The NHS constitution sets out that the health service “touches our lives at times of basic human need, when care and compassion are what matter most”. This picture certainly describes the role we as nurses play within the NHS.
With that in mind, it is unsurprising that in clinical commissioning groups (CCGs), while quality of care is everyone’s responsibility, it is usually a chief or executive nurse that is responsible for ensuring quality in a local area.
This encompasses a range of different functions – quality assurance of service provision, safeguarding our most vulnerable, acting as the Caldicott Guardian and equality, diversity and inclusion are just a few quality responsibilities that fall within my remit as chief nursing officer at NHS Northern, Eastern and Western Devon and South Devon and Torbay CCGs.
Last year, the NHSCC Nurses Forum produced The role of the nurse on the CCG governing body, demonstrating the value of the commissioning nurse across the country and the positive impact they are having both for organisations and local populations.
We included a number of case studies which, among others, showed how they were leading projects to reduce rates of smoking in pregnancy, re-procuring mental health and community services and providing a voice for practice nurses.
A further case study brings out how the nurse representative led a service redevelopment plan co-designed with patients, and focused on experience-led commissioning. It showed how they advocate for quality and bring the patient perspective through the nursing lens to governing body discussions and commissioning functions. All in all, it shows how essential the commissioning nurse role is for ensuring quality of service for patients.
This is the reason that both I and other members of the NHSCC Nurses Forum steering group are concerned that as the health and care landscape evolves with the advent of STPs and new care models, there is a lack of clarity over the role of the commissioning nurse in some areas of the country. When the financial pressures increase – particularly at times of organisational change – surveillance around quality has to be increased or patient care may suffer; something that as nurses we are all too aware of.
”Working with our regulators and our providers, this local intelligence can make all the difference and is important to ensuring patients receive safe, effective care”
We know from the Mazaars report that where the focus is on organisational change, quality can deteriorate. To combat this, it is vital that the nurse has a clear role in the future commissioning landscape and continues to be involved in local decision-making as new ways of delivering care are developed.
The idea that instead in the new world an accountable care system can monitor and improve quality of services with scrutiny only falling to the CQC is of concern. National organisations inevitably simply cannot have the same local intelligence that CCG quality leads will. Working with our regulators and our providers, this local intelligence can make all the difference and is important to ensuring patients receive safe, effective care.
So what can we do? For a start, as nurses we must all make sure we continue to speak out to ensure that quality remains on the map. We are the biggest workforce in the NHS, and together with other NHS professionals, we touch the lives of a huge number of people every day – not only in terms of the clinical care we deliver, but through being there to look after them, treating them with kindness and compassion when they are at their most vulnerable.
Our frontline experience is invaluable to patient care and our voices must be heard when it comes to ensuring quality of services.
When CCGs were established, the Royal College of Nursing played an instrumental part in ensuring nurse representation on their governing body. It is important that we don’t allow this to be lost now.
The NHSCC Nurses Forum is keen to work with the RCN and with NHS England to make sure it doesn’t and that in this new world, the strategic nursing voice for quality remains.
Lorna Collingwood-Burke is chair of NHS Clinical Commissioners Nurses Forum