Published: 11/4/2002, Volume II2, No. 5800 Page 26

I agree with Yvonne Sawbridge (letters, 14 March) regarding the importance of strategic nursing leadership at an 'executive' level.

But I cannot agree with her inference that this can only be achieved by the lead nurse (nurse director) operating at board level.

While not wishing to negate the vital role and responsibility of a primary care trust board, surely the whole ethos and directive for PCTs and Shifting the Balance is for clinicians and other professionals, as an executive committee, to set the 'strategic direction and make important decisions' about how local clinical services should be delivered and developed. This is where PCTs need to ensure the lead nurse, together with elected professional executive committee nurses, have influence in ensuring nursing services are equipped to deliver the modernisation agenda.

Some PCTs, by automatically appointing their lead nurse to the nurse-member position on the board, have missed both the fundamental difference between PCTs and traditional trusts and an opportunity to provide strategic development for nurses within the organisation.

Of course, there need to be nursing representatives at board level who can bring a nursing perspective to debates and develop other board members' understanding of nursing issues, but to imply this can only come from the nurse director ignores the expertise of many 'hands on' nurses who have chosen not to go down the management route.

Perhaps I am fortunate in the capability of the PEC and board nurse in our PCT. I am confident our nursing services are not disadvantaged, or the board at risk in terms of accountability, because I do not sit on the board. The proposal to remove article 4 from PCT establishment allows the PCT to consider the extra value I would bring to board debates, but I wouldn't wish to be appointed to the exclusion of a practising nurse.

Helen Parker Wyre Forest PCT