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Anger following attack on chief nurse role


Nurses are demanding the role of chief nursing officer for England – the most senior representative of the profession – is protected after it emerged it faces being scrapped or “diluted” by the government.

A draft of a new top-level structure for the Department of Health, seen by Nursing Times, does not include the CNO. It is understood the DH intends for the most senior nurse in the department to report to one of five director-generals – two rungs below the CNO’s current position.

There will be a separate role for a nurse director on the new NHS Commissioning Board, reporting to its chief executive, but this will be independent of the DH.

The role of the chief medical officer is shown as on a par with the chief civil servant, the DH’s permanent secretary Una O’Brien.

The plan raises questions about whether there will be any nurse with the title of CNO and could therefore contradict a promise by health minister Anne Milton in November when she said: “There will be another CNO.” The minister paid tribute to the contribution of the current post holder Dame Christine Beasley, who will retire in the autumn, and said a “high level” of nursing input to the department would be vital.

Senior nurse and nursing consultant Gerry Bolger, a senior adviser to the CNO until April, told Nursing Times if the plans went ahead, “we have been let down and misled by politicians”.

He said: “The [CNO] has brought huge impact in improving patient experience, reduction of prevention and infection, and improving the care and experience of mothers.

“The CNO role is an invaluable role and needs parity because of the key relationships the role has with the other three UK countries, [and] represents nursing and midwifery at government level. If this role is diluted it gives a message that nursing and midwifery can be devalued at political whim.”

Royal College of Nursing policy director Howard Catton said the structure suggested the senior nurse role was being “doubly downgraded”, because it was now two rungs of seniority below that of the chief medical officer Dame Sally Davies.

He said: “If this is what is being proposed there is a clear disparity with the CMO role. Given what we know about future healthcare needs and demands – and the crucial role nursing will play in meeting those needs – there should be parity between the nurse role and CMO role.

“The chief nurse role should report directly to the permanent secretary.”

Dozens of readers have also spoken out against the plan on the website.

Bill Whitehead said: “This is another sign of the oppression that nurses experience every day as a profession.

“If we don’t have the prestige as a profession to have an automatic place at the top table we must be prepared to take action to get it. Otherwise our patients will lose a strong voice as well as us.”

A reader called Tinkerbell said: “To downgrade nursing input at the top level really speaks volumes about what this government really think of nursing as a profession.”

Michael Stone said: “I am not a nurse, but I see absolutely no reason why nurses and doctors should not be represented at the same level on these things.”

The document says of the plans: “This is still under development and does not include all details.” A DH spokeswoman told Nursing Times: “Details will be announced shortly.”

The first guidance on the conditions for becoming a clinical commissioning group – the bodies which will replace primary care trusts – lacks detail on how nurses will be involved in decisions.

A draft of Developing clinical commissioning groups: Towards authorisation, which was sent to interest groups on Thursday and seen by Nursing Times, begins to set out requirements for the GP-led groups to take on budgets. It repeats the requirement for CCGs to have at least one nurse on their governing body, which was announced by the government in July following a campaign by Nursing Times.

The government also said it would “strengthen” CCGs’ duty to “secure professional advice and ensure this advice is from a full range of health professionals where relevant”.

However, the authorisation paper gives no other details of how the NHS Commissioning Board – which will run the process – will check if they CCGs are meeting it.

Royal College of Nursing primary adviser Lynn Young called for more details, adding: “They haven’t described the attributes we will be looking for [in CCGs], or what kind of knowledge and skills.”

She said the DH also needed to move quickly to ensure skilled nurses are involved in commissioning, and stop those working for PCTs from leaving.

However, NHS Ealing borough director Ursula Gallagher, who leads the NHS Alliance nurse network, said she believed the final authorisation process would ensure nurse involvement, and that there would be support for nurse commissioners.



Readers' comments (34)

  • tinkerbell

    A reader called Tinkerbell said: “To downgrade nursing input at the top level really speaks volumes about what this government really think of nursing as a profession.”

    it's OK NT, i realise you might have needed to tame me a bit and censor the last bit of my post which said 'perhaps this government still sees nurses as gin swigging old prostitutes' so i have put it back in to assist. I am no longer looking for a job in the diplomatic corp.

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    A taste of ones own medicine?No pun intended! Us lowly minions had the Agenda (for short) change' inflicted upon us and how many nurses were down graded or did not get the banding they deserved?! Hmmmm I rest my case!

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  • Adrian Bolt

    Bill Whitehead said: “This is another sign of the oppression that nurses experience every day as a profession."

    Are we not in danger of getting this a little out of proportion here. Not having a seat at the top table as well as being a reality check is no more than an insult to our collective egos, it is hardly an a sign of oppression.

    "What have the Romans ever done for us?"

    Don't worry Bill we will fight for your right to have babies brother, er sister.......

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  • most nurses on the shop floor dont give a didly squat about this, they are more interested in what is happening to their pensions. Reality check needed here I think!

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  • Welander Linh | 16-Aug-2011 1:53 pm and Anonymous | 16-Aug-2011 6:27 pm, absolute rubbish.

    First of all, many of us 'Nurses on the shop floor' DO give a damn about this, those who do not are being introspective and short sighted in the extreme.

    And this attack, coupled with constant attacks on our pensions, our pay, our working conditions and status, is FAR, FAR more than a simple bashing to our collective egos. It IS a symptom of the pervasive opinions that the government, management and to an extent the general public view our profession. As far as they are concerned we are not highly skilled professionals, we are not indispensable, we are not worthy of having our opinions count.


    This needs to stop. Now.

    If we do not fight this tooth and nail an see this as a clarion call to FINALLY stand up for ourselves as a profession, then we may as well just give up and go home now.

    Our profession IS indispensable to the NHS, without us, there is no healthcare system. Our profession deserves the status, pay and respect that should be demanded by every highly skilled, educated and qualified profession; and we deserve BY RIGHT to have a representative voice at the highest levels of government equal to and alongside the CMO.

    If we don't have someone at the top speaking for us (and this is were the anon above me really needs to wake up and smell the coffee) who do they think will fight to protect our pensions and demand terms and conditions, working conditions and pay that we deserve? Who do they think will ultimately speak out for patient care and standards of best practice? The CMO? The politicians? Get real.

    We need to fight this tooth and nail and demand the post is reinstated with someone in it with enough backbone who would not even allow this to happen in the first place!

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  • I agree with anon - most nurses are not angry about this. It's simple not important enough to worry about.

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  • tinkerbell

    Anonymous | 17-Aug-2011 8:45 am

    I agree with anon - most nurses are not angry about this. It's simple not important enough to worry about

    Neither do i go to bed festering about it but what mike says is the bigger picture.

    A chilli con carne without the chilli is after all just a bowl of mince and a nursing profession without a voice at the top is the same. We are either a profession who need a seat at the top table to represent us more lowly minions on the shop floor or we are just scivvies pushing trolleys of mince around all day.
    We do need a healthy self image of ourselves and respect for ours profession otherwise how can we expect others to have any respect for us if we have such a low opinion of our role within the NHS. We are of paramount importance to the running and continuation of the NHS. If i were just thinking about myself then quite frankly i wouldn't care as i'm out the door next year, but i want to hand the baton on to the next generation of nurses, i want them to feel empowered and know that their sense of duty is not taken for granted. Think on before you say that most nurses aren't bothered by this, most nurses probably don't even know because they are too exhausted and busy working to have time to find out. Same as most of the public don't know how our NHS is being decimated. It might not affect you now but in the long run, not too far away, it could when your pension is not enough to live on, when all posts are cut within your hospital to the bare minimum, when staff nurses are no longer need to cover a ward because the role has been diluted to something less and when you are too decrepid to enjoy any pension anyway because your bodys too knackered after all the years of back breaking service.

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  • Marjorie Lloyd

    If this happens then the message is very clear that nurses are not valued in the UK as genuine equals to other health professionals. I really hope the politicians read these sites, especially the health ministers and post some genuine replies. Only then will nurses feel listened to.

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  • Adrian Bolt



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  • Welander or Edwin or whatever, don't be foolish. Nurses ARE indispensable. A health service in any society is indispensable, and without us, there is no health service. Do you really need me to spell that out to you?

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