'Halt the reforms now before they create considerable turmoil'

7 February, 2012

The health bill is dangerous, divisive and disruptive, warns Peter Carter

For nursing staff on wards and in the community, the corridors of Westminster can feel very distant. That said, recent weeks have seen the nursing voice heard loud and clear in the House of Commons and beyond.

Last month, the Royal College of Nursing moved to a position of outright opposition to the health reforms. The Health and Social Care Bill is the most radical set of changes that the NHS in England has ever seen. The sheer scale is such that nurses in every setting in the health service will be affected.

As you’d expect from an organisation that represents 420,000 nurses and healthcare assistants, the RCN has been heavily involved at every stage. From the publication of the NHS white paper back in 2010, to the listening exercise at RCN Congress last year, and our response to the NHS Future Forum, we have been influencing and improving the plans at every turn.

“The nursing voice may have been listened to, but it hasn’t been acted on”

However, despite raising our serious concerns repeatedly, we just do not feel that sufficient changes have been made to the reforms. As they stand, the plans are dangerous, divisive and disruptive. At a time when the NHS in England is being asked to save billions of pounds in efficiencies, the bill is an unnecessary distraction.

The sad reality is that, despite principles and promises to the contrary, the bill will increase bureaucracy, drive up health inequalities and inject an unhealthy dose of competition into our NHS.

Take bureaucracy and red tape, which we all know gets between patients and nurses. In an attempt to get rid of what it saw as unnecessary structures, the government has sought to abolish primary care trusts and strategic health authorities. However, instead of reducing the number of bodies, it is proposing more of them.

The reforms see the creation of clinical commissioning groups, clinical senates, the NHS Commissioning Board and Public Health England. The increase in structures and red tape will see nursing staff face more bureaucracy, not less. As we all know, if there’s one thing nurses can do without, it’s more paperwork.

The government also proposes to increase private involvement in the NHS to an unacceptable level. The private income cap, introduced by the last government, limits the number of private patients that NHS organisations can treat. The government proposed to abolish this limit. After significant concerns were voiced by organisations like the RCN, the government has agreed to keep it, but at a rate of 49%. This means that NHS organisations could take on far more private patients. This could lead to a two-tier service, with NHS patients being forced to the back of the queue as organisations are distracted by the financial benefits of private patients.

The RCN has very real concerns about the government’s desire to increase competition in the NHS. The health service works best when all parts work together, not against each other. Patients don’t want services that compete with each other - they want them to cooperate.

The RCN and a high-profile campaign by Nursing Times demanded that nurses should have a seat on the boards of the all-important CCGs. The government heeded this call and said nurses would have a place at the table. However, experienced and senior nurses are not being appointed and their knowledge and skills are being lost.

The RCN has highlighted these concerns - and many more - but the government has failed to make significant enough changes to the reforms.

Put simply, the turmoil that these reforms stand to create is greater than the potential turmoil of stopping them. In short, the nursing voice may have been listened to, but it hasn’t been acted on.

Peter Carter is general secretary and chief executive of the Royal College of Nursing

Readers' comments (48)

Anonymous | 8-Feb-2012 10:05 am
too little too late carter!!!
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Anonymous | 8-Feb-2012 12:23 pm
NHS London releases its risk assessment concerning the Health and Social Care reform changes:

http://www.london.nhs.uk/webfiles/board/11%20Meeting%2019%20October/Ga%20Board%20CRAF%20red%20risks%20only%20as%20of%2020111006.pdf

V interesting reading and frankly scary.
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tinkerbell | 8-Feb-2012 12:27 pm
so long as somebodys voice is listened to and hopefully that will be the doctors because they are usually more united and forceful, sorry nurses but that seems to be the case.

The big question is what kind of society do we want? Do we want a society where my life is more important that yours because i have the means to fund my healthcare and you don't?

Just cos' other countries don't have an NHS does that mean that we shouldn't either? How about selling one of your kidneys to fund your treatment? Apparently it happens on a daily basis in some countries where it is the norm. Have we been so pampered that we don't know what we've got until we lose it, so much taken for granted.

Wake up everybody and get real about the changes and how they will effect YOU.

Love me, hate me but don't remain neutral on this issue. Tme to stand up and be counted and united in our response. Stop moaning and take ACTION! If you've got some help and advice how to do this then offer it. Let's all share with each other how we can go about STOPPING this happening.
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tinkerbell | 8-Feb-2012 6:10 pm
http://www.mirror.co.uk/news/uk-news/andrew-lansley-labelled-a-disaster-over-677268
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tinkerbell | 8-Feb-2012 8:33 pm
we need to expose this governments depravity for trying to destroy OUR NHS and thank goodness it is at last happening.
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tinkerbell | 8-Feb-2012 8:41 pm
http://www.telegraph.co.uk/news/9069858/Government-suffers-new-health-bill-defeat-in-Lords.html
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Anonymous | 8-Feb-2012 9:46 pm
It's a bit bloody late to wake up and start smelling the coffee now Carter. Where have you been all this time?
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tinkerbell | 9-Feb-2012 10:12 am
Anonymous | 8-Feb-2012 9:46 pm

One does wonder :) These are the people who are meant to be on the ball. I was starting to wonder why they have only just suddenly realised these reforms are a load of old bullocks.
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tinkerbell | 9-Feb-2012 11:43 am
Latest from 38 degrees below.

Is our NHS still in mortal danger? Andrew Lansley's NHS plans are due to become law within three months. So we need to vote now to decide what we should do together in the next few weeks to keep our NHS safe.

Our campaign has made real progress. We have just heard that under pressure from us, the House of Lords has watered down Lansley's plan to scrap his responsibility to provide an NHS. [1] That's a huge success and shows that our campaign can work.

But there's still plenty to worry about. Leading medical organisations like the Royal College of GPs and the Royal College of Nurses are now calling outright for Lansley's plans to be dropped. They warn that - even with the changes we've campaigned so hard for - the plans are "a mess" and the future of the NHS is still under threat. [2]

Can you fill in a quick online poll to help decide what we do next? Then we can spring back into action next week.
https://secure.38degrees.org.uk/saving-our-nhs

It's no surprise 38 Degrees members keep make protecting the NHS a priority. We all know that it's a national treasure. We can't afford to lose it. So in the past year half a million of us have got involved with this campaign - e-mailing and visiting MPs, signing petitions, donating cash, buying ads and even hiring a team of expert lawyers to cut through Lansley's spin. [3]

What should we do now? Is it time to zoom in on the parts of Lansley's plan which would introduce more competition and privatisation to the NHS? Or should we step back from the details and join with the doctors and nurses demanding the entire plan is withdrawn? Or something else? [4]

It's up to you - please take 3 minutes to help plan our next steps:
https://secure.38degrees.org.uk/saving-our-nhs

38 Degrees members have proved time and again that people power works. When we launched our campaign against the government plans to sell off our national woodlands we were told we had no chance. But we kept at it. And after months of working together, we forced the government to stand up and admit they got it wrong. [5]

In the same way, people have been telling us for nearly a year now that Lansley's NHS plans are a done deal. We have never let that put us off! And already by working together we've helped rein in some of the worst parts. There's so much more we can do in the next three months – so let's decide our plans together.
https://secure.38degrees.org.uk/saving-our-nhs

Thanks for getting involved,

Johnny, David, Marie, Hannah, Cian, Becky and the 38 Degrees team
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DH Agent - as if ! | 9-Feb-2012 12:28 pm
'As they stand, the plans are dangerous, divisive and disruptive.'

At least the RCN has got that bit right. I'm not sure I would necessarily agree with the RCN about what a 'good' Bill would look like, but I agree about the current one !
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tinkerbell | 9-Feb-2012 12:44 pm
In a nutshell a good bill in my opinion would look like this

We will never allow the fundamental principles of the NHS to be abolished because these are pivotal to our civilised society. We will always maintain free care at the point of delivery to every race, creed or colour regardless of financiall status. We will not put profits before our nations healthcare or money before peoples lives. If we are found to be making a fast buck ourselves on the nations misery we will be imprisoned'

Fill in the blanks.
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Anonymous | 9-Feb-2012 1:55 pm
how is the NHS and border control going to cope with the huge extra influx of tourists for the Olympics and for the Jubilee. Have provisions been made? The government seems to have so little foresight.
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tinkerbell | 9-Feb-2012 6:52 pm
http://www.guardian.co.uk/commentisfree/2011/nov/11/andrew-lansley-nhs-private-sector-circle
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tinkerbell | 9-Feb-2012 7:32 pm
http://www.youtube.com/watch?v=Dl1jPqqTdNo&feature=player_embedded

Don't watch this if you are easily offended by swearing.

Let's get the truth out there. Well done young uns
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tinkerbell | 11-Feb-2012 11:51 am
http://www.guardian.co.uk/politics/2011/apr/03/andrew-lansley-rap-youtube
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tinkerbell | 11-Feb-2012 11:53 am
This comment has been removed
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DH Agent - as if ! | 11-Feb-2012 2:16 pm
Tinkerbell, a bit more moderation, please !

I'm with you about the NHS being there for the people, and not to make a profit, etc - but some of us delicate folk have got grey hair (mainly in my beard), are old codger-ish and are reasonably manky !

I'll be sobbing into my tea, now, so easily upset am I by such scatter-gun remarks !
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DH Agent - as if ! | 11-Feb-2012 2:57 pm
Tinkerbell, after my previous post I was scanning The Times and a leader article on page 2 told cameron to sort out the mess. By carrying on with the 'competition' bit of the bill, and scrapping the 'commissioning' part.

Which is the problem - I quite like the 'putting decision-making more in the hands of the patients and those who are directly involved in patient care' part (so I would like the commissioning bit, IF the details made sense), but I don't like competition if that leads to fragmentation, profits being made from the NHS, care which cannot be joine dup when experienced as a patient, etc (I don't mind 'an aspect of competition to improve efficiency' but I dislike competition being primarily motivated by profit).

But so far as I can work out, at the moment this bill is a complete dog's breakfast which makes no overall sense, is largely incoherent and undeveloped, and which cannot be properly argued about as it is so ill-defined and vague that nobody at all can definitley say what it would mean in practice.

Of course, Goverments do like Acts which are so open to their own interpretation, that after they are enacted the Goverment can twist the meaning to suit their objectives - probably why politicians dislike judges who keep pointing out 'the wording of an Act must have a point to it - if you wanted it to mean something else, you should have enacted a different set of words !' (judges don't often be that blunt, unless a serious spat develops).

Keep up the good work !
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tinkerbell | 11-Feb-2012 6:11 pm
Bit grey myself Micheal under my hair dye, probably a lot greyer since all this inane waste of money started.

Well said. We can at least move with the times. Still young at heart regardless of the passing years.
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tinkerbell | 11-Feb-2012 6:14 pm
in fact most everyone that works with me on our unit is grey:)
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