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News analysis: Brown sets out strategy for a preventive NHS

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Gordon Brown has started the new year by setting out his vision for the future of the NHS. In an exclusive interview Mr Brown told Richard Staines that nurses will be central these plans

THE PRIME minister has placed the health service at the centre of a raft of new policies that he hopes will win back voters alienated by government performance over the last few months of 2007.
In his first major speech on health last week since taking office, Mr Brown set out what he described as the third stage of Labour’s
NHS reforms.
He spoke at length about the need to create an NHS that gives greater focus to detecting diseases before they happen – signalling a move to a more ‘preventive health service’. Two key elements of his vision are a new national screening programme for abdominal aortic aneurysm and the introduction of regular checks for heart disease, stroke, diabetes and kidney disease.
Mr Brown also reiterated his commitment to a state-funded health service but said further change – including the involvement of independent-sector companies – was necessary to create a ‘personal service’ fit for the 21st century, with patients engaged and taking greater control over their own health.
He followed up his speech by talking exclusively to NT about his plans, recognising the need to reconnect with a profession becoming disillusioned with government reform policies and last year’s staged pay award.
This was also apparent in his choice of venue – his speech was made at the Florence Nightingale School of Nursing at King’s College London.
The prime minister defended his stance on continued health service reform, suggesting nurses would be supportive of reforms that were proposed by clinicians – the results of the review of the NHS by junior health minister and surgeon Sir Ara Darzi is due later this year.
‘We are not talking about structural change,’ he told NT. ‘Our reforms are proposed in the interests of patients, recommended by consultants and clinicians. It is not change for change’s sake and I think that all nurses would want to support that.’
But nurses may view his comments with more scepticism. In a recent NT survey seeking their views on the health service nurses cited ‘frequent reorganisations’ as one of the greatest problems facing the NHS.
Mr Brown praised nurses’ ‘extraordinary work’ over the last 10 years and stressed that the profession would play a key role in his planned reforms.
‘Nurses will play a very big part in the whole of this agenda. People will turn to these nurses.
I must give praise for the work done by all nurses, whether
they are specialist nurses, diabetes nurses.
‘All of these areas are where we are focusing. We really want to praise the work that nurses
have done.’
He also pledged to support the continuing development of advanced nursing roles.
‘Over the last 10 years we have created more than 80,000 nursing posts,’ he said. ‘We are committed to the nursing profession and training more nurses. We are trying to give more scope for specialist nurses, the nurse consultant, the nurse prescriber. I would like to see the status of nurses enhanced.’
In his interview with NT, Mr Brown accepted personal responsibility for last year’s unpopular staged pay award for nurses – a decision he took when still chancellor.
He reiterated previous claims that it had been implemented to safeguard the economy but claimed that he genuinely had wanted to give nurses more.
He said that staging the award for nurses and other public sector employees had been vital to curb inflation.
However, he would not be drawn as to whether he would honour the decision of the independent pay review body in this year’s pay settlement, insisting that this decision was ‘for the future’.
‘I wanted to pay nurses more for the great contribution that they have made. But people have got to remember that we were in a situation where we had to control inflation. Interest rates would be higher now and any pay rise would be cancelled by the interest rate rise.
‘The reason for the staged pay award was not that we did not want to value nurses. But we could not put interest rates at risk in the whole country,’ he said. ‘People must understand that this was done because we were worried about the state of the economy as a whole.’
Mr Brown words were followed later in the week by an announcement that the government is keen to implement a three-year pay deal for a range of public sector workers, including nurses, the police and teachers. The reason again given was the safeguarding of the economy.
But nursing unions have denied that nurses’ pay has any significant impact on inflation. Indeed, a study by the London School of Economics, commissioned by the RCN during last year’s dispute over the staged pay award in England, showed staging nurses’ pay had a minimal effect on the economy.
RCN general secretary
Peter Carter said: ‘We are not asking for extravagant pay awards and we will not be fuelling inflation – that is
caused by factors beyond
our control’.


‘The NHS of the future will do more than just provide the best technologies to cure: it will also – as our population ages and long-term conditions become more prevalent – be an NHS that emphasises care too.’

‘Our vision for change will be based on clinical evidence and the new drive for a more preventive health service. It will be founded on greater local control and greater freedom for staff…’

‘If we are to prevent as
much suffering and save as many lives as possible, utilising these new technologies must continue to be at the heart of any progressive health policy.

‘People tell me of the truly excellent experiences of care when they get into the NHS, of the nurses and doctors dedicated to their care – but at the same time of their frustrations with access to services, with a service too often centred on the needs of the providers rather than those of patients.’

‘The NHS of the future will be more than a universal service – it will be a personal service too. It will not be the NHS of the passive patient – the NHS of the future will be one of patient power, patients engaged and taking greater control over their own health and their healthcare too.’

‘If in the last generation the big medical advance was the doctor administering antibiotics, in the coming generation it will be patients working with doctors and
NHS staff to improve our
own health and manage our own conditions.’
‘We must do far more to make sure that NHS organisations and incentives are truly responsive to patients while supporting clinicians in keeping people healthy. And that funding not only follows the patient through an illness, but prevents illness too.’

‘To be true to its principles, the NHS must continue to change. So we will reject the views of those who say the NHS must put a moratorium on change and reject those who oppose further reform. This would be a massive failure of leadership.’

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