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A new dawn for the nursing profession

Marilyn Eveleigh
Nurse Adviser and Independent Trainer
East Sussex

Let's take the good news first: nurses will have a place on the board that commissions for patient health services. At the end of the government's 'listening' exercise, David Cameron confirmed each commissioning governing body will include a registered nurse. This is a major achievement and is reflected in a change of name. The 'GP-led consortia' originally identified to undertake commissioning of patient care (because GPs were considered closest to knowing patients' needs) have been renamed 'clinical commissioning groups', as GPs are now in partnership with others.

Membership must now include a hospital consultant and two lay members of the public. To avoid a conflict of interest, the registered professionals must not come from those local providers that the clinical commissioning group (CCG) choose, such as a district nurse or respiratory consultant - but they could come from a neighbouring provider. In many areas, the nurse is likely to be from a practice as GP services are to be nationally commissioned by the NHS Commissioning Board.

Nurses will have a key role to play in clinical senates. These are groups of clinical experts that form large networks to advise and scrutinise all the different commissioning groups on their commissioning plans, ensuring they are clinically robust, joined up with efficient pathways that meet patients' needs. They already exist for some clinical areas, such as cancer and cardiac care, but will be expanded to others such as diabetes and MS. A major expectation is the joining up of services to reduce social and health inequalities with an emphasis on the vulnerable and dependent.

This latter point brings me to the wretched news that tarnishes the profession: another revelation by an undercover reporter into shocking care in the Winterbourne View care home for learning disabilities.

The Panorama programme highlighted the cruelty and humiliation of residents, following on closely from the Care Quality Commission report on sub-standard essential nursing care for older people and the Parliamentary and Health Service Ombudsman report on the hospital care of 10 elderly patients, outlined in this column in March 2011. The scandals begin to blur in their detail, but they all involved care by nurses for the vulnerable and weak, and all damaged our reputation. Such damage weakens our individual professional pride.  

The good and the bad news should be related. Will having a nurse on the clinical commissioning board make a difference to such standards of care highlighted in these exposures? I strongly suggest it must. Commissioning for care is no longer about the numbers, price and waiting times; rather, it is about the quality of care that patients receive - quality that we expect as taxpayers and the care we would expect for ourselves and those we love. Nurses must make these elements join up.

As part of their new clinical commissioning group role, nurses must scrutinise the new commissioning proposals. They should constructively challenge commissioning intentions and they must bring their experience, local evidence and patient views to decision-making. They must ensure that we pay organisations to provide nursing care that the public can rely upon. This includes:

  • Registered nurses and healthcare professionals with appropriate clinical competencies.
  • Sufficient nursing numbers to provide a safe service.
  • Nurses with integrity to challenge poor practice in others.
  • Nurses with accountability to report poor care provision to commissioners.

This is regardless of whether care is in hospital or the community, whether it is an NHS or private provider, or whether it is deemed as social care or healthcare. Dignity, compassion and professional responsibility recognise no boundaries. Good luck to those nurses already identified for the commissioning boards. They need our support to fulfil the role and reassure the public that they are safe in nurses' hands. We must not shy away from this achievement. Check out what is happening around nursing representation at your local clinical commissioning board.