The name Dr Crystal Oldman has almost become synonymous with community nursing.
For more than 40 years, she has been a leading figure in the field, most recently as the chief executive of the Queen’s Institute of Community Nursing (QICN), known until very recently as the Queen’s Nursing Institute (QNI).
“From the very beginning of my nurse training, I could see the impact that nurses make 24/7 to people’s lives”
Crystal Oldman
Ahead of her retirement on 1 July, Dr Oldman has spoken to Nursing Times about her career, what drives her passion and the challenges that remain for community nursing.
Qualifying as an adult nurse in 1980 from University College Hospital in London, she began her career as a hospital staff nurse, covering areas including burns, oncology and intensive care, which she said she loved.
However, while working in hospitals, Dr Oldman “became really curious” about public health.
“I started to see people come back for more surgery and more surgery, and it was because they couldn’t wait to have a cigarette,” noted Dr Oldman.
“As soon as they got the surgery, [they thought] ‘right, now I can go back to the lifestyle that I used to have’.”
This interest in public health led Dr Oldman to quickly transition from acute care into the community, registering as a health visitor in 1983.
At that time, health visiting was different from what it is now, she explained.
While today’s health visitors work primarily with families with children under the age of five, previously they covered all ages within a defined geographical area, though still with a focus on infants.
“You talk to any other health visitors of my era, they would have been the same. It wasn’t unusual. That was what health visiting was, so it’s true public health work,” she said.
She added: “If anyone talks about neighbourhood nursing… that’s what it was.”
As a health visitor, Dr Oldman started in the London Borough of Ealing and said a big part of her caseload was women who had come to the UK from Pakistan for an arranged marriage and then had a baby.
Crystal Oldman
These women were “quite isolated” because they often could not speak much English and were living with their parents-in-law and husband, whom they had only recently met, she explained.
“It was really, really interesting; fascinating to understand the cultures, and [they were] beautiful people who I worked with, [a] beautiful community,” said Dr Oldman.
“I just absolutely loved it. I thought I’d never leave, because it was so good.”
However, Dr Oldman then became “really interested in research” and took on a role at Great Ormond Street Hospital for Children NHS Foundation Trust as a clinical research health visitor, while also undertaking a master’s in social research.
After further health visiting work in London, she moved into academia and got a job at Buckinghamshire New University in 1994, where she would stay for 18 years.
During her time there, Dr Oldman developed its first programmes for health visiting, school nursing and general practice nursing.
She progressed to become the university’s dean of enterprise and business management, before the opportunity became available to lead the QICN – then named the QNI – which covers the UK except for Scotland, where the Queen’s Nursing Institute Scotland fulfils a similar role.
Becoming chief executive of the QICN was a good fit for her, said Dr Oldman, because the charity was education and community nursing focused.
“It seems like a complete own goal”
Crystal Oldman
Explaining why she took the job, Dr Oldman said: “As I got more senior in higher education, you get further and further away from your passion because you’re so generic.
“I was overseeing a faculty of programmes that were policing and law and psychology and education and early years – and community nursing and pre-reg nursing, but all of a sudden it’s like, ‘OK hang on a minute’.
“I gradually had got further and further away from community, and here was an opportunity to go back to my roots of community and education.”
Dr Oldman started as the QICN chief executive in 2012 and has remained in that role ever since.
During her 13 years at the charity, she has been a persistent advocate for community nursing, using her platform to champion the profession in an authoritative but fair way.
Asked what she saw as among her biggest successes, she cited work the charity had done to protect specialist community nursing post-registration education programmes.
For example, she noted how, in around 2017, the QICN – with support from others including nursing peer Baroness Mary Watkins – pushed back against a move by Health Education England to make the advanced clinical practitioner (ACP) programme the primary route for progression in nursing.
Dr Oldman said she was told that “the future was ACP or nothing” and that the specialist practice qualifications (SPQs) in community nursing were “dead in the water”. In discussions that were mostly held behind closed doors, the QICN managed to head off this threat.
But the QICN was spurred into action again in 2020 when the Nursing and Midwifery Council (NMC) announced plans to axe the nine different SPQs and replace them with a generic community qualification.
Following pressure from the QICN and others, the NMC did a partial U-turn and said it would keep existing SPQs in district nursing, general practice nursing, community children’s nursing, community learning disabilities nursing and community mental health nursing, but that it was going to get rid of the bespoke standards that underpinned them.
While this was not the outcome it had wanted, the QICN responded by creating its own standards for the fields of community nursing covered by the SPQs plus other fields like inclusion health nursing and adult social care nursing.
She said almost half of the universities delivering these programmes were now endorsed by the QICN as adhering to the charity’s standards. “It’s a really good outcome,” she said.
“Here was an opportunity to go back to my roots of community and education”
Crystal Oldman
However, as Dr Oldman is departing, a new threat has emerged in the form of the government’s decision to scrap funding for level 7 apprenticeships from January 2026 – a move that affects post-registration community nursing programmes.
The announcement, from the Department of Education, comes amid plans by the Department of Health and Social Care to move more care into the community as one of its three “big shifts” that it wants to deliver for the NHS.
“It seems like a complete own goal, and maybe it’s a feature of one department not quite in line with the other. And maybe what we will see is a future where there will be a solution to it, we just haven’t seen it yet,” said Dr Oldman.
She described the situation as an “unmitigated disaster right now” and said the QICN would be looking to put forward a “plan B” for the government to consider under the leadership of Dr Oldman’s successor, Steph Lawrence.
A group has been formed involving Ms Lawrence; Mark Millar, who is the chair of the Association of District Nurse & Community Nurse Educators; and other interested parties to work collectively to come up with alternative proposals.
Meanwhile, during Dr Oldman’s tenure, the QICN has grown its flagship Queen’s Nurses programme from 120 nurses to 3,000.
Dr Oldman has also managed to tick off a key item from her to-do list that she wanted to achieve before she left – securing a name change for the charity from the QNI to the QICN.
Explaining the reason for the change, Dr Oldman said that she had spent years around policy tables having to explain what the QNI did and was, therefore, keen to add the word “community” to the title to make its commitment to community nursing clearer.
Retiring to spend more time with her family, Dr Oldman still plans to stay involved in nursing, aiming to stay true to her strapline of: “I want to add value wherever I go.”
She will remain a trustee of the Nuffield Trust think tank and is supporting a project it has underway on district nursing.
She is also due to take up a role supporting a small nursing charity, the London Network of Nurses and Midwives.
In addition, Dr Oldman is planning to write a book about the history of advanced practice and how it has evolved, which will see her interviewing nurses currently working at an advanced level in different sectors.
Asked what makes her so passionate about community nursing to have dedicated her career to it, Dr Oldman said: “From the very beginning of my nurse training, I could see the impact that nurses make 24/7 to people’s lives.
“We’re the professionals who are there all the time with them, alongside them, spend the most time with them.
“And that huge potential for us to be able to not only deliver that, but… the opportunity to make a difference to people’s lives on a bigger scale than one-to-one delivery.”
In terms of her work at the QICN, she said her achievements had only been possible due to the good team she had around her and that her key motivation was improving care for patients and families.
She said: “I quite often, as a reminder to the team, say, ‘remember what we’re here for’.
“It’s the people who the nurses serve, and we’re here to support the nurses who support the communities and people.
“I think that’s really, really important – it’s not about us, it’s absolutely about communities who could have better care.”
