Scotland’s interim chief nursing officer Anne Armstrong outlines her priorities and ambitions, the importance of listening and collaboration, and why she’s determined to get the job done well and promptly.
As in nursing, there is no typical day for Anne Armstrong, who’s been Scotland’s interim chief nursing officer (CNO) for almost a year. But every day involves listening. ‘I try to spend as much time as I can listening to frontline colleagues,’ says Anne. ‘I want to really understand what their jobs are like day-to-day – whether in the community, hospital, social care, third or independent sector – because I want to make sure the advice I give is based in reality and reflects where we are in the service.’
Listening was key to the approach adopted by Scotland’s Nursing and Midwifery Taskforce, which published its final report in February, and of which Anne was a member. The associated Listening Project collected feedback from more than 4000 nurses, health visitors, school nurses (SNs), midwives, students and academics to shape improvements. It led to 44 recommendations to improve education, recruitment, retention and people’s work-life balance.
‘We are keen to implement the recommendations as quickly as we can, and to be ambitious about the implementation,’ Anne says. Neil Gray, the cabinet secretary for health and social care who chaired the taskforce will also chair the implementation group.
‘We’re going through every single recommendation, identifying where we think we are, who the best people are to lead, and what the timeline is for each of those,’ Anne adds. ‘If it’s a longer-term piece of work, what will it take to make it a medium-term piece of work? We’re not going to let the grass grow under our feet.’
One priority is to attract as many people as possible on to undergraduate nursing programmes, given that the taskforce report highlighted a decline in applications and unmet targets for funded places in recent years. Anne says: ‘We need to attract people into health and care services, including community-based services, so we have the right people and right skills to meet the needs of Scotland’s population.’
Another key area is the need to ease the movement of the workforce from one clinical area to another, ensuring that staff feel supported in order to deliver their best care, Anne says. ‘We still need flexibility within the workforce, but how can we make that better and more supportive? We’ll work on that as quickly as possible’, Anne says. ‘Our colleagues took the time to tell us what work is like, and I want to ensure that they see we take them absolutely seriously and are moving on with things.’
THE IMPORTANCE OF COLLABORATION
As interim CNO, Anne has professional responsibility for the largest component of NHS Scotland’s workforce: that’s all of nursing, including community practitioners (CPs). She is supported in the role by her fellow chiefs of profession across midwifery, allied health professions and healthcare science. The CNO directorate manages the undergraduate programme and registration into all the professions.
Anne also leads on diverse policy areas, such as healthcare-associated infection policy and antimicrobial resistance. ‘We work as a large, multidisciplinary team. It’s great to get the perspective from different professions about how services can be developed and designed, learning from each other and improving practice,’ she says. Anne also meets ‘regularly’ with her CNO counterparts for England, Northern Ireland and Wales to share relevant experiences, reports and data. ‘Health is a devolved issue and it’s about responding to different population needs, and making different choices,’ she says. There’s plenty that Scotland can ‘be proud of’, she suggests, citing the smoking ban, minimum unit alcohol pricing, the Health and Care (Staffing) (Scotland) Act 2019, and being the first UK country to launch a Women’s Health Plan (see our cover feature).
‘I’M KEEN WE’RE AMBITIOUS FOR THE WORKFORCE AND WE’RE AMBITIOUS FOR THE COUNTRY. WE NEED TO BE DEVELOPING IN LINE WITH THE NEEDS OF THE PEOPLE OF SCOTLAND’
ANNE’S CV |
Anne graduated in nursing from Glasgow Caledonian University before holding a variety of posts in Scotland’s largest city. In 1999, she became director of clinical practice development (a post that incorporated the executive nurse director role, with Lanarkshire Community and Primary Care NHS Trust). |
She then spent 16 years at NHS Lanarkshire, which was created in 2004, in senior positions including both executive and non-executive roles and chaired several national groups. |
In January 2020, Anne joined the Scottish Government as nurse adviser in mental health, before becoming Scotland’s interim CNO in May 2024. |
GOALS AND CHALLENGES
Aside from the addressing the recommendations of the Nursing and Midwifery Taskforce, Anne has many more goals. Some were set out in a high-profile speech by Scotland’s First Minister John Swinney in January, which focused on improving public services and NHS renewal. Key themes included shifting the balance of care from acute services to the community and a creating a ‘healthier Scotland’.
‘The speech sets out the direction for us, and we need to ensure as a workforce we are able to meet population needs and work in that way,’ Anne notes. ‘I’m keen we’re ambitious for the workforce and we’re ambitious for the country. As we’re developing as a profession, we need to be doing so in line with the needs of the people of Scotland.’
The health and social care challenges facing Scotland are like those facing other UK nations, Anne points out. ‘We’ve come out of a pandemic, so we’ve got people waiting for their care and treatment, and while they’re waiting, their needs are more complex when we see them. We’re trying to address that backlog.’
An ageing population brings more complex needs and, as with the rest of the UK, finances are a challenge, Anne acknowledges. ‘There are lots of tricky questions. We need to be thinking about the workforce having the appropriate skills and competencies to meet future demands. We need to be thinking about the development of education, research, technology and new interventions alongside implementation of the adult practice multidisciplinary model: getting it right for everyone,’ she adds.
When it comes to CPs, Anne says: ‘Given levels of deprivation, HVs and SNs have a really difficult job in ensuring children are safe, meeting their milestones and that their life chances are improving.’ How services like district nursing, Hospital at Home and CPs fit together is important too. ‘We need use the skills of everyone to make a difference,’ Anne adds.
LOTS TO FEEL PROUD ABOUT
Anne is modest when it come to her own achievements. ‘It’s not about one person. I’ve got a fantastic team who really want to make a difference. They’re creating the policies and the conditions that enables great care to be delivered on the frontline. We are all one team. We’re just working in different places, doing different roles.’
Visibility and collaboration are also important to Anne, who holds regular meetings with the chairs and vice chairs of all the nursing and midwifery committees in NHS boards across Scotland. ‘It’s about hearing first-hand the reality of work, and I’m keen that they’re able to influence future policy,’ Anne says. ‘I want to grow the number of people who feel they can directly speak to me.’
A key topic subject is workplace culture. ‘We’re kind and compassionate to the people we care for, so how do we make sure we’re also kind and compassionate to the people we work with too? At the end of the day, we’re all nurses, and we’re all trying to do the same thing – improve patient outcomes and deliver good care.’
Finally, CPs should be proud of the ‘absolute difference they make every single day right across the country’, Anne adds. ‘My hope is that we continue to have a vibrant profession, who continue to deliver the great work that they’re doing, who grow and develop to meet the needs of people, and who feel valued.
ALL ABOUT ANNE
How do you relax?
‘By spending time with my friends and family. Maybe not doing very much, doing mundane things around the house, or on holiday. But it will always be about spending time with friends and family.’
What’s the best piece of advice you’ve received?
‘Make your case. If you’re putting proposals forward, utilise evidence and data – otherwise it’s just your opinion. And we’ve all got one of those.’
What’s the most important lesson you’ve learned?
‘Don’t sweat the small stuff. Sometimes something can feel huge and if you take a step back it’s not. I’ve also found reflection helpful. For example, when we do a revalidation, we’re busy, we might not think we’ve been impactful in a situation. But we often did make a change, we were just in time.’
What drives you?
‘People. I enjoy spending time with folk from all different backgrounds and learning. I’m here to learn from people about what their worlds are like, understanding their stories.’
What would most people be surprised to learn about you?
‘I don’t think there is much – I’m an open book!’
2nd Photo credit | Unite-CPHVA
