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Minister: CCG nurse must not be corporate 'fig leaf'


Nurses sitting on GP commissioners’ governing bodies should be active decision makers and not merely provide a “fig leaf of involvement”, a health minister has said.

Paul Burstow was pressed on the issue by Baroness Shirley Williams, the influential Liberal Democrat peer, who said she was concerned there was “some discussion in the Department of Health at the current time… that these other representatives should [sit on] corporate governance boards as distinct from [being] decision makers”.

Baroness Williams, who repeatedly raised the issue at the party’s conference in Birmingham last week, said it was “crucial they [nurses] are a part of the decision making because often they know more about saving money [than doctors]”.

Mr Burstow responded: “That is exactly the intention. This is not about having a fig leaf of involvement.” He said the government was “making sure they [nurses] are an integral part of the decision making process”.

The requirement for a nurse, and a doctor with secondary care experience, to sit on the governing body was promised by the government following Nursing Times’ Seat on the Board campaign and an outcry from staff.

Baroness Williams said she was concerned nurses could be “whizzed off to some corporate board which meets four times a year”.

However, she expressed support for changes made to the government’s plans during the summer and suggested the reforms may now contribute to improving services.

She said she still had concerns - including the role of nurses - and would call for further changes when the Health Bill was debated in the Lords next month.

These should include changes to ensure the health secretary retained responsibility for securing provision of NHS services. She also said government regulations which will follow the bill – for example to set out governance rules for CCGs – should have to be reviewed by the Commons health committee rather than only being “rubber stamped” under the normal parliamentary process for regulations.

She said: “If we don’t do that the regulations might undermine everything we have done [in amending the bill/reforms].”

Baroness Williams is also calling for plans to scrap foundation trusts’ private patient income cap to be dropped. Instead, she said, she wouldl propose a system where at least a majority of FTs’ income is from NHS patients; and each FT should agree a cap with the regulator Monitor. Currently each FT’s cap is set at a historic level.

Last week health minister Earl Howe indicated the government would amend the bill to require FTs to explain how their private income is benefiting NHS patients.

Earl Howe said in a Lords debate: “We are confident that, as and when the cap is lifted, private income will benefit NHS patients. We are determined that that should be seen to happen.

“However, we will explore whether and how to amend the bill to ensure that foundation trusts explain how their non-NHS income is benefiting NHS patients.”


Readers' comments (2)

  • Well done Baroness Williams for raising the issue, but I do take issue with the statement “crucial they [nurses] are a part of the decision making because often they know more about saving money [than doctors]”

    We are crucial because we have the most direct involvement with our patients, our clinical knowledge and skill is as high as a Doctors and our input into exactly how services are run and our patients are affected is as equally as valuable!

    Saving money! The bloody cheek!

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  • michael stone

    Of course it is about saving money - expressed as 'getting a better deal for the patients for the same outlay'.

    But this does bother me. I still cannot work out what the 'hospital doctor' is doing there, but the important bit here is to use the commissioning body to stop the GP Consortia from 'getting on both ends of the commissioning'.

    So in my opinion, the nurse and the two laymen, must be entirely disconnected from any of the GPs involved - so not their patients, not their clients, and not employed in any of the consortia GP Surgeries. The laymen should, in my view of this, be inputting 'the view of local lay patients who cannot be influenced by these particular GPs' - for example, it might be clinically more efficient to treat everyone at a single hospital 70 miles away, but patients like a short trip to hospital, other things being equal !

    Presumably the nurse is supposed to input a nursing perspective.

    And technical expertise about 'deal making' should be provided by people who are NOT part of that 'statutory 4' - I have no problem with people such as the GP's Practice Managers being in there, provided nobody associated with any of the GPs, has a 'checking on probity' role.

    The idea/claim/justification was that GPs understand the clinical needs of their patients better - that leads to a concept of GPs describing what needs to be purchased by way of secondary services. That is all it leads to - it doesn't even lead to a requirement that GPs need actually be on these boards, as they could send people such as practice managers to explain what needed to be purchased for patients.

    I think this will be twisted to suit political aims.

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