Once the chief executive of NHS England, Lord Nigel Crisp has since become a major ally for the nursing profession worldwide.
He has spoken with Nursing Times about his interest in global health, why he backs nursing and what he thinks the profession needs to thrive in the future.
“If your nurses are healthy and happy in their jobs, then they will provide better care”
Nigel Crisp
In 2016, independent peer Lord Crisp authored the Triple Impact report as part of his role as co-chair of the All-Party Parliamentary Group on Global Health.
This influential report argued that strengthening nursing around the world would bring three key benefits: improving population health, promoting gender equality and supporting economic growth.
Lord Crisp said he took the report to the United Nations, the World Health Organization (WHO) and the UK government, but none were interested in taking it forward at the time.
“What they basically said is, ‘Oh, gosh, that’s really interesting, thank you very much, excellent report, but we’re going to concentrate on other things’. So, nobody wanted to do anything about it,” he explained.
Undeterred, he decided to take action himself.
Teaming up with nursing leader and fellow crossbench peer Baroness Mary Watkins, Lord Crisp launched a global nursing campaign – Nursing Now – in 2018, to try to raise the profile and status of nursing around the world and realise the triple impact the profession could have.
Through Nursing Now, Lord Crisp and Baroness Watkins managed to convince the WHO to conduct a first-of-its-kind global analysis of nursing.
Subsequently, the inaugural State of the World’s Nursing (SoWN) report was published in 2020 and is considered a landmark.
Last month, on International Nurses Day, the WHO – in partnership with the ICN and others – published a 2025 update.
While Lord Crisp was not involved in the creation of SoWN 2025, he has supported its launch.
Key findings from State of the World’s Nursing 2025
Global nurse shortage down from 6.2 million in 2020 to 5.8 million in 2023, and expected to be 4.1 million by 2030
High-income countries host 46% of world’s nurses, despite representing only 17% of world’s population
International recruitment more prevalent in high-income countries (23%) than low-income ones (3%)
Advanced practice nursing present in 62% of countries, compared with 53% in 2020 report
Only 42% of countries have provisions for nurse wellbeing
Median entry-level wage for nurses globally is US$774 (£575) per month
Nursing gender pay gap is 7% in favour of men, despite profession being 85% female
Countries with national chief nursing officer or equivalent up from 71% (2020 report) to 82% now
He told Nursing Times that he believed “raising the profile and status of nursing is one of the big strategic changes that will have a knock-on effect”.
Triple Impact had shown that nurses “are not valued in the way that they should be, not able to work to their training level, not listened to”, warned Lord Crisp.
However, he said nurses were “everywhere” – both geographically across the world and in every care setting 24/7 – and, as such, they often knew health services the best, along with solutions to the challenges within them.
“Nurses are there all the time; they manage continuity of care. They know what happens in a very practical sense, but they don’t get listened to. They’re not involved in decision making,” he added.
“I’m generalising, [but] too often around the world, they are still in the bit of being the, sort of, doctor’s handmaiden.”
Lord Crisp’s support for nursing dates back to his time as NHS England chief executive, between 2000 and 2006, when he oversaw a major change to allow nurses to prescribe.
He said the idea of nurses being able to prescribe was “controversial” at the time but was now a normal part of practice in the UK.
However, he said in many countries, the role of nurses remained “confined” and in some health systems, “almost every decision a nurse makes has to be checked by a doctor”.
Looking to the future, he wanted to see nurses continue to be given opportunities to take on extended or more advanced roles.
A key message in SoWN 2025 was around the value of advanced practice nursing, which is currently in place in 62% of countries.
Lord Crisp said that all countries needed to “allow nurses to work to the top of their license”.
Another recommendation in SoWN 2025 that Lord Crisp highlighted was on boosting working conditions and mental health support for nurses.
Only 42% of countries had provisions to help nurses mental wellbeing, according to the report.
“I think nurses have, for too long, felt that they have to deal with the consequences of other people’s decisions”
Nigel Crisp
Lord Crisp said: “Very often – and this is true in the UK, but not as bad in the UK – working conditions can be fairly poor, and I mean working conditions both in terms of environment [and] also in terms of expectations of shifts and so on.
“More attention needs to be paid to mental health support, for [the] support of nurses as individuals, because if your nurses are healthy and happy in their jobs, then they will provide better care.”
He also flagged findings in the SoWN 2025 report around “managing migration” of nurses.
Lord Crisp wanted to see the UK become more “self-sufficient” in its staff supply and, if it does recruit overseas, continue its approach of making agreements with the countries providing the nurses, as well as investing in the nursing workforces in those countries.
Having now spent around two decades being strongly involved in the global health agenda, Lord Crisp said he believed countries had a lot they could learn from each other in terms of approaches to health and nursing.
“We need to be aware of what’s happening at the global level. We are part of it – very much so – and we need to learn from each other,” he said, noting how nursing was a very mobile profession.
Nigel Crisp. Credit: PARLIAMENTARY COPYRIGHT
In the UK, Lord Crisp felt nurses had a key role to play in the government’s current plans to move more care out of hospitals.
He was of the view that community and primary care were areas in which the nurse role could be utilised even further in the future.
“We will see primary and community care being a real focus and where nurses have got a lot to offer this government, if this government would but realise it,” he said.
He urged ministers to work in close collaboration with nurses to bring their plans for the NHS to fruition if they wanted to find “some practical solutions” to the challenges that are facing the health service.
“Treating nurses with that sense that they are the experts, that they’re the people who will make a difference, will do a lot for morale,” he said.
“I think nurses have, for too long, felt that they have to deal with the consequences of other people’s decisions.”
All in all, Lord Crisp felt the future for nursing was “potentially bright” if the right support, structures and conditions were in place.
Highlighting a finding in SoWN 2025 that a third of nurses globally are aged 35 and under, he stated: “This is a very powerful young force.”
