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 Nursingtimes.net 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.