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