A court case involving a dispute over care home payments between local councils and the NHS has exposed a serious lack of understanding about the definition of nursing, which must be tackled urgently, a leading nurse has told Nursing Times.
Dame June Clark, former president of the Royal College of Nursing who is now retired, said the four-year case, which was brought to an end earlier this month, had shown NHS health boards in Wales wrongly believed personal care was not a part of nursing.
“[If we] allow basic nursing care to be taken out of the concept of nursing… we diminish our whole underpinning of the role”
She warned that if the profession allowed the “concept of basic nursing care to be taken out of the concept of nursing… we diminish our whole underpinning of the role”.
Dame June told Nursing Times the lack of a clear definition needed to be addressed immediately by the nursing profession – and in particular by the RCN, which had a duty to do so – to ensure nursing was not reduced to a series of tasks.
Otherwise, she said there was a “danger” that policymakers would believe new roles, such as nursing associates in England, could be allocated these tasks, potentially removing the need for a nurse.
The case, which concluded at the Supreme Court on 2 August, was between all local authorities in Wales – except the County Council of the City and County of Cardiff – and health boards led by Cardiff and Vale University Health Board.
“Either we let external bodies decide what nursing is. Or we take this opportunity ourselves”
It centred on how much funding local councils and the NHS should each contribute for the nursing of residents in care homes who required nursing care for only some of the time.
The row stemmed from a decision, made in 2013 by the country’s NHS health boards, to increase the rate they paid for nurses in care homes – but not by as much as local authorities said they should have.
The seven health boards said they should not have to fund nurses’ time spent doing “non nursing” tasks, such as dressing and washing, because it was possible for other staff members to do these instead.
The local councils disagreed and argued that the NHS should pay for everything done by a registered nurse in a care home and that their time should not be “atomised” into different tasks, according to court documents.
Care home payment row case ‘reveals urgent need to define nursing’
At the hearing this month, a judge said the relevant legislation – Section 49 of the Health and Social Care Act 2001 – “quite clearly envisages that there will be some circumstances in which care does need to be provided by a registered nurse, even though it is not care which only a registered nurse can provide”.
The Supreme Court judge, Baroness Hale, concluded that the health boards’ decisions were based on a misinterpretation of the legislation and “must be quashed and re-taken” in light of additional guidance she provided in court.
In this guidance, she stated it was her view that the definition of nursing care provided by a registered nurse included “time spent on providing, planning, supervising or delegating the provision of other types of care, which in all the circumstances ought to be provided by a registered nurse because they are ancillary to, or closely connected with, or part and parcel of the nursing care which she has to provide”.
Baroness Hale said that councils and health boards would, on that basis, now need to renegotiate how far each pays for nurses’ time in care homes.
“There will be some circumstances in which care does need to be provided by a registered nurse, even though it is not care which only a registered nurse can provide”
Speaking to Nursing Times after the case, former RCN president Dame June, who is also emeritus professor of nursing at Swansea University, said the dispute had highlighted a lack of understanding about the profession.
She called for action from nurses – and especially the RCN – to avoid external organisations deciding what the profession should or should not do.
“Either we wait for local authorities and health boards – who have shown they know nothing about nursing – and let those external bodies decide what nursing is. Or we take this opportunity ourselves,” she said.
Dame June said the RCN should either promote a previously decided definition of nursing from 2003 – which she led the development of – or it should develop a new version, taking into account new roles such as nursing associates.
“The lead judge repeatedly asked for a definition of nursing, was told there wasn’t one, and recommended that the health boards and local councils should sort it out between them. I believe it is the job of the profession, not health boards or local authorities, to say what nursing is,” she added.
“We will be seeking the support of our members to help inform and progress this work”
In response, Stephanie Aiken, deputy director of nursing at the RCN, said: “The definition of nursing is publically available on our website and was last updated in 2014. This definition is due for review in December 2017.
“The RCN is actively engaged in work to articulate the value of nursing, which involves a wide range of stakeholders, including the chief nursing officer,” she said.
“This will consider how we define the scope and contribution of contemporary nursing, and how we communicate this to professional and public audiences,” she said. “We will be seeking the support of our members to help inform and progress this work.”