Leading nurses have raised serious concerns about a loss of vital nursing expertise and influence over policy at the highest level after the Department of Health outlined proposals to cut up to 700 jobs.
Under the confidential plan seen by Nursing Times, the department’s workforce will reduce from 2,000 to around 1,300 to 1,400 over the course of this parliament.
“Losing one DH nurse could have an impact on ensuring the voice of nursing is heard loudly and clearly in central government”
The plan – circulated to DH staff – sets out how the department must change to cope with having a third slashed off its budget.
DH insiders have confirmed the few posts currently held by those with nursing expertise are all at risk amid the re-organisation, prompting fears the profession will lose vital input in high-level policy with a knock-on effect on frontline care.
“We will lose that impartial voice in nursing leadership and sophisticated handling of policy will suffer,” warned one source.
The move comes amid ongoing concern that nursing’s influence at the department has been diluted, after the chief nursing officer role moved to arm’s-length body NHS England in 2012.
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In addition, there is no longer a director of nursing based at the DH, following Professor Viv Bennett’s move last year to Public Health England to become its chief nurse and the government’s principal advisor on public health nursing.
The latest round of DH job cuts – to be made at all levels – will start with the executive committee and a reduction in the number of director generals by April next year.
The number of directors will fall from 25 to around 16 to 18, the number of deputy directors from 116 to around 70 to 80 and other civil servant and professional adviser roles will be cut from 1,800 to between 1,200 and 1,300.
Roles under threat include those at the Nursing, Midwifery and Allied Health Professions Policy Unit. The unit has already seen staff reduced from nine to seven, meaning key policy advisers are “all doing basic admin, which is not the best use of their talents”, said a source.
Gail Adams, head of nursing at Unison, said it was vital to retain nursing expertise within the DH.
“There are only a handful of nurses in the DH now, so just losing one of them could have an impact on ensuring the voice of nursing is heard loudly and clearly in central government,” she said.
“The chief nursing officer now sits within NHS England, but it’s absolutely vital the health minister retains a nursing team within the DH,” added Ms Adams, who said losing senior nurses at the top would damage the profession as a whole.
“If you start to get rid of nurses and feel that anyone can advise on nursing you devalue the profession,” she said.
“You need a strong advocate for nursing and nurses to continue to make sure the importance of our role is heard, understood and appreciated and respected at the highest level,” she said.
“If policy isn’t influenced at the top then that filters down through the system”
Last month the DH and its arm’s-length bodies published a “shared delivery plan” setting out their joint priorities up to 2020. The DH’s internal re-organisation plan includes looking in detail at the department’s role and relationship with agencies like NHS England, Public Health England and Health Education England.
It will include a workload assessment looking at where there is overlap between the organisations and could mean senior nurses in the arm’s-length bodies taking on more responsibility.
“If nurse leadership is being rubbed down at the DH, it could mean nurses in bodies like NHS England become more important as the only national nurse leaders left in the system,” said Jon Restell, chief executive of union Managers in Partnership.
But others said a key advantage of having nurses actually working within the DH was they were able to “get in under the radar” to influence policy teams without getting caught up in the politics and varying priorities of different agencies.
Baroness Audrey Emerton, former senior nurse and now a cross bench peer in the House of Lords, claimed nursing was “very often put down” at the highest levels of government and it was vital the profession was represented by people who truly understood it.
“I believe there should be a nursing voice at the top – in the Department of Health, NHS England and at every trust – a strong leadership voice involved in policy and able to influence and persuade change,” she said.
“If policy isn’t influenced at the top then that filters down through the system,” she added.
But Lisa Bayliss-Pratt, director of nursing at Health Education England, said there was “very strong alliance of senior nurse leaders” across the arm’s-length bodies under the leadership of the CNO.
“What we have done over the last three and a half years together is build up a strong network so we have system leadership and we do have a voice in nursing at every level,” she said.
“There are always concerns when things change and about the pace and scale, but we do have a very strong senior nurse leadership that is headed up by our CNO.”
A DH spokesman confirmed the fate of specific roles had yet to be decided and said this would not happen until the department’s new permanent secretary, David Wormald, was in place later in the year.
“It has not been specified at the moment which roles are going to go, but it will be pretty even at about 30% at each grade level,” he said.