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Time to stand up and be counted

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Nurses have a unique position in the community Nurses have a unique position in the community and can inform commissioning

When it comes to clinical commissioning, there is a simple truth that everyone needs to understand. You cannot do it without nurses.

If Clinical Commissioning Groups (CCGs) want to have a deep understanding of the health of their local population, if they want to know what the issues are and how best to address them, then they will need to draw on the knowledge, skills and experience of nurses.

Valuable insights

Nurses have a unique ability to reach out into their communities, build strong relationships and gain valuable insight into what is needed to improve the health of communities.

There has been a good deal of debate surrounding what clinical commissioning means and the role nurses will play within it. Some think commissioning is mostly about the dry stuff of procurement and contract management. While this is certainly part of it, it is only one piece of a much more significant task.

Far more important will be working out how local NHS and other services can work together to help people live healthier lives and help those who are unwell or injured to recover. These are questions that can only be answered with the key input of nurse professionals. That is why there will be at least one nurse on the board of every CCG, to pull in the expertise of the profession throughout the commissioning process.

Let's be honest, sometimes a doctor will not be the best person to improve a patient pathway. Often it will be a nurse or an allied health professional. If a CCG wants to improve rehabilitation after stroke they would most likely put an occupational therapist or a physiotherapist in charge of the redesign. If they wanted to reduce the number of people being admitted to hospital from care homes, a nurse could be in a much better position than a GP to lead on this. That is why I have met nurses running CCGs, leading clinical service redesign and specialist nurses at the key interface between community and acute services.

The specialist skills nurses possess, combined with their high degree of contact with patients, mean nurses are ideally placed to lead the transformation of local healthcare - from redesigning services and determining the best pathways of care to measuring the effectiveness of that care in terms of health outcomes and the experience of individual patients.

Take the example of West Cheshire CCG. There, nurse professionals have been central in the design, development and implementation of their new Hospital@Home service that covers a wide range of emergency ambulatory care conditions.

This GP- and nurse-led service means that some patients who would previously have been seen in A&E, such as those with cellulitis; some COPD patients; and some patients with heart failure, can be seen in their own homes.

Across the country, there are CCGs that are seizing the potential that nurses can bring to the commissioning process. But there are still too many that are not. I fully support Independent Nurse's 'No Tokenism' campaign to highlight the need for nurses to achieve real influence in commissioning and will take every opportunity to encourage CCG boards to do more.

But nurses also need to do more. They need to fully embrace and demand the opportunities the new system presents. Sadly, I have heard of nurses saying that they were 'not allowed' to get involved in commissioning because of potential conflicts of interest. This is not only wrong, it is the exact opposite of what is needed. Nursing input is essential to successful clinical commissioning. It simply won't work properly without them.

The new system of clinically-led commissioning empowers nurses to take the lead in shaping patient care and local decision-making. We have seen, through the experience of the pathfinder CCGs and of Practice Based Commissioning before them, how this way of working is not only better for patients, it is more rewarding for nurses.

I know some nurses had concerns about our plans for the modernisation of the NHS. I understand that. Any change - especially of this magnitude - to an institution as precious as the NHS, will be controversial, but the principle of clinically-led commissioning was widely supported and is at the heart of the changes.

Working together

Now the Heath Act has become law I hope we can put arguments behind us and work together for the benefit of patients. I was heartened to read the results of Independent Nurse's survey showing that the majority of nurses are now willing to work with CCGs to make the reforms work.

I honestly believe that the new NHS will be one where nurses can come to the fore of patient care, where they can take more responsibility and have a far greater say and a far greater impact on the way that patients are treated.

When nurses are involved in commissioning, the results are impressive. CCGs are now taking on their responsibilities, including the majority of local commissioning decisions. It's now time for nurse professionals to stand up and be counted, to take responsibility, to speak out on behalf of their patients and communities and to make the difference I know they can make.

Andrew Lansley is secretary of state for health

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