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We find ourselves once again at one of those moments when ministers have decided that change is necessary to somehow make the NHS run better, without simply investing in more services and staff.
Last time there was a major structural reorganisation of the health service in England, the nursing profession had to fight hard to ensure it had a seat at the table. I hope this won’t be necessary again.
With that in mind, my column this week is meant as a pre-emptive strike, as I have learnt never to assume something in health policy until I see it happen and preferably see it stated in a document.
Each clinical commissioning group (CCG), which currently decides the NHS services commissioned locally, is required by law to have a registered nurse on its governing body – equivalent to a board.
But this was not necessarily always going to be the case. When the creation of CCGs was originally set out in government proposals, there was no requirement for a nurse on the governing body.
Nursing Times – through its Seat on the Board campaign – and many others, including the Royal College of Nursing, successfully lobbied to ensure it became a legal requirement to do so.
Having a nurse represented alongside the various medical professionals and lay people on the governing body seemed like an obvious move and not to do so would be wrong for many reasons.
Not only would it mean the views of nurses were somehow seen as less important than GPs and the rest, but nursing would be absent from having a voice in key local commissioning decisions.
As NHS England guidance on the role of the nurse on the governing body states: “This person will bring a broader view, from their perspective as a registered nurse, on health and care issues to underpin the work of the CCG especially the contribution of nursing to patient care.”
“The timing of the new white paper might be suspect, given the coronavirus pandemic, but it’s roughly on schedule politically”
Nearly a decade has passed since the Health and Social Care Act 2012 saw primary care trusts (PCTs) swept away and replaced by CCGs, and we are now going to see the deckchairs moved around once again.
The Department of Health and Social Care (DHSC) has just published a white paper that paves the way for a new Health and Care Bill to be introduced in 2022.
The timing of the new white paper might be suspect, given the coronavirus pandemic, but it’s roughly on schedule politically. This sort of restructure seems to happen every decade.
For example, the predecessor of the 2012 legislation was the Health Act 1999, which saw commissioning taken away from health authorities and given to PCTs.
Under the latest plans, CCGs in their present form will be abolished. So, what replaces them? Something inevitably does but with a different acronym and a slightly different mode of operation.
This time it’s integrated care systems (ICSs) that will formally bring together NHS and local authority organisations to take joint responsibility for the health outcomes of people in their population.
Each ICS will be made up of a statutory ICS NHS Body and a separate statutory ICS Health and Care Partnership. CCG commissioning functions will pass to the ICS NHS Body.
Now, back to my original thread – nurse representation in such organisations. The chief nursing officer, Ruth May, has already indicated via social media that ICSs will have nursing directors.
Speaking on Twitter, she said: “The proposed ICS structure in the DHSC white paper indicates a very welcome move towards more joined-up health and social care in the future.
“To deliver this ambition, there will naturally be directors of nursing among the executives on ICS leadership teams – just as there will also be chief financial officers, medical directors etc,” she said.
Presumably, something prompted the CNO to make this reassurance, possibly even concerns or questions looking back to what I was talking about in relation to the early days of CCGs.
Her words sound promising though and she has the support of Nursing Times in making this happen, because having nurses represented in board-level decision-making roles at ICSs will be vital.
Nursing Times will be ready to scrutinise the government’s new bill when it is published to ensure it clearly states that nurses will have a seat on the board of ICSs and stand ready to act if it doesn’t.