‘These three individuals will leave very big shoes to fill’ | Nursing Times

I was expecting a change of political leadership this year but not, if I’m honest, within nursing – at least not until after the election. But that is what the profession in England is facing.

Three key people representing leadership at the highest levels of the NHS, the regulator and the union most often associated with it have within a matter of weeks announced they are stepping down.

Chief nursing officer for England Dame Ruth May announced in April that she would be retiring later this year, though no firm date has yet been revealed.

Last week, the Nursing and Midwifery Council also announced that its chief executive and registrar, Andrea Sutcliffe, would be stepping down at the end of June.

And earlier this week, the Royal College of Nursing released a statement revealing that its chief executive and general secretary, Pat Cullen, would also be exiting her role with immediate effect.

“Discussion has already turned to who will replace them”

Why are they leaving now? Dame Ruth has always indicated to me that she did not want to remain as CNO for an extended period and would go when she felt the time was right.

Perhaps a certain amount of frustration with government policy on the NHS and, more specifically, budgetary constraints have helped her make the decision to retire.

The level of ministerial turnover at the Department of Health and Social Care, to whom she is the top advisor on nursing, must on its own have been a major challenge.

While she has been CNO, there have been five different people in the role of health and social care secretary, with one of them doing the job twice. She may even see another one before she leaves.

In addition, she and her team had developed a national nursing strategy for England, based around 7Ps, that was revealed in draft form at last November’s CNO summit.

But, in spite of Dame Ruth publicly stating that she hoped to see the final version published in March, there has been no sign since of it emerging.

Any lack of willingness to sign it off by government, or a basic lack of interest in doing so, must have been very frustrating and possibly a further lever towards the door.

Meanwhile, Ms Sutcliffe certainly did not want to go at this time, with much more still on her to-do list at the NMC, but has had to take the difficult decision to step aside due to health reasons.

A recent scan unexpectedly revealed an almost-certainly benign tumour requiring urgent neurosurgery. A full recovery is expected, though a lengthy recovery period will follow.

However, I fully expect to see her back again working in the health and care sector in future.

In contrast, Professor Cullen was previously due to be leaving her role at the end of this year and has always fulfilled it in either an acting or interim capacity, which is no doubt often forgotten.

Her political ambitions and the calling of the general election on 4 July have, however, unavoidably brought her departure forward.

A Northern Irish national, Professor Cullen is seeking nomination to stand for Sinn Féin in the Fermanagh and South Tyrone constituency.

Nonetheless, her announcement took many people by surprise, especially being so close to next week’s RCN Congress.

All of these individuals will be missed by the profession and the health and care sector in general, as they have done much to support, steer and inspire nursing and midwifery in their respective roles.

As the popular idiom states, they will leave big shoes to fill; in this case, and without meaning to cause any offence, very big shoes indeed.

While all would probably admit that they will be leaving unfinished work and challenges on their desks, the three of them have achieved much during their tenures.

Both Dame Ruth and Ms Sutcliffe came to their respective roles at NHS England and the NMC in January 2019.

As a result, both of their tenures have been, to some degree, dominated by the Covid-19 pandemic and its aftermath. However, that is only part of their leadership story.

Among other things, Dame Ruth has overseen the introduction of the national preceptorship framework for nursing and the ongoing rollout of the nursing associate role in England.

She has been a highly visible and approachable CNO, promoting the profession at endless visits and events across the country, while juggling this public side of the role with hard work behind the scenes.

The latter, arguably more difficult, has resulted in key achievements such as nursing and midwifery featuring heavily in the NHS Long Term Workforce Plan and other recent policy documents.

Importantly, she has been a very strong advocate of internationally educated nurses and members of the profession from Black and minority ethnic – or global majority – backgrounds.

Ms Sutcliffe has brought warmth, empathy and, like Dame Ruth, high visibility to a traditionally tough job at the nursing and midwifery regulator.

During her time at the top, the NMC has delivered a raft of new standards for the profession as well as making common-sense changes to rules for the benefit of internationally educated nurses.

She also had the confidence to commission independent reviews into the NMC’s culture and regulatory processes, in the wake of serious questions about both.

Meanwhile, Professor Cullen took over the executive reins at the college in April 2021. During her three years in the role, she has become one of the most recognisable union leaders in the country.

She will be best remembered for leading RCN members out on official strike action for the first time in the college’s history and her outspoken stance on NHS pay negotiations in media interviews.

The departure of Dame Ruth, Ms Sutcliffe and Professor Cullen over the same short period means their organisations will inevitably feel an impact over the remainder of 2024.

Discussion has already turned to who will replace them. There are certainly strong candidates that I could mention for the CNO and RCN roles, so perhaps things will not feel too unfamiliar or uncertain.

What is certain, however, is that nursing in England requires strong leaders to make its voice heard and ensure that it has a seat at the table when decisions are made on pay, policy and regulation.