Chief Nursing Officer for Wales: priorities 2022 to 2024

The priorities of the Chief Nursing Officer have been developed in order to set the strategic direction for the Nursing and Midwifery professions. The specific areas of work are supported by and/or led by the Office of the Chief Nursing Officer at Welsh Government to aid delivery of A Healthier Wales (2018) and to enable delivery of the Programme for Government (PfG) within this government term.

The publishing of this document follows my first seven months as Chief Nursing Officer for Wales. During that time I have met with nurses and midwives at all levels across Wales both in person and virtually to truly understand their perspectives and to inform my observations of the health system here and what our priorities should be for the immediate future.

This is the first time the CNO priorities have been actively set in collaboration with the Executive Directors of Nursing from NHS health boards, trusts and special health authorities in Wales. Given the pace required to realise these priorities over the next two years, taking a truly collaborative approach in their design has been important to me to ensure a sense of collective ownership.

This document outlines a number of actions that I will support and promote as the head of the professions, but I am under no illusions that I will be solely leading the delivery of this work. The themes and areas covered within these priorities span several different parts of the NHS, social care, Higher Education Institutions and Health Education and Improvement Wales (HEIW) and much of the work will need to be supported, promoted and implemented by you in the system. It is hoped the Independent sector workforce will also align itself to these priorities and support delivery of them.

You may see subjects covered within these priorities which are familiar to you, however I want to assure you that we have no intention of duplicating work in these areas. This is an opportunity for us to pull together and coordinate what is already being undertaken and pool the resources available to us to maximise what we can deliver for the people of Wales. This should also ensure we are in a position to learn from that work and empower organisations and professionals with implementing different ways of working with an emphasis on meeting the holistic needs of service users / carers.

It is clear to me that leadership of the professions is a central part of the system developments needed to allow our health services to continue providing high quality care for our patients into the future. I am therefore committed to guide the workforce through the inevitable transitions that lie ahead of us and inspire more people to choose both nursing and midwifery as dynamic and rewarding careers.

I am also adamant that the future model of nursing care will be grounded in multi-disciplinary working. The idea of a “team around the patient” to deliver the appropriate care is the right direction for how we structure our workforce going forward, and I believe it is important that the nursing voice is underpinned throughout that approach.

Finally, you will see in these priorities the importance I place on the tone of the voices in the professions. I am a firm believer in compassionate leadership and I want our nurses and midwives to lead the way in Wales on working together across health and social care in an empathetic, kind and understanding manner. It is my hope that this will foster the health and wellbeing of both our staff, and the people and communities within which they provide care.

Sue Tranka

The Nursing and Midwifery professions are enabled to consistently deliver high quality, safe, person centred care across Wales.  

With national leadership and expert support the Chief Nursing Officer’s priorities will support and enable improvements and facilitate seamless, accessible and equitable service provision.

By encouraging creativity in teams to influence policy and delivery improvements this will result in better patient experience and improved outcomes.

Good quality, safe care must clearly underpin all policy development and service provision across the system.  The OCNO will work in partnership with several professional and policy advisory groups to set the direction and influence policy for improved quality and safety outcomes.

We will work together with the Nursing and Midwifery and education professional leaders in the NHS, Social Care, independent and third sector to tackle inequity and inequality and break down barriers, promoting a culture where all staff are enabled to reach their full potential.

To achieve this we will:

• consistently demonstrate leadership with kindness and compassion to foster a just culture approach where honesty, integrity, objectivity, trust and respect are at the heart of everyday working
• attract, recruit, train, educate and retain the nursing and midwifery workforce so that the nursing and midwifery vacancy factor is reduced, working towards no vacancies over 3-5 years
• support the mental health and well-being provision for the workforce.
• develop policy which enables positive workplaces for nursing and midwifery staff with equity for all.
• attract and develop professional relationships across Wales using a collective and inclusive leadership model
• expand and strengthen the value of learning organisations with regional, national and local teams.
• encourage a research and innovation culture in care delivery, informed by professional and patient feedback, to enhance the delivery of professional standards.

The 5 overarching priorities which have been agreed are:

1. Leading the Professions
2. Workforce
3. Making the Professions Attractive
4. Improving Health and Social Care Outcomes
5. Professional Equity and Healthcare Equality

Our ambition

Our ambition is to invest in and develop nurse and midwife leaders at all levels in health and social care through dedicated leadership programmes in order to build a talent pipeline at all levels, with initial focus at senior levels. 

Why this is important

As CNO it is vital to support strong and effective leadership at all levels in all organisations to deliver consistently high standards of care, spot talented workforce and develop successive leaders to champion change and create an environment where professional curiosity is welcomed and staff are actively encouraged to speak out if they have concerns

How we will achieve this

We will achieve this through:

• Active listening and engaging with colleagues and patients to foster a ‘one team philosophy’ to reignite kindness in nursing and midwifery.
• Establish formal links with Higher Education Institutes (HEIs) and universities to foster joint working and to demonstrate strong academic commitment to leadership roles.
• Develop guidelines and an implementation toolkit to support the launch of collective leadership models, using shared governance to underpin compassion thus enabling quality transformation across care sectors.
• In partnership with HEIW, fund the Florence Nightingale Foundation Global scholarship nursing programme for an initial three year period in order to maintain a high profile expert nursing and midwifery contribution in the national and international arena.
• Offer a programme of experienced nurse and midwifery led mentorship and coaching to emerging senior and aspiring executive professional leaders through the retired executive Director of Nursing Network.
• Establish a CNO network for nurses working in social care and the independent sector, to improve engagement, share ideas and receive feedback to inform professional policy areas.
• Collaborate with HEIW to develop an All Wales succession and talent spotting programme that creates opportunities for exposure, experience and invests in future leaders.

Our ambition

Our ambition is to close the vacancy gap and to attract, recruit and retain a competent, motivated, skilled nursing and midwifery workforce who have the capacity and attributes to assume their roles with confidence in meeting the needs of the population, whilst working to their full potential. We will grow and transform our workforce promoting multidisciplinary, multi-professional teams collaborating to improve outcomes through innovative ways of working, supported by technology.

Why is this important?

The health and care needs of the population are changing and we must have a clear methodological approach to workforce planning across all sectors to support these changes to ensure we have the right workforce employed across care sectors and settings in Wales.

We will achieve this through:

Retention

• Ensuring nurses and midwives are supported, enabled, empowered and listened to.
• Providing career opportunities and trajectories, supported by identified targeted education and development.
• Ensuring nurses and midwives have access to career spanning supervision appropriate to their roles.
• Promoting parity of development opportunities across fields of the professions.
• Improving our intelligence around staff leaving data.
• Supporting the health and well-being of the professions by working in partnership with workforce to review and influence policy.
• Commission the review of advanced practice frameworks as part of career frameworks.
• Retention of nurses and midwives, including generational incentives to work for NHS Wales.
• Supporting the development and implementation of career frameworks, and increasing the numbers of consultant nurse/midwife, clinical academic and specialist nursing and midwifery joint funded posts to meet population healthcare needs.
• Ensuring equal opportunities for nurses and midwives from ethnic minorities.
• Establishing networks to ensure formal connections to ‘grass roots’ nursing and nurses at all levels having a clear route through to the CNO office for advice and support on policy development.
• Make Wales the career place of choice for opportunities, personal well-being and self-actualisation.

Attraction

• Supporting the system to deliver a national nursing and midwifery attraction, recruitment and retention strategy.   
• Support health boards and NHS trusts to improve utility of the Nurse Staffing Levels (Wales) Act to enable workforce models that will meet the needs of the population.
• Work with Welsh Government workforce policy and Health Education and Improvement Wales (HEIW) to set a clear direction for nursing and midwifery (all fields) workforce planning.
• Supporting new workforce models of care, for example consideration of  policy direction for Band 4 registered roles in support of ‘team around the patient’.
• Working in collaboration HEIW and HEIs to support expansion of  placement capacity for students in health and care settings, across care sectors wherever care is delivered for people with learning opportunities made available.
• Working in collaboration HEIs to increase the numbers of under graduate nursing and midwifery applicants to Welsh universities.
• Work with policy colleagues, workforce leads and stakeholders to enable a nursing and midwifery workforce that will support an integrated delivery approach across sectors focusing on ‘place-based’ care to meet the local needs of communities, and to address health inequalities. 

Recruitment

• Develop an international recruitment strategy through a once for Wales approach.
• Embed improved recruitment processes
• Expanding the graduate workforce in line with workforce planning needs.
• Embracing the challenges of a changing health and social care context with flexibility, promoting the interface between staff working across care sectors including through development opportunities.
• Establish and embed a once for Wales ‘skills passport’ for the professions around clinical skills eg. IVs administration, NG, catheters etc.

Our ambition

Our ambition is to inspire people to select the nursing and midwifery professions as the healthcare professional career of choice in Wales.

Why is this important?  

We are in the third year of the Covid-19 pandemic and now more than ever, as the largest and most trusted healthcare workforce, nurses and midwives must leverage their professionalism and trust in their registration, to work at the top of their licence to flexibly and sustainably meet the health and social care challenges Wales now faces.

How we will achieve this

We will achieve this through:  

• Promoting the professions - influencing regulatory reform; establishing a nationally consistent direction and policy position around professional career-spanning support (preceptorship and clinical supervision); launch excellence award recognition programme.  Supported by:

• Increase the number of professional secondees for health, social care, HEIs and the independent sector working with CNO team annually to lead focussed / key policy work.
• Evaluate the impact of the 2017 model of clinical supervision for midwives and the support it has provided.
• Launch a national recognition programme in 2022. First CNO Excellence Award winners announced in April 2022 at the CNO Annual Conference.  This will include RCN Nurse of the Year and the Betsi Cadwaladr awards.
• Influence policy at every opportunity to ensure the nursing and midwifery professions are represented.
• Engage a professional secondee for education to the office of the CNO (2023-2024) to realise for the system a vision for research career pathways in Wales and scope robotics in Nursing – to formulate a policy position.
• Actively pursue digital systems which support nursing and midwifery practice, patient and public engagement, involvement and coproduction in care and outcome monitoring to enable a data driven value based approach to nursing and midwifery.
• Strengthening professional identity through consistency in nursing roles and titles (where appropriate) to support professional alignment across Wales.
• Through “Here for Life” and “Nursing Now” raise the profile and improving image/ perceptions of the nursing and midwifery professions.
• Define strong nursing and midwifery careers that deliver a strong professional alignment with the Chief Nursing Officer office and consistency in roles and titles across Wales.
• Role model to the system by creating a positive working environment within the CNO directorate, committed to compassion, honesty, equity and transparency and making #CNOCymru a great place to work.

Our ambition

Our ambition is to deliver equitable, good-quality, person-centred care consistently at population health level, enabling nurses and midwives to cultivate learning organisations; utilising risk stratification and PROMS/PREMS data to deliver high quality, safe and effective services

Why is this important?

Nurses and midwives have a pivotal role in understanding safety factors and in the development of patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs), which can be used to assess the quality of healthcare experiences. By supporting these measures nurses and midwives are able to contribute to the ethos of learning organisations, leading improvement and evaluation of the outcomes and/or the process of care.

This knowledge will enable co-production with citizens, healthcare providers, commissioners and other stakeholders to support wider learning, sharing of best practice, innovation and clinical quality improvement via a national learning network.

This approach aligns with key legislation by encouraging long-term thinking and integrated and collaborative action that works to achieve the well-being goal of A Healthier Wales (2018).

We will achieve this through:

• Working collaboratively the Value Based Healthcare Team to design and develop a feedback framework that can facilitate individual feedback from patients and citizens so that outcomes can be better tailored to individual need as part of implementation of the Duty of Candour - (The health and social care (Quality and Engagement) Wales Act 2020); (NHS Quality and safety Framework 2021).
• Developing the standards for a ward accreditation framework to help drive improvements in quality and safety standards aligned to dementia standards and service user charters.
• Supporting scale and spread of the quality dashboard as part of implementation of the Duty of Quality - (The health and social care (Quality and Engagement) Wales Act 2020); (NHS Quality and safety Framework 2021).
• Work with the Delivery Unit to expand its national quality knowledge hub to provide/ inform wider sharing of patient and staff feedback, best practice, innovation and clinical quality improvement.
• Funding every health board to have in post a staffing lead to meet the expectations of the Nurse Staffing Levels (Wales) Act (2016) and to aid roll out of the staff rostering digital systems, e.g. Allocate.
• Influencing the monitoring and learning from Covid-19 including a programme of investigative work into cases of hospital acquired COVID nosocomial incidents
• Implementation and delivery of the maternity and neonatal safety support programme.
• Support and deliver seamless services for children and young people through engagement across agencies.
• Support the network to develop and deliver a mental health and learning disability safety support programme.
• Deliver primary and community care programmes that support a data driven community nursing service.
• Deliver the professional review of nursing and midwifery and service standards.

Our ambition

Our ambition is a Wales that is equal and fair where our nursing and midwifery workforce should reflect the populations that we serve and where nurses and midwives shine a light on and address the inequalities that hinder the lives of our diverse communities.

Why is this important?

Health and social care in Wales will be equal and we will not accept any form of discrimination or inequality for employees or patients. It is crucially important that this ethos is embedded in all areas of the system, to foster the delivery of equitable care for the whole population of Wales, irrespective of cultural or ethnic differences; ensuring patients receive services in their language of choice.

How we will achieve this

We will achieve this by narrowing the health and well-being gap reducing inequalities and improving health through targeted intervention by:  

Women’s Health

• Influence the direction of travel for women’s health to reduce inequalities. 

Strengthened allyship of ethnic minority nurses and midwives

• Develop bespoke education and leadership for aspiring black, Asian and ethnic minority leaders. We will launch a professional Equity Sponsor programme by 2023.
• Support national networks for ethnic minority nurses and midwives which links to CNO by 2022; e.g. Philippine Nurses Association, British Indian Nurses association.
• Deliver on health actions for An Anti-Racist Wales Action Plan (formally known as the Race Equality Action Plan) 2021.
• Support a Professional Framework for reverse mentoring.

Improve the gender balance within nursing

• Raise the profile for nursing as a profession for all genders and work with HEIW to attract more men into the profession.

Raise awareness of those with protected characteristics

• Influence and support the development of the Workforce Race Equality Standard as part of the health actions of An Anti-Racist Wales Action Plan and work with HR colleagues to use the data meaningfully to support ethnic minority workforce into more senior positions.
• Influence policy development to take account of the need and address those with protected characteristics.
• Understand the current position within population health regarding people with protective characteristics. This includes the lived experience as equal to other sources of evidence to ensure data is used appropriately to inform policy

Delivering health services in a bilingual country

• Influence the culture that Cymraeg belongs to us all and leadership at all levels to support the delivery of the actions in the 'More than just words action plan' and embedding of the actions especially for vulnerable groups/ priority services to improve the patient experience.
• Seek evidence from clinical networks which demonstrates learning and the sharing of best practice regarding bilingual care across services and communities.

Enablers

• Digital technology.
• Shared governance to drive better engagement.
• Professional influence and collaboration.
• External partnership working nationally and internationally.
• Strong alignment with policy and strategy from WG to NHS