Strategic Health Authorities (Hansard, 24 February 2003)

§ Baroness Cox
asked Her Majesty's Government:
Whether they will reconsider their position with regard to nurse membership of strategic health authorities.

§ The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)
My Lords, strategic health authorities have been in operation for less than 12 months. The majority have now appointed a director of nursing or lead nurse. The department is working with authorities that have yet to appoint. Time must now be given to allow the new arrangements to bed down.

§ Baroness Cox
My Lords, in declaring an interest as a vice-president of the Royal College of Nursing, perhaps I may thank the Minister for that partially encouraging reply. However, does he agree that, as nurses represent two-thirds of the National Health Service workforce and carry direct clinical responsibility for patient care around the clock, they have the most intimate knowledge of the impact of healthcare policies at the front line of care?
Therefore, does he accept that it is perhaps worrying that strategic health authorities have a mandatory responsibility to appoint a communications officer but not a nurse and that reportedly some SHAs have not appointed any nurses to their boards? As a matter of great urgency, will he undertake to address that anomaly—an anomaly both in practice and in principle—which is bad for patient care and damaging for nursing morale?

§ Lord Hunt of Kings Heath
My Lords, I certainly agree with the noble Baroness that nurses have a key role to play in terms of both the direct patient care that they provide and the leadership that senior nurses can give. Strategic health authorities are required to have a senior nurse but they are not mandated to appoint a nurse as an executive director because we wish to give them as much discretion as possible. There is no mandatory requirement to appoint communications officers to the boards of those authorities. The chief executive pointed out to the authorities that it is as well to allow information officers to attend board meetings so that they can inform the community of the decisions taken. There is no question of that being a mandatory appointment.

§ Lord Campbell of Alloway
My Lords, will it not be rather difficult for senior nurses to provide input into the requisite strategic planning within the strategic health authority unless they are represented at board level? I wonder whether the Minister, with his good intentions in this matter, could consider that request.

§ Lord Hunt of Kings Heath
My Lords, that matter was given a great deal of consideration. Although we recognise that nursing makes an important 6 contribution to strategic planning, it was decided that it would be wrong to lay down an absolute requirement for a strategic health authority to appoint a nurse as an executive director. However, it was made clear to SHAs that they needed to have a nurse in a senior position. I say to the noble Lord that NHS trusts, which provide the bulk of NHS services, are required to appoint a director of nursing to the board. There is also a requirement for a nurse to be on the board of a primary care trust and the executive committee. Therefore, nurses are strongly represented in places where key decisions are made about the provision of services to patients.

§ Baroness Emerton
My Lords, I declare an interest in that I have served nearly 50 years in the NHS. I have two brief, inter-related questions for the Minister. First, can he assure the House that action will be taken to fulfil the promise made in Shifting the balance of power that a visible senior nurse will be provided at every level of the NHS to ensure that the contribution of front-line nurses and midwives is optimised and that high quality services are delivered? I heard the Minister's response about the requirement for a nurse to be appointed at NHS trust level and at primary healthcare level, but that is not necessarily so right through the organisation of the NHS.
Secondly, does the Minister agree that at the moment the high wastage of qualified nurses causes a problem? I know that efforts are being made to recruit nurses, but in order to promote career progression it is important that they should have a place at the management team level so that nurses know that their voices are being heard. Can the Minister assure the House that such a requirement could be put in place?

§ Lord Hunt of Kings Heath
My Lords, I believe that I have answered the point in relation to primary care trusts and NHS trusts where there is visible nurse representation at the most senior levels. With regard to the limited number of strategic health authorities that have not yet appointed a senior nurse, I intend to let the chief nursing officer of the department loose on them. I am sure that we can look forward to their quick compliance.
More generally, I accept that the nursing profession is critical of our plans for developing and improving the health service. I believe that the appointment of nurse consultants and the greater authority that nurses are being given through the modern matron approach are the most visible ways in which we can indicate to nurses and former nurses that nursing is a very good profession to be in.

§ Baroness Gardner of Parkes
My Lords, those, like myself—I am a dentist—who have spent a lifetime in the NHS would accept that nurses come second to doctors in relation to having a place on the boards of strategic health authorities. Does the Minister agree that the document is unclear as to whether nurses should be appointed to boards? He has spoken widely about nurses having senior positions, but is he aware that those who believe in the National Health Service 7 are of the view that a nurse is one of the most important people and should certainly occupy an executive position? Will he ensure that those strategic health authorities that have not made such an appointment do so?

§ Lord Hunt of Kings Heath
My Lords, on strategic health authorities that have yet to appoint a senior nurse, I have already informed the House that I shall ensure that that happens. I do not believe that there is any confusion about the membership regulations that lay down the requirements on strategic health authorities. There is no requirement to appoint a director of nursing who would be an executive director of the strategic health authority, but there is a clear requirement to ensure that a senior nurse is appointed to the strategic health authority. Nurses make a real impact in the direct provision of patient care services. At the NHS trust level, a nurse is an executive director as the director of nursing.

§ Baroness Greengross
My Lords, is the Minister as concerned as I am that the National Nursing Leadership Project is to be dissolved on 1st April, leading to thousands of nurses being unable to train in leadership skills?

§ Lord Hunt of Kings Heath
My Lords, the various approaches that are being undertaken to encourage nurse leadership are expanding. Over a two-year period £4 million has been spent embracing 30,000 nurses in nurse leadership courses and programmes. In the future we shall expand such programmes. More and more nurses are taking on senior positions, not just in relation to nursing, but also in general management. We want to encourage the profession to do more in that regard in the future.

§ Baroness Maddock
My Lords, the Minister has told the House that in the future strategic health authorities will be closely monitored on their appointment of nurses. Can he give us the timescale for that? Will he promise to report back to the House on the progress? Given that it is not mandatory, does he expect to see a nurse on every strategic health authority?

§ Lord Hunt of Kings Heath
My Lords, as I have made clear to the House, it is not mandatory. Therefore, I cannot give an assurance that I shall report back to the House on the matter. However, strategic health authorities are required to employ a nurse in a senior position. I have told the House that the chief nursing officer will be exploring the matter with vigour with, I believe, the three strategic health authorities that have not made an appointment. When appropriate, I shall report back to the House on that.

§ Baroness Masham of Ilton
My Lords—

§ The Lord Privy Seal (Lord Williams of Mostyn)
My Lords, we are into the eleventh minute, I am afraid.