Nurses are mission-critical to culture change in the NHS

Secretary of State Matt Hancock's speech at the Chief Nursing Officer for England's Summit

It’s good to be back in Birmingham – I wasn’t sure if I was going to make it today…

There’s been a few things going on in Westminster this week, as you may have heard, and the entire nation could probably do with a little nursing at the moment.

So, I’m delighted to be here with you, at my first ever Chief Nursing Officer Summit.

And there’s a lot I wanted to say today.

But when I was thinking about it, there’s really one message I want to leave with you, more than any other.

And that message is that nurses, and chief nurses in particular, are mission-critical to the change in culture we need to see in the NHS.

Because you lead the organisations that you work in, at every level, from chief nurse to clinical specialist, to paediatrics, to ward matron, to theatre nurse, every nurse, caring for every patient, in every setting across the land.

Because the foundation of nursing and the NHS is the same: caring.

Valuing the care you provide is fundamental to creating the right culture within the NHS.

So I will pledge you my support to tackle the challenges I can take on and I’ll say a little about those in a moment.

And in return my request from you is that you seize this challenge to change the culture of the NHS:

To make it the best it can be, by breaking down hierarchies, integrating care, removing barriers, empowering staff, embedding that spirit of continuous improvement that’s vital to making the NHS the best it possibly can be.

And in doing so, we need to change how people think of this profession.

I’ve worked with the NHS, as a local MP, for almost 10 years now, and I know the incredible work that nurses do, but I also know that the public perception of the profession is deeply sympathetic, yes, and we must never lose that.

But the public just don’t get what a highly skilled, highly technical, knowledge-based profession nursing is, so we must change that.

And I’m delighted that Ruth has been doing so much to challenge and raise the public perception of nursing since she started.

She’s a vital and valued part of my team, and let me tell you: she makes sure your voice is heard at the top table – and she can be pretty direct.

Ruth and I met some primary school pupils from here in Birmingham this morning.

They are part of the brilliant Nursing Now campaign to encourage more young people to think about a career in nursing.

I asked how many wanted to be nurses when they grow up and many of them said they would – strangely none of them wanted to be MPs.

And what was refreshing is that girls, and boys, were excited about the idea of becoming a nurse.

And we were able to tell them that this is a profession at the cutting edge of research, science, and technology.

Caring, yes, perhaps more than any other profession, but it’s so much more too.

We could tell them what we need to tell the world about what modern nursing is all about:

You are pioneering new treatments and new clinical models.

You lead teams across wards, departments, hospitals and trusts.

You run the show, whether it’s the frontline or the boardroom.

I’ve seen it for myself. You know it too.

You’re the brains and the heart of every organisation you work in.

You’re so in demand that an NHS nurse could go to any country on earth and be guaranteed to get a job – not that I want you to of course.

Junior doctors look to you for leadership.

Senior doctors – the smart ones at least – work with you hand-in-glove.

Frankly, without you there is no NHS.

And yet…

Our society doesn’t value nursing enough.

Why? Why is that?

I’ve been thinking about this a lot.

I think it’s because not enough people know what modern nursing is.

Too often, nursing is still seen as Florence Nightingale – maybe not the lady with the lamp, but ladies with sponges and bandages: the most basic level of nursing.

The image of nursing in the popular imagination is half a century out of sync with the modern-day reality. Nursing is an aspirational career choice for girls and boys.

Caring, compassionate, and highly, highly skilled.

We need to talk about the reality, the possibilities and opportunities of a nursing career.

Equal as a challenge to being a doctor or an engineer, a profession young men and women aspire to join.

As Professor Alison Leary puts it:

The compassion and caring are really important, but it isn’t generally compassion that will save somebody’s life.

If we can help society to understand that nursing is a “knowledge intensive occupation”, she believes it would help nursing to be more valued and attract more men and women into the profession.

I wholeheartedly agree with her.

I don’t need reminding that nurses are some of the most caring and compassionate people in our society: I’ve seen it for myself.

I see it every time I visit a hospital.

I see it every time I’m on a night shift.

I’ve seen it in simple gestures that speak volumes:

Senior nurses bringing junior staff cups of tea in the middle of night, checking they’re OK, asking if they need anything – even though their own night has been just as tough and tiring.

But the real reason I understand what it’s like, and what it takes to be an amazing nurse, and where my admiration for nurses comes from, is my grandma, Pem.

My grandmother Pem Hills worked nights at the Pilgrim in Boston until my early childhood.

And I saw first-hand her dedication, her love for the job and her sacrifice. I can see her now, in her uniform, with her funny upside-down watch.

And even after she retired, she never stopped caring.

She had a deep reservoir of love and kindness to draw on, just when you needed it.

But she was also the most ferociously organised person I ever knew. And I bet she kept those doctors under control.

So let’s shout loud and clear about the value of nursing.

And I tell you this straight: let’s not talk down the profession either.

I fear that sometimes – and in particular the public debate – people talk so much about the struggles and the difficulties – and I get that there are serious challenges in the NHS, but we focus on them so relentlessly that we rarely hear, in the public debate, about the possibilities and the opportunities.

Now of course, we must tackle those challenges – and we will.

And I will do my part, and the NHS leadership will do their part too.

We need to recruit more nurses. We now have a record number of undergraduate nursing places. Dido is going to expand that number even further in the Workforce Implementation Plan.

We need to attract the best international talent. And after Brexit we must and will continue to welcome nurses from around the world into the NHS.

We need to do more on retention. Retention isn’t a single policy – it’s about asking how we can keep people supported and motivated in their jobs.

We are going to have a constant focus on continuous improvement to policy. One of the things I’ve heard repeatedly is about the motivational power of CPD and how there’s not enough of it. I agree.

I’ve been hammering home the importance of continuous learning and education since I started.

So I’m delighted Simon set out yesterday that he’s going to do whatever it takes to restore CPD because it is vital to valuing and retaining our nursing staff.

So, we will do our bit at the centre. We don’t have all the answers – we don’t even have most of the answers. You do.

Let’s work together to address those challenges, but let’s also talk about how fulfilling the profession is, how exciting and essential being a nurse is.

Let’s give people reasons to want to join this great, noble profession and the brilliant, talented people within it.

Let’s challenge old-fashioned, outdated perceptions of who nurses are, and what nurses do, and tell the story of why a bright, talented 18-year-old would choose to become a nurse.

We do that by creating the right culture. And the right culture starts at the top: it starts with leaders.

It starts with you.

The type of leadership we need in the NHS is the type of leadership John F Kennedy demonstrated when he visited NASA after setting them the Apollo mission.

Kennedy stopped to talk to a janitor sweeping the floor and said: “Thank you, for helping to put a man on the moon.”

The only difference I have with what JFK said is that I really think he should have been gender neutral.

Great leaders know the importance of making everyone feel valued, making everyone feel part of the same team, with the same mission.

And I’ve found that nurses are some of the best leaders within the NHS.

Nurses often make better leaders than doctors because you understand that caring for your staff is mission-critical for caring for your patients.

You know hierarchy can be a hinderance to improvement.

I find it shocking that, in my grandmother’s day, nurses were expected to stand up when a doctor entered the room.

And worse, I find that’s still the case in some antiquated, archaic corners of the NHS. I want it to stop. If anything, it should be doctors standing up for nurses.

Because who runs a hospital at 2am in the morning?

Who keeps the show on the road?

We need more nurses as leaders.

We need more nurses leading NHS trusts: inspiring others to aim higher, empowering staff through empathetic leadership.

We need better leadership to build a better, and bigger, workforce.

That’s the only way we’re going to seize this once-in-a-generation opportunity.

It’s the only way we’re going to get the best return for the taxpayer on the longest and largest cash settlement in the history of the NHS – the £34 billion injection confirmed again yesterday.

It’s our only hope of making the ambitions within the NHS Long Term Plan a reality.

Because one thing’s for certain: the NHS can’t afford to stand still.

So I just want to end by talking about the future.

None of us can know exactly what 2030 will look like in my profession – perhaps not even what next week will look like…

But here’s what we do know:

As people are living longer, their health needs are becoming more complex, their expectations are growing.

New technology, like genomics, AI, robotics, personalised medicines, is going to transform healthcare systems around the world.

Some people say these new technologies will take away human jobs, but the truth is that the thing that can’t be replicated by machines is the caring, compassion that’s at the heart of your profession.

So we’re going to need more people in caring jobs, even before we think about the ageing population, using the power of technology to take away the boring stuff, giving more time for the empathetic, because that simply can’t be replicated.

And for those who worry about those technologies, it won’t be a case of should we, or shouldn’t we, have these technologies within the NHS: the NHS has always embraced the best technology.

The question is how we embrace these technologies within the NHS for patients and staff. And your role is crucial as leaders, shaping and influencing their development, so they adapt to the NHS, so they benefit everyone, so they stay true to the founding principles of the NHS.

Building that technology must be done in a way that frees up time to care.

And you know who I think is best placed to help the techies design the tech to work for you?

Yes, you guessed it: you.

The techies should be asking what your needs are and how we use the best technology to help you to care.

So let’s bring the perception of nursing up to date.

Let’s ensure leaders lead with compassion and conviction.

Let’s embrace change.

Let’s work together.

I fully recognise the challenges.

I will do my bit.

But I’m relying on you.

Without nurses there is no NHS, so we need you – to make it, to shape it, and lead it to the brighter future we all want to see.

Department of Health and Social Care
The Rt Hon Matt Hancock MP