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'Corrosive competition and conflict will be Lansley’s legacy'


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


Readers' comments (10)

  • It will be interesting to see how many Lib Dem MP's are returned in the next general election. They have turned their backs on their own principles and on those they claim to represent. It will take the voting public a long long time to forget this and when the NHS no longer exists the LibDem role in its demise will never be forgotten. When a nurse manager in my trust turns round and says, "Nurses earn a damn fine wage and should be glad they have a job at all", then it is does not augur well for the future of patient care or nursing status and development, especially as the same person seems to think that multidisciplinary notes do not improve care and that nurse/patient ratios of 1 to 12 are perfectly acceptable.
    As a minor corollary, it is also noticable that much mandatory training now takes place on-line, at nurses' expense in unpaid time and power costs - another example of the continual subsidy that we are expected to provide gratefully in order to maintain competencies to work.
    This bill will not only place our health service back many decades, it will re-inforce the belittlement of nursing as a profession until nurses learn how to engage the bullying tactics this government and many hospital managements utlise.

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  • Yes But

    Yes - I agree with you Chris. Loads of people agree with you - it is as you say ideological, disguised as something else.

    But didn't NT claim its Seat on the Board campaign had been a success, without looking at the small print of its victory, so to speak ? And stop its campaign instead of carrying on ?

    Anonymous | 20-Mar-2012 12:47 pm

    Re your: This bill will not only place our health service back many decades - no argument with you about that, except it might totally destroy the NHS rather than just setting it back !

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  • Well as a nurse i can say that nurses will get everything they deserve from this health bill. Decades of impotent leadership has left nursing without a a voice. The political apathy within our ranks is staggering. BUT nurses don't become nurses to get all political! We become nurses to nurse. So the apathy isn't suprising really. More should have been done by our leaders a long time ago to ensure we had more of a say in everything.

    It hasn't we won't.

    labour can take a lot of blame for this as well. They made such a mess of the country that the electorate chose tory over them!!!! And By God will the public regret that decision. Sympathy? Zilch.

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  • The only way to deal with bullying govts and managers is to give them a good hiding. And until nurses get it through their thick heads that strike action is the only route to go down they can look forward to a further deterioration in standards of care, pay and working conditions.

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  • tinkerbell

    Anonymous | 21-Mar-2012 2:00 pm

    Well said. Time to give them a bloody nose, will it happen though, no, nurses are mostly the 'silent majority'.

    | 20-Mar-2012 3:14 pm

    Totally agree but in my mind things are going to get drastically worse and there's no 'might' about it. Until the next election we are all well and truly stuffed.

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  • tinkerbell

    | 20-Mar-2012 3:14 pm

    P.S. You haven't read my latest joke i posted for you. It's a ripping yarn and good enough for the comedy store.

    As i said i haven't noticed goats falling over when surprised when i was a goat herder.

    As for my ankle i have now also had to give up my footballing career.

    I noticed the corrosive treatment i was receiving compared to Micky Rooney, i mean Wayne, in the physio room. He was getting the 5 star treatment and i was left in the wings, but from our close proximity i could see that his hair transplant was taking really well.

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  • We nurses have been consistently ground down by appalling administration and it is going to be this same administration that will continue to use these reforms to further their own careers. I am constantly disappointed by the way NHS management blindly agree to any amount of nonsensical change, refuse to listen or debate the point and then shamelessly drop the changes when what we predicted comes true.

    When I hear the phrase 'more integrated health and social care' my heart sinks, what this means in reality is social workers pushing as much of their work onto nurses as they can. Social care is struggling because it is in the hands of private companies and offers limited training and poor wages as well a ridiculous pressure to meet clients needs in limited time with no time allowed for travel [or expenses]. And now that is the way we are headed too. In a way it is almost a good thing that these changes are so radically bad - it should make it more likely that they will see the demise of the current government and the next one will only get in on a promise to put things right. Labour did after all get rid of the disastrous fund holding.

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  • Yes But

    tinkerbell | 21-Mar-2012 8:54 pm

    One of your recent jokes, posted elsewhere, was an improvement.

    Pity about your footballing career. I could just picture you on the wing for Man Utd, with headlines of 'Tinkerbell twinkled down the flanks'.

    Utd had the best woman player I have ever seen a few years ago, probably during the 1990s, playing as a winger - she was a bit butch, but had long fair hair and was called Carol something or other.

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  • tinkerbell

    If only I had a magic wand | 23-Mar-2012 12:26

    I am working on my next joke, i just haven't heard it yet.

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  • tinkerbell

    But i do have a question about this site.

    Is the most commented article also the most popular article? What's the difference? I don't understand. Please discuss as i am losing sleep over this one.

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