Nurses to take over doctors' role

NHS NURSES are to take on more duties currently performed only by doctors under plans being put forward by Alan Milburn, the Secretary of State for Health.

In his first keynote speech since his appointment, Mr Milburn will say next week that he wants to remove some of the demarcation lines between doctors, nurses and other health workers. He will tell the first joint conference between the NHS executive and the committee of vice-chancellors and principals that he wants hospitals to follow the lead taken in the emergency out-patient services department at Leicester Royal Infirmary, where treatment is administered by "generic" health workers.

Mr Milburn is also enthusiastic about allowing nurses to take responsibility for administering powerful drugs, including chemotherapy for cancer sufferers. As part of the new strategy and to tackle the nursing shortage, Mr Milburn is also reforming the pay structure to remove ceilings to promotion and higher pay for nurses.

Mr Milburn will say in his speech that modernising the NHS means getting to grips with the way care is delivered. He will announce the establishment of a new training centre to provide more clinical responsibility for the 250,000 nurses working in the national health service.

Doctors and other health professionals will be nervous about seeing aspects of their jobs taken over by nurses, but Mr Milburn has told colleagues he is keen to see the removal of demarcation lines between health workers, including nurses, assistants and physiotherapists in the NHS. "Where we want to get to is an NHS that offers people faster treatment," Mr Milburn told The Independent last night. "We have to deliver care in a way that is unrecognisable in terms of 1948. It means revolutionising the heart of the NHS.

"If you look at somewhere like Leicester Royal Infirmary, they are re- engineering their outpatient service. They changed the demarcations between staff. They have speeded up treatment, improved levels of patient satisfaction. We can do that everywhere and that is precisely what I want to see."

Nurses' leaders are likely to be cautious of the moves. The Royal College of Nursing has been campaigning for nurses to be given a wider role in health care, but would be concerned about merging roles. Although a spokesman described the plan as "exciting" and insisted the college was "positive" about the idea, he said: "We want to look at the detail and would be wary of going down the generic health worker route."

Nurses were given more power to prescribe drugs under protocols set out by doctors after an inquiry that produced the Crown report. The Royal College has also been pressing for nurses' prescribing powers to be extended. Mr Milburn will not be able to announce that step in Monday's speech, but he is keen to give nurses more responsibility in hospital wards, and GP surgeries, to help to end the shortage of NHS nurses.

He is determined to press ahead with the modernisation of the NHS, and will promote more flexible working by family doctors, nurses and hospital consultants. Mr Milburn wants to see more out-of-hours use of cancer scanning equipment in hospitals and is also seeking to expand the scope of private finance initiatives in packages for entire health authority areas, to encompass primary care surgeries as well as hospitals.

Expanding the role of nurses is a key element in Mr Milburn's strategy of shifting the focus of attention away from health waiting lists - an issue that dogged the tenure of his predecessor as Secretary of State, Frank Dobson - to the question of faster healthcare for priority cases. The commitment to ensure that suspected breast cancer sufferers see a consultant within two weeks of referral by their GP is to be extended next year to all cancer patients.

Mr Milburn is planning to announce local health guarantees to patients to ensure that they know where they can find health care during the extended period of the millennium bank holiday. However, he will resist demands by junior doctors for extra pay for working over the holidays in England and Wales.

The Secretary of State is bidding to secure a big increase in the health service budget in the Government's three-year spending review that is now under way.

His case to the rest of the Cabinet and the Treasury will be strengthened if he can show so called "performance-related improvements" in the service.