London School of Hygiene & Tropical Medicine

Nurses are the key to restoring public confidence in UK hospital care, argues an expert in this week's BMJ.

Nurses led the transformation of hospitals in the 19th century. So, why after a century of outstanding success, is the future of the large general hospital in question? asks Professor Nick Black of the London School of Hygiene and Tropical Medicine.

Hospitals are partly a victim of their success, he says. Developments in pharmaceuticals, information and communication technology now offer alternative ways of delivering care. And when patients do need to attend hospital, they are less likely to stay overnight.

These changes are generally welcomed by the public, healthcare professionals, managers, and politicians. But negative reasons also threaten the future of large hospitals, arising from changes over the past 20 years in management, nursing, and building strategy.

So, what can save the hospitals? If public confidence is to be maintained, nurses must have a central role. Indeed, nurses rather than doctors have always really run the hospitals at the clinical level with doctors providing specialist help, writes the author.

Nursing also has the potential to moderate the public's need for hospital care through innovations such as nurse led telephone help lines and delivering more care in the community.

In many ways, nursing is the key profession and doctors, managers and politicians must recognise and respect the contribution nurses can and must make, he argues. The response to the current crisis posed by MRSA suggests that this may be happening.

The 19th century teaches us that nurses must be central to the running of all aspects of hospitals, not just those areas deemed appropriate by the medical profession.

This will require improved leadership and enhanced opportunities for nurses. In this way everyone can benefit: hospitals will remain viable, doctors will be able to pursue the activities in which they excel, and the public's concerns will be allayed, he concludes.