Talking it through

It's a bit like admitting you haven't got a sense of humour.'

Kate Harmond, clinical director of the national patients access team and former regional director of nursing for South Thames, is aware that modernisation is a hard concept to argue with.

As Pippa Gough, policy director at the Royal College of Nursing, put it: 'It is an interesting word, modernisation.

It has actually given us a lot of headaches. It's not something you can argue with. If you say you can't do something, they argue that you're not with it, that you're out of date, a traditionalist.'

The summer school for nurse leaders, organised by the national patients access team, couldn't have been better timed, coming on the heels of the NHS plan, with its focus on nurse leadership, development and training.

And while delegates were enthusiastic about the plan's potential, there were warnings that the process surrounding it could leave egg on everyone's faces.

As Ms Gough said: 'We have all been co-opted in to this plan. The NHS is key to the election: Tony Blair has taken personal responsibility for the waiting lists coming down. But if by the next election the NHS has failed, we have failed because we were all involved. There is whole layer to blame because we were all co-opted into the modernisation action teams.'

The plan's warm words about increased autonomy and powers to prescribe were all very well, but did not stand up to analysis. Ms Gough spotted that the document's claim that 'by 2004 a majority of nurses should be able to prescribe' could not be true.

Department of Health nursing officer Jenny Kay admitted the wording was a mistake, which she blamed on 'a proofreading error'.

In fact, the claim relates to the number of nurses expected to be able to follow patient group protocols to administer and supply drugs, under the authorisation of a doctor and pharmacist.

On prescribing itself, the document is rather more woolly. Consultant in public health medicine Dr June Crown, who chaired the advisory group on nurse prescribing, set up in the dying days of the Conservative government, told HSJ this offered nurses the opportunity to 'take the initiative in taking these ideas forward. I am a great believer in the bottom-up approach.'

She welcomed the new political will, which she contrasted with the 'nervousness' of the previous government.

Fears that nurses would over-reach themselves - that 'give her a felt tip pen and she's anybody's'- had proved to be unrealised.

And she said that despite the lack of detail about how prescribing powers would be rolled out, she was reassured by the fact that it was listed in chief nursing officer Sarah Mullally's top 10 key roles for nurses, listed in the plan.

Also in there was the announcement that senior nurses would be given 'clear authority at ward level ' following public calls for a 'modern matron' figure.

Ms Harmond said the push to give senior nurses 'greater autonomy and recognition' had met enthusiasm. But she admitted she did not think the use of the word matron was 'terribly helpful' - what was more significant was ensuring patients knew who was in charge of their care.

And national patients access team head Sue Jennings said plans to employ 1,000 extra nurse consultants provided real opportunities for nurses 'who want to progress but remain patient based'. She was among many highlighting the government's plans to create 100 extra workplace nurseries as crucial to delivering targets on recruitment and retention by making jobs more flexible and family friendly.

Speakers expressed concern that a political drive against 'dodgy doctors', which paved the way for the NHS plan, could backfire on nurses. Ms Gough said putting in place a cultural change where 'the patient is king also means dismantling the system. We have seen the attacks on doctors. We have seen some of that splattering on the rest of the professions.

'While I have been talking to nurses over the last few weeks I have come across quite a lot of triumphalism about what is going on in the medical professions and that is a really unhelpful way forward.'

If there was a risk that 'if we do not deliver this [the NHS plan] eight years or five years down the line, will we come under attack in the same way?' asked one delegate.

But in a session on 'engaging consultants', surgeon Mr Harry Naylor offered a few tips on how to get 'inside the mind' of difficult colleagues.

One delegate voiced her own idea:

'You need to get to know your consultant's weaknesses then stick the knife in and turn it. That works.'

Forcing the pace: new nursing bodies The conference came the day after the DoH launched proposals to 'modernise and strengthen' professional regulation by abolishing the UK Central Council for Nursing, Midwifery and Health Visiting, the four national boards and the Council for Professions Supplementary to Medicine with its 12 professional boards.

The UKCC will be replaced by the Nursing and Midwifery Council and the CPSM will be replaced by the Health Professions Council. The NWC will increase lay involvement, to 11 out of 23 members. The new councils promise 'tougher powers to tackle poor professional conduct and performance'.

They will be overseen by an umbrella body - the UK Council of Health Regulators - to ensure closer liaison.