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PM's commissioner begins review of specialist nurse roles

  • 16 Comments

A former member of the Prime Minister’s Commission on the Future of Nursing and Midwifery has said she will start reducing the number of specialist nurse roles at her trust.

Chelsea and Westminster Hospital Foundation Trust chief executive Heather Lawrence, who has a nursing background and sat on the prime minister’s commission last year, told Nursing Times she had begun discussing changes to inpatient specialist roles with staff. She also plans to look at outpatient and community nurse specialists.

One of the commissions’ recommendations was to regulate advanced practitioners and make sure, based on their skills, they deserved their title. It is thought that could mean reducing some specialist roles and using savings to support ward sisters, whose pay and status is regarded as significantly lower than some specialist nurse roles.

Ms Lawrence said she was looking at reducing the number of specialist roles alongside a review of the staff mix for different services and care pathways, with the aim of reducing costs while improving care.

She said the trust’s many nursing roles in different specialities should be significantly reduced to “about 10”, though the trust has yet to decide on what specific roles these will be.

Conclusions from the review will be discussed with other trusts and used to help commission training. Ms Lawrence also hopes the process will inform the future regulation of specialist roles – another recommendation of the commission.

 She said: “We have to take health services forward at a time of constraint, so we have to review all of our roles and job plans.

“We need to be able to say: ‘This is the skill set for a role that will give confidence to us and to the public,” she told Nursing Times.

“It is down to people like myself to work collectively to see what patients need and work to make sure we have those roles – not to just let people arrive willy nilly.”

  • 16 Comments

Readers' comments (16)

  • Not sure waht the specialsits nurses in Ms Lawrence's trust do but at my trust ward Sisters are on Band 7s and I am a band 6 - the work I have done & achieved is far beyond my banding. I am being asked to do more and more and to write policies, develop more teaching sessions as well as my clinical work. I work 10 hours over every week to ensure patients on the wards get a good service. "Reducing costs while improving care"? In the words of Jim Royle "my a**e!"

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  • Ms Lawrence how about looking at managment pay, wages and bonuses in relation to reducing costs? I would suggest that a 10% reduction in chief exec and managment pay bill plus a no bonus scheme would reduce your wage bill. Anyone who works in the public sector should not require a bonus as an incentive to do a good job. Ask any nurse.

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  • Anyone who works in the public sector should not require a bonus as an incentive to do a good job.

    You are absolutely wrong. I'd take a bonus for good work anytime of the year. I guess it would require some sort of one to one appraisal and this is where the process would come undone.

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  • This is a complete joke and sums up ALL of the failings of the current NHS. Nurses and Sisters are the backbone of the NHS and work the hardest for least financial return.

    This is the time for the waste that is The Management to be significantly cut and for the NHS to focus on what they do best - caring for the people.

    This is a disgrace.

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  • Ward managers in my Trust are paid the same as nurse specialists and are also termed as ward matrons so they have equal pay and status - as always some Trusts just don't do right by there staff, just going for economy not truly providing a career structure for nurses. Will this executive uplift the ward mangagers grades in her trust, no, she'll just drag everyone else down.

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  • I work as a Community Matron, and yes I have done a great deal of learning to achieve masters level education in order to be an advanced practitioner. However, I believe this role is a luxury that I dont think the NHS can afford! Don't shoot me yet.....Having done this for a while now the main thing I find that makes the difference to the patients I see, is my time. I have the ability to dedicate time to them so they can talk and I can think. However the actual skills I use are often not over and above the skills of a competent DN. I am of a mind to think that if the DN complement was increased they could fulfill this role. Indeed I believe years ago they would have, in conjunction with the GP's - I now think we plug a gap due to increased demands on health care. Obviously that may not in a sense save money, but they would be far more flexible than someone with a specific title.

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  • I just read the comments from an anonymous community matron...It seems to me that what the anonymous claimer was not operating as a community matron, or possibly not developed her potential, as she compare her work with DN...The DH has clearly defined the role of Community matrons (DH2004, DH 2005a, DH2005b).
    I work as community matron and have pioneer this services since 2005 in a very deprived area. I find that my role has not just saved money to NHS, but improved quality of life for patients and carers. The role of the community matron is vital for the future of the NHS. I am constantly identifying gaps in services and feed back, helping to shape services in order to manage patients health and welbeing. The NHS cannot afford not to have community matrons because community matrons save unecessary admission and reduce the numbers of days in hospital, orchetrating services locally to meet patient and carers needs. A patient once told me that she felt she "now had one port of call" and another describe the community matron services being " like an umbrella, protecting his wellbeing and preventing his health from deterioration"...

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  • If any cuts on NHS has to happen, it should be on the large numbers of manager, leads, manager assistant (to assist managers???) and not reduce vital professionals in our NHS, which are actually saving money, such as Community Matrons and specialist nurses. What we need is good admin support, robust audit systems, doctors, matrons, nusing staff and the appropriate enviroment and resourses to meet the ever changing health needs. The Government also needs to look if what is being demanding from PCTs and NHS foundations trust is actually generating the need to develop the large numbers of managers to manage what Government is asking for. This is where the waste is being generated from!

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  • Lets keep what is important to patient when reviweing specialist nurse roles. Community Matrons are vital in managing long-term health conditions and they save NHS unecessary hospital admissions. The Government was aware that people are living longer and that they consequently develop long-term health conditions, thus was wise to start this new role, as Community Matrons deal with complex, cormobidity and chronic patients, who often are on polypharmacy. Those patient deserve the care of Community Matrons, who can mange those patient and reduce the need for unecessary admission, GP visits and Out of Ours call and improve their quality of care/ life. Listen to patient, lets keep them safe, keep Community Matrons and support them to continue with their great work.

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  • This sounds like an 'I'm all right Jack' attitude from Heather Lawrence. I work as a specialist nurse in diabetes. I am the only one in a 400+ bedded hospital. I am responsible for direct patient care, education and training of all staff in the hospital, writing of policies and guidelines and implementation of new projects to improve care. I really resent her attitude. I don't get any more money in this job than I did as a ward manager, both jobs were band 7. As a ward manager I never thought of myself as being 'inferior' to a specialist nurse, as a specialist nurse I do not consider myself to be 'superior' to a ward manager. ALL nursing roles should have equal value in the eyes of those in management.

    I think Ms Lawrence is obviously an extremely well paid chief executive, who needs to look more closely at her inflated army of bureaucrats, all those endless layers of management, if she wishes to save money.

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