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What would Florence say?

Nurses play an enormous part in the attempts to shape healthcare. Nurse power and influence has enhanced in recent years, but we still have much to achieve…

Lynn Young
Primary Healthcare Adviser for the RCN

Autumn 2007 has arrived far too quickly and with it lots more healthcare policy and practice changes to get our heads around. New ministers bring a range of different priorities, values and perspectives so, once more, with our new prime minister and health ministerial team, interesting times lie ahead. It seems the everlasting debate continues. What is the future of the district general hospital in light of all this more modern talk relating to poly-clinics, diagnostic centres and, of course, care closer to home?
Up and down the country hospitals, mainly community ones, maternity units and A&E departments are at risk under the banner of improving patient care and modernising services.
New secretary of state for health, the right honourable Alan Johnson has appointed professor Ara Darzi, who will continue to practics as a surgeon and as a health minister. His first national task is to carry out a review of the NHS, while his completed review of London NHS is undergoing the rounds of consultation.
But this is not a new debate. Since the beginning of the NHS the value and need of the hospital has constantly stretched the minds of ministers, NHS managers and clinicians - let alone the public, who always turn out in droves to protest against any threat of local hospital closure. The wisest of words tend to come from the lips of Florence Nightingale, who in 1867 told Henry Bonham Carter: "My view, you know, is that the ultimate destination of all nursing is the nursing of the sick in their own homes […] I look to the abolition of all hospitals and infirmaries. But it is no use to talk about the year 2000."1
Clearly the state of the UK healthcare system barely relates to Florence's brave vision, but yet again we are in the middle of a hot debate about where modern healthcare should be provided. While enlightened clinicians are committed to new ways of working, getting to the bottom of how many hospitals, A&E departments, specialist centres and primary care organisations are affordable and needed by the public, taxes the greatest of minds.
European working time directives, fast moving technology developments, changing society health needs and a nontraditional workforce add major complexity to audits, number crunching, patient turnover and
consultation figures.
Nurses, regardless of where they are currently working, play an enormous part in our attempts to shape a healthcare service that is both affordable and effective in the 21st century. Nurses need to always remember that they form 70% of the healthcare workforce, thus making them the backbone of hospitals and community settings. So where are we in the debate? Take a look around. Are senior nurses taking their part on PCT boards and executives? Where are nurses at practice-based commissioning level? Are nurses doing business with policy advisers, strategic thinkers and ministers?
The answer to this is yes, but not in enough numbers and without the clout and influence of other disciplines - such as doctors and senior managers. This has always been so, and without doubt nurse power and influence has enhanced in recent years, but we still have much to achieve if the public is to receive the services it wants and needs.
One view is that this state of affairs is less about the power of medicine versus the lack of power held by nurses, but more about gender. While medicine is becoming increasingly feminine it is interesting to note that the current medical leaders are for the main part male. The prime minister's cabinet is mainly male, as are most senior managers.
This is quite interesting when you consider that it is mainly women who use healthcare - for themselves, their children and other family members. Caring still seems to be the work of good women and managing and leading is predominately male.
I wonder what Florence would have to say if she was able to take a look at today's modernised healthcare services?

Reference
1. Baley ME. A history of the Queen's Nursing Institute. Beckenham: Croom Helm; 1987.

Your comments: (Terms and conditions apply)

"I think Florence would be well pleased with direction of most healthcare services - screening and diagnostic techniques, minimally invasive surgery, pain control never dreamt of in the Crimean War. She would ask the same questions now as she did then about the effectiveness of treatment and care i.e. is the patient relieved‚ unrelieved‚ or dead. However, she would be disappointed that decisions about nurses and nursing are being made by non-nurses and would wonder where our voice has gone. I totally agree with Lynn Young's plea that senior nurses need to be included on every Board and Committee where healthcare policies are being planned." - Cath Gleeson, Practice Nurse, West Yorks