The health bill will destroy any chance of a coordinated, comprehensive and cooperative NHS, says Chris Hart
As the NHS reforms go through a Westminster version of pinball, it’s easy to miss the impact the politics are having on the clinical work and ethics of nursing.
Whatever the nuances about the bill’s contents, this is ideological. A political party is using an economic crisis to realise its wish list: NHS “reform” sits alongside other policies affecting welfare provision, education, pensions and policing.
The Conservatives’ pre-election manifesto did not mention NHS reforms, partly because it would have lost them votes. They also knew they could not get something this radical enacted with a small majority and two parties opposing them. Coalition government changed everything.
The Tories seized their opportunity. But the bill was rushed and incoherent and the coalition was ill prepared for the backlash. Professional opposition may have been expected but the fact the NHS still occupies a unique place in the English psyche seems to have completely surprised them.
The Tory response was predictable. It included rubbishing the NHS, trying to censor research showing its successes and misinterpreting statistics.
Mauled in the local elections, the Lib Dems rebelled, but settled for concessions, leaving the thrust of the bill intact. At the recent Lib Dems spring conference despite Nick Clegg’s support for the bill, the party voted against backing it in its current form. If Mr Clegg really wanted to prevent US-style competition, he could simply demand removal of section 3 of the bill.
“The corrosive effects of competition, cuts and shedding of jobs ahead of the bill are storing up problems”
Following the defeat of the Labour motion to drop the bill in the Commons last week, there is little chance of rowing back from the reforms. Money is already being diverted away from the NHS into the private sector. The corrosive effects of competition, cuts and shedding of jobs ahead of the bill are storing up problems. As the NHS struggles, the coalition response will simply be more involvement from the private sector.
What of nursing in all this? Its lack of political clout renders it irrelevant. Doctors were put at the heart of the changes. Doctors are no more prepared for commissioning than nurses - they made a mess of it under the last Tory administration when they tried the “fund-holding” system.
Mr Lansley was surprised the main beneficiaries of his revolution became its earliest opponents but still wrote nurses out of commissioning groups. National campaigns may have won concessions but have to be seen in the context of directors of nursing being publicly told to sign up to cuts packages. Nurses have little influence.
Unfortunately, excellent journalistic campaigns, such as Nursing Times’ A Seat on the Board campaign, and political lobbying are no substitute for a united workforce that has the confidence to make its voice heard.
An alternative to the argument about reform is needed. Better integration of health and social care is an obvious start. And nurses know managing services effectively at every level is an urgent and long overdue priority. Effective management is needed to address problems that lead to conflict and poor working practices.
Stability in the NHS requires collaboration between managers and clinicians, providers and commissioners. The saddest irony is that the lasting legacy of Lansley’s bill will be corrosive competition and conflict, not the accountable, coordinated, comprehensive and cooperative NHS the majority would have voted for if asked.
Ethical and clinical questions loom large for nurses. What type of service do we want to work in? What sort of nursing will we do? Do ideas of solidarity with patients still have currency for our profession? If we duck these issues, we will not be forgiven.
Chris Hart is principal lecturer at Kingston University and St George’s University and nurse consultant, South West London and St George’s Mental Health Trusts