards in the education change programme. The NMC moved from a prescriptive, input driven approach to an outcome focussed, evidence-based model of regulation.

In 2016 the NMC launched a programme of change for education and undertook a major review of all pre-registration nursing and midwifery education standards. Following this, new standards for pre-registration nursing and midwifery programmes were published in 2018 and 2019 respectively. It’s important that the NMC’s education standards are considered together as a package. The NMC’s pre-registration nursing and midwifery programme standards state that programme learning outcomes must reflect the standards of proficiency, which in turn emphasise the importance of compassionate and person-centred care.

Revalidation is the process that all nurse and midwives in the UK and nursing associates in England need to follow to main their registration with the NMC. This process needs to happen every three years. Revalidation encourages reflection on the role of the Code of professional standards for practice and behaviour for nurses, midwives and nursing associates.

The Nursing and Midwifery Council has commenced the evaluation of their standards for pre-registration education for nurses and midwives. Central to the evaluation are questions about the effectiveness of standards in preparing nurses and midwives for their professional roles and responsibilities which include care, compassion and leadership. The Nursing and Midwifery Council is in the final stages of appointing an independent evaluation supplier and expect to publish the final report in September 2015. The interim findings will be shared with Health Education England to tie into the Shape of Caring Review, which will ensure high quality education and training is received by nurses and care assistants supporting high quality patient care. The outcomes of the evaluation will provide an evidence base for future reviews of their pre-registration standards for education so that they can, where necessary, enhance the UK standards for nurse and midwifery competence and education. The NHS Leadership Academy’s new healthcare leadership model for the NHS was published in November 2013. The model is applicable to all NHS staff roles and builds on the earlier Leadership framework, and is comprised of nine ‘leadership dimensions’ which set out the qualities that should be demonstrated by leaders at all levels. The initial group of 150 aspiring nurse students have now completed up to one year working as healthcare assistants, gaining experience of caring prior to starting their studies. In April 2014, Health Education England established a second set of pilots with 90 aspiring student nurses beginning work as healthcare assistants. A group of 160 healthcare assistants began work in September 2014, with between approximately 250 and 400 further participants expected by Spring 2015.

This recommendation was accepted by the Government.

In the January 2014 Hard Truths report, the Government said that the Nursing and Midwifery Council had introduced new education standards (these were introduced in 2010, with all universities required to be compliant by September 2013), requiring students to be tested for aptitude in literacy, numeracy and communication skills, and assessed as to health and good character on admission to programmes. Students were required to pass all assessments at every progression point before they completed their programmes and were assessed for good health and good character as to their fitness for award and fitness to practice.

The Government also referred to NHS Leadership Academy’s new leadership development programme, which was to focus on values, attitudes and behaviours.

The Government said that NHS England was working with Health Education England to embed the ‘6Cs’ set out in ‘Compassion in Practice’ in all nursing and midwifery education and training. The Government also said its mandate to Health Education England contained a requirement to ensure that selection into all new NHS-funded training posts incorporates testing of values.

The Government also said that NHS England was working with Health Education England and NHS Employers to support the introduction of value-based recruitment and appraisal for all registered or unregistered staff.

In the February 2015 Culture Change report, the Government said that the Nursing and Midwifery Council was in the final stages of appointing an independent evaluation supplier and had commenced the evaluation of their standards for pre-registration education for nurses and midwives. The Nursing and Midwifery Council undertook a review of the new education standards was completed in 2015. The review concluded that the standards were broadly effective, but that there were points of consideration for future development or revision of standards, including revision of use of language to reduce ambiguity; improvement in the structure of standards; further promotion of awareness of their content among key audiences; some outcomes to be added to the standards; and further entry criteria.