The must-read stories and debate in health policy and leadership.

The new chief nurse’s vision

Nursing is the largest workforce group in the health service and, as research has made clear, repeatedly the group that is most crucial to patient outcomes.

But, over the past 10 years, it has largely been neglected. In the five years post-Francis, the NHS has struggled with 40,000 vacancies and demands on trusts to balance their budgets.

Roles have been introduced both at the sub-nurse level with the new nursing associate role and at the sub-doctor level with physician associates and other non-medical roles.

New chief nurse Ruth May certainly has her work cut out. There are challenges for nursing wherever she looks.

In her first major interview with HSJ, she did the inevitable call to celebrate the profession and encourage people to choose it as a career. She also called for an increase in the undergraduate supply into nursing.

Ms May was also right to acknowledge, when asked, about the risk of care being reduced to tasks – something repeatedly shown to be a negative for patients. However, her solution of enhanced leadership is hardly a cast-iron protection.

Ward leaders cannot reasonably be expected to be the dam holding back the flood of demands for task-based care. Ms May is right  – ward leaders are key to maintaining safety in their teams but, against the run of policy, they stand little chance.

The chief nurse needs to be making the case around the table at NHS England, NHS Improvement and the Department of Health and Social Care that policy needs to support nursing and not undermine it, as it has been doing for too long.

Nursing needs a champion. Ms May needs to find her voice now she is leading the whole profession.

Chickens coming home

When an NHS trust goes cap in hand to the Department of Health and Social Care for a cash bailout midway through the year, heads often roll.

However, it appears this won’t happen at DHSC – which has gone cap in hand to the Treasury for £600m – because there’s official acceptance that its additional cost pressures were “unforeseen”.

The department says the pressures were outside its control. We should be able to scrutinise that when its finance chief appears before the Parliamentary public accounts committee next week.

Meg Hillier, the committee chair, reckons the bailout is partly a result of the “creative accounting” which has masked the department’s real financial position.

She said “chickens are now coming home to roost” after various controversial accounting measures had enabled the DHSC to “cover up the fact” that the money flowing into NHS trusts was insufficient.

Next week’s session should be interesting.