The prime minister recently made a speech backing the NHS reforms and although he said nurses should be more engaged in commissioning, no formal role on consortia boards was alluded to - the RCN’s Dr Peter Carter explains why this is so essential.
Nursing is unlike any other profession in the world. Nurses working in the NHS undertake roles that would surprise, impress and amaze many outside observers. They balance technical knowledge and skills with a desire to deliver care, compassion and comfort to patients. Most care is given by nursing staff, from patients’ first admission into hospital to follow-up visits at home.
Nobody knows the NHS quite like nurses - so they need to be a part of running it. The Royal College of Nursing backs Nursing Times’s A Seat on the Board campaign for this very reason.
The Health and Social Care Bill is the most radical set of changes to the NHS in its history. We’ve all seen reorganisations, revamps and redesigns - but we’ve never seen anything on this scale. One of the most controversial changes is GP commissioning, which involves handing over £80bn to GP-led consortia to commission and pay for patients’ services.
The A Seat on the Board campaign demands all boards should have at least one nurse - hardly an unreasonable request. In the same way that directors of nursing have been able to influence trust boards on behalf of patients and nursing staff, nurses on commissioning consortia would be similarly influential and important.
What’s more, we know that where nurses have been involved in commissioning, results follow.
We have proof that, when nurses start to design services, patients benefit. Take Wendy Fairhurst and the nurses at the Atherleigh Patient Focus consortium. As a partner in her general practice, Ms Fairhurst was asked to take a representative role on the practice-based commissioning board when it was established three years ago.
As the only nurse on the board, she was keen to establish a more permanent nursing voice and lobbied for a dedicated nurse forum and a nurse representative on the board who wasn’t there solely to represent a practice.
The board had been asked to select an area of chronic disease for service redesign. As Wigan is a former mining town, Ms Fairhurst proposed breathlessness. She and her team decided to look at primary care and, in particular, a nurse-led service to improve the diagnosis, assessment and treatment of patients with chronic obstructive pulmonary disease, heart failure and asthma.
The nurse forum that Ms Fairhurst had lobbied for was vital to the entire process and the service was commissioned as a pilot. Now, more patients are diagnosed correctly, exacerbations are prevented and treatment is being changed in line with NICE guidance. If any more proof of its success is needed, just listen to what the patients say. As one said: “This is a brilliant service, it made my daily life much better.”
Ms Fairhurst and her team are a perfect example of what happens when a little faith is put in nurses. With a seat on a commissioning board, a nurse will bring their unique experience of how patient care is delivered to where it is needed most, in deciding how to fund crucial services.
No one else will bring the knowledge, perspective and understanding of the NHS like nurses. They deserve a seat on the board and they deserve it now.