What a turnaround from 2009 when David Cameron won nurses’ plaudits for promising no more pointless top-down reorganisations …
Last month the crisis of confidence in the government’s NHS plans reached a new level when the RCN Congress delivered its stark message. What a turnaround from 2009 when David Cameron won nurses’ plaudits for promising no more pointless top-down reorganisations.
When health secretary Andrew Lansley finally arrived to meet with a selection of delegates he tried to give the impression of listening. But it turned out he was “sorry” only that other people - including 98% of the conference - didn’t understand him better.
But nurses, doctors and patients understand only too well what the government is trying to do with the NHS.
Breaking their promise on reorganisation, the government is breaking up area-based health service planning and replacing it with closed-door decision making by consortia, potentially managed day-to-day by private companies.
Rather than a single body responsible for population health and commissioning the whole pathway of services for an area, NHS planning will be fragmented and chaotic.
There are particular fears for specialist services, with charities voicing concerns about a loss of focus and a return of postcode lotteries.
The biggest changes, however, will affect NHS provision. Mr Cameron won’t talk about these plans but they make up a third of the bill. They will turn the health service into a real market like the privatised gas, water or telecoms utilities.
Financial success or failure in the marketplace will determine whether many services - or even whole hospitals - stay open. Key decisions will be taken by a new economic regulator, staffed by lawyers and economists, not by clinicians or patients.
Labour has argued for nurse and patient representation on consortia, but this concession would not be enough on its own. A much more fundamental rethink is needed to protect the founding values of the NHS.
After all the investment Labour put into the NHS, I don’t want to see things going back to how they were in the 1990s. Many readers will remember patients waiting on A&E trolleys in corridors, annual winter crises, infamous hundred-hour weeks and exhausted, overstretched staff.
I know that nurses felt Labour meddled with structures and didn’t always get the best deals from the private financial initiative, but we showed our commitment to the values of the NHS when we rescued it from near-collapse, doubled real-terms spending, built 100 new hospitals and hired 200,000 extra clinical and support staff.
People benefited from the resulting falls in maximum waiting times from 18 months to 18 weeks, there were significant victories over MRSA and C. difficle and improved outcomes for heart disease and cancer.
All the effort nurses put into achieving 18-week and four-hour waiting guarantees for patients is starting to unravel, while efficient treatments are being stopped and good services are under threat.
Ministers say they will pause to listen on their plan, but I remain sceptical. After all, they ignored 6,000 consultation responses last year and rejected over 100 Labour amendments to the bill in committee.
While government officials are pushing through the reorganisation on the ground, I suspect there will be a few piecemeal concessions and the media will be encouraged to move on.
Although the pause looks like a PR stunt, nurses have the power to make a difference to the bill. Like others who continue to voice their concerns, you must and will be heard.