The Nursing Times news story on reducing the number of nurses in the Department of Health (5 April 2016) exposed a serious issue of which the nursing profession should be aware.
baroness audrey emerton
In February 2016 the DH published its shared delivery plan, which outlines its prime function. It says, it:
“…will set the direction and coordinate action across the health and care system, which comprises public health, the NHS and adult social care. We work with our partners to ensure everyone can access the health and care they need, from supporting people to have the best start in life, to staying in good health and, where that might not be possible, supporting people to live as independently as they can”.
This has considerable impact and is a commendable vision: it is bigger than the NHS and is particularly relevant for nurses because they practise in public health and social care as well as the NHS. And yet, according to the article, the DH intends to meet these aims relying on a civil service that has no embedded nurses.
The nurses in the DH are employed as civil servants, bound by the civil service Code as well as the that of the Nursing and Midwifery Council. They advise ministers and policy teams on nursing and midwifery policy and have a liaison relationship with the UK and European chief nursing officers. Appointed on merit through fair and open competition, they are expected to carry out the role with dedication and commitment to the civil service and its core values of integrity, objectivity and impartiality.
If there are no nurses in the civil service there is a chance that nursing advice won’t be sought or it will be sought from those with a vested interest, who might give their opinions without supporting evidence, integrity, objectivity, impartiality or, importantly, accountability. These are the very things that support good governance and ensure the highest possible standards are achieved, which helps the civil service gain and retain the respect of ministers, parliament, the public and its partners.
It was not until I became a regional nursing officer that I realised and benefitted from the presence of the DH. Each region had a dedicated nurse for advice and guidance from the chief nursing office and could appoint a research nurse. Scotland, Wales and Northern Ireland likewise had a chief nursing officer and departmental nursing officers. The link between the chief nurse and departmental nurses ensured policy issues were discussed and implemented with understanding. The chance to influence policy was afforded through regular meetings between the chief nurse and regional officers which, in turn, helped determine which future policy issues were presented to ministers.
The DH has wide responsibilities outside advising ministers on the governance of healthcare provision in England (and, to an extent, devolved countries) – it also advises ministers on international health matters. It is understood that in an economic crisis savings have to be made, but it is important that before deciding to remove a function that has proved to be essential over the years (particularly when there is no indication that such a need may change), cognisance should be given to retaining the nursing voice when advice is given on policy issues relating to all matters of health and healthcare delivery.
The nursing profession represents the largest single workforce in the health service and deserves to have a voice at the table that influences future healthcare policy. Do we really want our nurses to return to a pre-Florence Nightingale era?
Baroness Audrey Emerton is a former nurse and cross-bench peer in the House of Lords