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CNO says nursing needs 'independent royal college'

Nursing needs its own dedicated royal college free from union concerns to drive up standards, the chief nursing officer has said.

Giving evidence to the Mid Staffordshire Foundation Trust public inquiry today, Dame Christine Beasley said there were some advantages to combining the union and the professional organisation in the Royal College of Nursing but these were outweighed by the conflict of interest.

She said: “I don’t often want to emulate medicine in my role as a nurse, but I do think one of the things that we lack is an independent royal college that can do some of the things that royal colleges of doctors and medicine do.

“The RCN do a lot of work on standards but because the [professional side and union side] are linked that can have some problems when you start to want to implement it.”

In response, RCN chief executive and general secretary Peter Carter said: “The RCN provides a comprehensive service to its members, and we believe that combining the trade union function with the professional body enhances both. The RCN can work to influence on behalf of members locally and nationally, precisely because our reputation is strengthened by our work as a Royal College in using evidence to improve patient care and drive the profession forwards.”

He added: “Over the years, the RCN has represented thousands of members and receives incredibly positive feedback about the service we provide.

“The RCN has a key role in providing nursing leadership, and without our influence the profession could have been left without a voice in the face of enormous challenges.”

Dame Christine also answered questions on the future role and status of the CNO under the government’s NHS reforms, which will see her replaced by two senior nurses.

As CNO for England, she currently holds the rank of director general in the Department of Health. When she retires later this year she will be replaced by a chief nurse on the new NHS Commissioning Board and a director of nursing in the DH, the latter focusing on public health and who will only have a director level role - a rung lower than director general.

However, Dame Christine said the role was envisaged as a powerful position advising across the department, although she agreed it was “confusing” that the role badged as “chief nurse” would actually be the one sitting on the commissioning board.

The inquiry also discussed the role of healthcare assistants in the case of Mid Staffordshire FT, where they were often used as an alternative to registered nurses.

Asked whether she supported the regulation of healthcare assistants, Dame Christine told the inquiry she did not think it was a “proportionate response”.

“[Healthcare support workers] covers a really broad area and I think to regulate in terms of professional regulation the whole of this workforce I strongly believe is not proportionate in terms of patient safety and cost to whoever pays and to the individuals themselves.”

Asked by inquiry chair Robert Francis QC if she had changed her mind since the Prime Minister’s Commission on the Future of Nursing and Midwifery - of which she was a senior member - recommended regulation for HCAs, she said there could be a case for regulating a higher level of HCA but not the whole workforce.

She called for more support for whistleblowers and suggested individuals who raise the alarm should have someone from human resources or the nursing team designated to them to look after their interests.

Dame Christine is one of a number of high profile figures appearing before the Mid Staffordshire Foundation Trust public inquiry this month.

Live coverage is available to subscribers of Nursing Times’ sister title HSJ

Readers' comments (22)

  • Not really planning her next role at all then? Can this really be a coincidence bearing in mind the apparent downgrading of the CNO role in the future?

    Bearing in mind the current culling of quangoes (sp?) is forming another one really in everyone's best interest?

    Am I just a cynic?

    Can anyone else get more question marks into a single post?

    Yes its been a long day!

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  • dont be stupid! dame watemecallit leave our unions alone you dont pay hands off! mike she is at it again where are you laterly chap thay wont us to go independent

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  • are you there mike we need input this is scarey!!!and its not halloween for about 7 weeks? mike your fan club awaits you????????????????????????????????

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  • I am confused (dosen`t take much) I thought that the NMC was there to `drive up standards` and `do some of the things that royal colleges do for Drs and medicine?`

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  • I’m no fan of the CNO and I think it is sad that it takes a public enquiry for her to air her views, but I think she deserves some credit here for some of the things she has said. Firstly, correct me if I’m wrong, but I think this is probably the first time nursing skill mix has been given such a public airing as currently Trust and private providers can and - as we’ve seen here - do as they please. You could argue about the exact Nurse to HCA ratio, but I think a ratio of 60/40 is much better than some of the conditions colleagues find themselves currently working in.

    Secondly, I have to say that she is right about the RCN: I want my union to concentrate on me, to support me in my workplace and I don’t particularly want my subs spent on formulating standards etc. I personally think the RCN is crap: I am a former member, but cancelled my membership having seen how obsequious and toothless they really are; what planet Dr Carter is on I do not know. I really think nursing needs a new union that is focused on its members etc; bring back COHSE is what I say.

    I have to say my worst fears seem to have been confirmed with regard to the regulation of HCA’s: as I warned in a previous post, it would seem that your average HCA isn’t going to be regulated, but these Assistant Practitioners are. If the NMC is foolish enough to get involved in the regulation of these AP’s and allow them onto the register, then the number is most certainly up for Registered Nurses. AP’s will be cheaper, easier and quicker to train than nurses and will be more flexible and our employers will literally be falling over themselves to employ them.

    I think what the CNO is intimating is that nursing as a whole is in complete disarray. There is a wide variance in the quality of nurse training being provided. The NMC is a busted flush: any regulatory body that denigrates a registrant for highlighting poor care or whistle-blowing - as in the case of Margaret Haywood - is clearly not fit for purpose and should be scrapped. Our unions are failing us and we don’t get the professional recognition that we deserved from the government and other professions as out royal college is viewed as a second rate union and not a serious body. I don’t ever usually agree with the CNO, but I have to admit she made a lot of sense in what is reported here!

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  • Further to my comment above, I just wish the CNO had done something to address the problems she has so clearly identified.

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  • I don't envy the role of CNO (be it as it is or demoted) to change/reform the nursing profession/NHS, in whatever guise and fighting against the government single handed. The CNO is a lone player, with no backing from the 'shop floor', so no wonder we don't achieve our aims. I hope this lady can gleen her successes throughout her career, to enjoy her retirement, knowing that she has done her best. Like us all on these blogs, we have a lot to say, but little influence, unless you put your neck on the line. When those of you near ending your career, you will realise the little effect, through belief and dedication, you can achieve. However, don't let me stop your ambition to do the best for the NHS/patients and staff, it keeps you going for a long while.

    What a sad response this is.

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  • Agree with CNO, who has a difficult job which few here really understand.

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  • Anonymous | 10-Sep-2011 0:06 am, Anonymous | 10-Sep-2011 8:59 pm
    The CNO has a difficult job? She has no backing?

    Rubbish!!!

    The ROLE of CNO absolutely has the backing of myself and I would argue the majority of the profession. The role of CNO as it SHOULD be, is there to fight for our profession, to give us a public figurehead, someone to look up to and emulate, a mouthpiece at government level alongside the CMO.

    However, the current waste of space who undeservedly occupies the role of CNO is a waste of space and an embarrassment to the profession and it will be a boon to us all when she is finally prised away from her cushy office. It is SHE, as an individual, NOT the role of the CNO itself, which many have criticised.

    I think however that a small portion of what she is saying here has merit, but she - as usual - has messed up royally in the implementation of that message.

    Nursing as a profession needs a strong, powerful and effective trade union, that looks after its members rights and fights for Nurses as a whole. Nursing needs a union that would not in any way allow the government to even MENTION pay cuts, job freezes or pension cuts without threatening to strike.

    Nursing also needs a body similar to the GMC that leads our profession clinically and speaks out on professional/clinical/medical issues. It should lead with evidence based practice and provide us with best practice and protocols for the care we give.

    These are, or should be, two separate entities, with two separate remits and fields of interest.

    The RCN at the moment is trying to straddle both roles and failing abysmally at both. Peter Carter has tried to justify the RCNs position with his usual flair for bullsh*t. “Over the years, the RCN has represented thousands of members and receives incredibly positive feedback about the service we provide. “The RCN has a key role in providing nursing leadership, and without our influence the profession could have been left without a voice in the face of enormous challenges.” Bull. Read the comments here by YOUR members you deluded fool. Your feedback is far from positive, and a voice in the face of challenges? Don't make me bloody laugh! The RCN is notable only for its singularly spectacular failure to give Nurses a voice on all the challenges we face!!!!!

    The RCN and the NMC need disbanding and completely scrapping. Beasley is right in one respect, (a sentence I thought I would never hear myself utter), we DO need two separate bodies, one that looks after us as a trade union, and one that speaks out for us and leads us professionally.

    However, as usual, on other issues she quite simply does not have a damn clue. Registration for HCA's 'not a proportionate response'????

    Just do the profession a favour Beasley, and go.

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  • OK - jumping into the fray.
    Let's define what we have now.
    There seems to be some confusion above.

    Regulatory bodies (such as NMC, HPC and GMC set education standards and regulate the profession). They are defined by statue.

    So one of the above people is wrong about the GMC.

    The RCN - is a professional association with a royal charter. But it has strayed into the union role and then strongly developed it, and therein lies a serious conflict of interest which many nurses have tried to challenge unsuccessfully. This has happened in a much more strategic way since 2001 when Eirlys Warrington was the Council Chair and Beverely Malone the new RCN secretary. Mrs Warrington, a strong union activist rather than a professional driver of high standards, drove the agenda for concentraing on union activities and getting rid of influencing professional standards, Forums, Faculties and finally getting rid of the RCN Institute.
    That is her legacy and she and the last 10 years of council members should be ashamed of what they did.

    What they should have done was separate the two actitivities totally and then do either - not both.

    In contrast - the Royal College of General Practitioners is not a Union but a professional association with a Royal Charter and epistomises the standards and functions of what GPs know and do.
    This is what the RCN should have done and lived true to the mission of the RCN - to support the art and science of nursing.

    How can the RCN support, as a union, a claim by a nurse, for instance as an example, to support them when they are a known bully and display poor professional practice.
    This is what they have done for nurses who have been practicing within in some of the organisations where these dreadful scandals of abusive practice of the past 10 years have taken place.

    This is the legacy of personal power trips, rather than a professional and moral conscience for developing and support high quality nursing.

    The legacy of the RCN of the past 10 years is shameful.

    I would say that their Royal Charter should be taken away from them, the NMC disbanded and nurses regulated within one body which includes other healthcare professions.

    A new independent professional body should then be set up with a new Royal Charter (if necessary) and with absolutely NO union role.


    Leave the union activities to -
    Unison, Unite/Amicus, GMB. They do it best.

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  • What a really interesting post concerning the last 10 years of RCN Council, and especially the roles of Eirlys Warrington and Bev Malone.

    Whoever wrote this post is very well connected in the RCN (possibly an ex Council Member), but they have got this issue very wrong.

    Lets get one thing straight, Bev Malone had the making of a really great General Secretary but feel foul of the UK nursing establishment who neither wanted a 'yank' or a (to put it as politely as possible) an ethnically different person in such an influential role.

    I remember being at a DoH reception soon after her appointment, and being challenged by DoH staff why we (RCN) had appointed her. My reply was quite simple, the British Nursing establishment was poorly focused on nursing, didn't have a great deal in common with nursing, and I thought, quite frankly, they were shite! Yep, I was a great supporter of Bev and was really dismayed at the sexist and racist treatment she received her.

    As Eirlys, I was her Chair of Membership, Representation and Diversity Committee (the trade union arm of the RCN). And in our tenure just have a look at what we achieved for nurses:
    1. AfC -with a minimum increase in pay of 16%. Overall (together with UNISON) a consistent raise in pay throughout the late 90's and early 00's.
    2. A huge increase in the safety at work across manual handling, needle stick injuries, violence at work, mental health, and female centred safety management.
    3. Fought for all nurses, including GP employed staff to be part of the NHS Pension Scheme.
    4. Widened the entry gate into RCN membership
    5. Lead on Pay Review Body submissions
    6. Created and maintained the only, and largest body of research into nurse employment

    As for the professional side of the RCN, it had become far too big and unwieldy to be effective, and a great %age of its forum membership were southern based and unrepresentative of the RCN membership.
    I didn't support the degree to how the Forums were cut, but the bigger mistake happened after 1997 when Forum members were no longer elected but appointed by a select few!

    But in the end Chris Beasley would say what she has said about the RCN because she failed the nurses at Mid Staffordshire by not protecting them and giving them a voice. The freemasonry set up of the chief nurses forums are just a recipe for failure as Mid Staffs, Maidstone etc has demonstrated.
    The RCN is a fine union. It is a fine membership organisation. If the Chief Nurse is trying to set herself up as the next Gen Sec, I'll oppose it!
    Lets see the CQC (or its predecessor), NMC, or DoH take its fair share of blame.
    The RCN does as good a job as any TUC union.

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  • Anonymous | 12-Sep-2011 1:53 am rubbish. Absolute rubbish. The RCN is shockingly shameful as a trade union, and it is poor as a professional body too. You list off all the things that the RCN has supposedly done, do you want me to list all of the things - especially recently given all our issues - that they HAVEN'T done? I can assure you the list is a damn site longer!!!!!

    The RCN, and the CQC and the NMC (if we are including the other organisations too) need scrapping and new organisations put in their place.

    Nursing deserves better than this shower of shite.

    We need a NEW Royal College of Nursing, with a Royal Charter that supports and leads the profession, with a focus on NURSES, not anything or anyone else.

    We also need a strong and militant union that is solely focused on protecting and supporting Nurses and Nurses alone.

    Nursing as a profession deserves no less.


    However, I do agree with you about the abysmal failure of Beasley and I will join you in opposing her if she tries to go for the next general secretary post!!!

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  • Mike, I repect your opinion, but your a bit short on content why the RCN is so 'shite'
    I'm an RCN steward and in my Trust I'm one of the leaders who are opposing the commercialisation of the NHS. But couldn't do it without GMB and UNISON support.

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  • Maybe in the last post I am Mike Travis for reasons of expediency, but read my many other posts on many many other threads on the inadequacies of the RCN.

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  • Hi Mike, noted-but a lot of the other comment is just..... comment. There are things that the RCN could do a lot better, but the same can be said for other unions as well.

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  • Mike Travis, that is true, noone is perfect, but at least other unions are vocal in their support for the professions/trades they represent and are successful in fighting for an improvement in conditions or to stop attacks on conditions. Do you want examples? Teachers, Firemen, BA workers, transport workers, the list goes on. The RCN does NONE of this. Look at the recent media attacks on Nurses, the RCN is again woefully silent in its response when it should be robustly defending us. Where was the RCN when Unison were threatening strike action not so long back? Nowhere! In fact, why have we STILL not been balloted for all out strike action by the RCN for the constant attacks on our pay, conditions etc? What are they doing about unsafe staffing levels? What are they doing about cuts to Nurse training posts. NOTHING! AS ALWAYS!!! Do you want me to continue Mike Travis? Because I can go on all day here! Nurses are pissed off , fed up and dissilusioned, and yet the RCN sit in their comfy plush offices and do NOTHING!!

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  • Any suggestions to fill the post for the next CNO? There are going to be 2 posts, one DoH, one public health.

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  • Anonymous | 13-Sep-2011 11:52 pm, a Nurse with a backbone with enough passion for the profession to fight for it? May be a good start?

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  • Mike Travis, if you need further examples or explanationa s to why the RCN is failing Nurses, do you want to explain to me where the hell they were today when all the main unions united in balloting for strike action? Silent. As usual. Pathetic.

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  • mike | 14-Sep-2011 5:26 pm

    Of course, but I was hoping for names of anyone that any nurse holds in high esteem that could carry out such imprtant posts.

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