Published: 14/03/2002, Volume II2, No. 5796 Page 23

Given that primary care trust chief executives are being appointed, and immediately looking to develop their structures, it is important to start the debate about whether PCTs need a nurse director.

The government has stopped short of making it a statutory requirement, but anecdote suggests that although senior nurses will be appointed, they may not be at board level.

This may impair the PCT from delivering its obligations. It is almost impossible to be accountable for a large part of the organisation that is not represented when the strategic direction and important decisions are made. The clinical governance agenda is multidisciplinary, and involves a range of perspectives to make it tangible and deliverable. The modernisation agenda is challenging for us all, and without a nurse leader at the top, implementing policies such as nurse prescribing will be more problematic.

Setting the organisation's strategic direction, which includes what nursing will need to look like, is even more challenging for boards without full representation. Nurses as invited guests presenting occasional papers on specific agenda items will not enjoy the same opportunities to input to the debates, or shape board members' understanding of key issues.

Would PCT chief executives be confident that an audit of their service would confirm financial control without a finance director? How then can the modernisation agenda, depending heavily on nurses, possibly be achievable without nurse leadership at an executive level?

Yvonne Sawbridge Director of nursing Burntwood, Lichfield and Tamworth PCT