Losing our voice - losing our profession?


Deborah Glover, MBE - Editor PCNR

BSc (Joint Hons), Dip. Care Policy & Management, RGN

What cruel mistakes are sometimes made by benevolent men and women in matters of business about which they can know nothing and think they know a great deal – Florence Nightingale

And Florence was right; the ‘benevolent’ men and women of the Department of Health have all but closed the Nursing, Midwifery and AHP unit. Dr David Foster, the Unit leader  has retired (after 30 years as a nurse & midwife - we will miss you!), and the remaining staff will have 'left the building' by the end of the year.

This represents the end of the independent and impartial voice of Nurses, Midwives and Allied Health Professionals.

Elizabeth Kenny, an Australian nurse who in effect, was the mother of the profession of physiotherapy due to her pioneering work in the management of polio (watch the film, Sister Kenny), once said:

He who angers you conquers you

So, I am conquered. They have won.

I have been made angry by various decisions of this government (https://pcnr.co.uk/articles/321/i-could-crush-a-grape), but the closure of the Unit was to my mind, the single most important (and idiotic) decsion of all. Despite a petition (https://petition.parliament.uk/petitions/132672 - still live until December), supported by the RCN, the Institute of Health Visitors, the NHS Alliance, The Nursing Standard, The Nursing Times, and many more, nursing has lost its voice. The Government has in effect, told a range of professionals what it really thinks of them. And that message is

'We do not value you. Yes, we will pay lip service to obtaining advice from the CNO and various other people and bodies, but that won't be impartial advice, and because we are in control of who we ask, we don't have to take any notice of them' (or sentiments to that effect)

I sent emails to  Baroness Watkins and Lord Prior as Hansard records that the former had raised it in the House of Lords as an issue. Baroness Watkins did not reply. A response on behalf of Lord Prior was received. This is it:

Dear Ms Glover,
Thank you for your correspondence of 11 August to Lord Prior about the future of Nursing, Midwifery and Allied Health Professional Policy Unit.  I have been asked to reply.

The Department of Health is changing the way it works to deliver its essential work for the Government while achieving efficiency savings.

While nursing will continue to be a priority for the Department, its approach is to have access to professional advice from a wide range of sources, including arms-length bodies, regulators, stakeholders and professional bodies, rather than from internal advisers. 

The Department’s policy teams will establish new networks and relationships with stakeholders and partners and work with NHS England’s Chief Nursing Officer (CNO) to ensure that appropriate advice can be sought when developing evidence-based policy.

These changes do not affect the role of the CNO at NHS England, as she is also CNO at the Department and already advises, and will continue to advise, ministers and the Department on nursing and midwifery issues.

Nursing, midwifery and allied health will continue to play an integral role in the Department’s policy making.

I hope this reply is helpful.

No, this reply is not helpful. It reflects the ‘party line’ and says nothing.

But what is more disappointing, what has made me want to throw in the towel, is the lack of response from nurses. Yes, the petition received the requisite 10,000 signatures required for the Government to ‘respond’ (10 days past and counting), which is a fabulous number, and a big THANK YOU to all those who have signed. But that represents only 2% of the 500,000 nurses currently on the register. And not all of those signatures are from nurses. If a mere 20% of all nurses had responded, the 100,000 required for the Government to debate the issue in parliament would have been reached.

It's worth recapping on the purpose of the unit. David Foster [1], explains: `

Each of the professionals in the team is currently registered with the Nursing and Midwifery Council or the Health and Care Professions Council as well as being civil servants… We follow the Civil Service Code and give advice with integrity, honesty, objectivity and impartiality – there is no room for professional territorialism or personal political bias. We get involved in a range of issues that straddle the Secretary of State’s priorities.

Giving advice and influencing takes a number of forms. Informal conversations about policy directions and intentions, followed by written briefing, face to face formal conversations with ministers and policy teams to firm details and make decisions.

… an external facing leadership role as well as acting as an internal resource to policy teams. Because we are all well connected and networked across the health and care system we make sure that we have rounded intelligence about issues and are not just reliant on our own experiences and views. This balance is crucial as the world changes beyond our experience and we need to have clear, current knowledge of the reality of health and care.

We meet regularly with stakeholders and partners to understand and influence the national context. This includes the arm's length bodies, the unions and professional bodies, membership organisations, the regulators of the professions and - most importantly - providers of health and care. Meeting people who, as a daily responsibility, give care is a really significant feature of understanding both the challenges and opportunities in the current system.

I think it is a shame that we have lost this valuable resource.

As Joan has succinctly postulated in his article (https://pcnr.co.uk/articles/340/citius-altius-fortius) nurses are not good at speaking up, except about pay, or the scrapping of the bursary. Perhaps that is because these two issues affect one’s pocket rather than one’s profession - which of course is perfectly understandable because we all need a decent wage on which to live.  And sometimes, we are not good at supporting one another - tall poppies, etc.

But given the scrapping of the bursary, the proposal for a nursing associate role, the shortage of qualified nurses and the closure of the advisory unit, I have to ask if we are letting our role as nurses, ethereal and indefinable as it is, erode in the pursuit of a role which is still largely indefinable and certainly unrecognisable to many professionals and patients? We now let others care while we plan care or undertake work previously within a Dr’s remit. Not all of this is to the patient's detriment of course, but... And lest we forget, everything we do (excepting being ‘with’ the patient and attending to their physical and emotional comfort, and all the other Florence stuff) has been handed down from doctors. The ‘basics’ such as taking TPR and BP, drug rounds, Doppler tests etc, were historically, the remit of the doctor.

We bemoan the lack of strong nursing leadership, and indeed, the Francis report (2013) suggested that nursing had a 'weak voice', and that profession’s voice to be strengthened, so why didn't every nurse near a computer sign?

Is it because the petition wasn't to stop the sale of tempura-battered fluffy kittens in the local farmer's market, or because it didn't support one's right to have 'sky-blue pinks with dots' hair? Or did we not sign because we are apathetic in relation to our profession and being a professional?

Of course, to many nursing is a job; it pays a wage and other things in life are more important. Nothing wrong with that – not everyone is a trailblazer or wedded to their work. The concept applies to solicitors, police, teachers, even pilots! But even ‘jobbing’ staff have a responsibility to maintain the standards of their profession, and more importantly, to protect it (the title Registered Nurse is protected in law) - otherwise, standards and what makes nursing (or any profession) unique, will disappear. Perhaps it's because we are wary about speaking up - whistleblowers to date, have rarely found the experience pleasant. Maybe things will change with the Freedom to Speak Up Guardians now appearing...

We have allowed an important impartial voice disappear, we seem to be allowing many aspects of our role disappear. We can’t allow our profession to disappear.

Because we are all well connected and networked across the health and care system we make sure that we have rounded intelligence about issues and are not just reliant on our own experiences and views