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Policy experts issue warning over NHS training budget cuts


There are growing concerns that nurse education budgets could be vulnerable to cuts in the government’s current spending review.

Health policy experts have warned that the Treasury are planning to redefine the current “ringfence” on health service spending to only apply to NHS England’s budgets, potentially putting billions of pounds earmarked for training and public health at risk from cuts.

“It would be short sighted and very worrying indeed if that supply of skills was put at risk by cuts to education budgets and taking health education out of the NHS”

Janet Davies

The results of the government’s 2015 spending review will be published in November, setting out savings it needs to help eliminate the national budget deficit by 2019-20.

Ministers have previously committed to increase NHS spending by £8bn in real terms by 2020-21, meaning health service budgets are protected from cuts in the spending review.

But leading health think-tanks said government officials had indicated that the Treasury was defining protected health service spending as only NHS England’s £101bn budget for commissioning health services.

It would mean other budgets for Department of Health funded organisations, including Public Health England and Health Education England, were not covered by the government’s NHS spending ringfence, they told Nursing Times’ sister title Health Service Journal.

Public Health England’s budget is around £3.7bn this year and Health Education England’s budget is £4.9bn.

“If funding is simply cut, we could see wholesale failure of the current workforce education system”

Jessica Corner

Nuffield Trust chief executive Nigel Edwards said: “Our concern is that the way they have carefully described the ringfence allows them to take large amounts of money out of training, public health, and research and development without breaching their promise on spending on the NHS.”

He suggested, in particular, that one area of education spending that might be vulnerable if unprotected was the provision of bursaries for student nurses.

Anita Charlesworth, chief economist at the Health Foundation, warned that the savings that trusts had already committed to would be “undeliverable” without an effective training and education system to ensure they had enough permanent staff to avoid overspending on agencies.

Meanwhile, King’s Fund chief economist John Appleby highlighted that the Treasury had already cut £200m from council controlled public health budgets this year, in a move billed as a saving on “non-NHS” spending.

Janet Davies, chief executive and general secretary of the Royal College of Nursing, said the recent £200m cut to public health budgets had “set a worrying precedent”.

“Cutting nurse training, development and bursaries will have very serious consequences for the NHS’s ability to provide high quality care to those who need it,” she told Nursing Times.

“It would be short sighted and very worrying indeed if that supply of skills was put at risk by cuts to education budgets and taking health education out of the NHS,” said Ms Davies.

“We have an ageing population and people live with long term conditions needing expert support. This is not the moment to stop investing in the workforce,” she added.

Professor Jessica Corner, chair of the Council of Deans of Health, said: “If funding is simply cut, we could see wholesale failure of the current workforce education system, with huge consequences for NHS workforce shortages.

“The need to move education of the future health workforce away from the annual recurrent funding pressures of the NHS is one of the reasons we’ve called for fundamental, thought-through reform of the way education is funded,” she told Nursing Times.

“The forthcoming spending review will set out how the government will continue to invest in priority public services including the NHS”

The Treasury

A Treasury spokesman said: “The forthcoming spending review will set out how the government will continue to invest in priority public services including the NHS, whilst delivering the further savings required to eliminate Britain’s deficit by 2019-20.”

He added: “The government is committed to delivering security for working people – the economic security of a country that lives within its means and the security that comes from a properly funded National Health Service.

“That’s why we’ve taken action to protect the funding the NHS receives and increase the Department of Health’s budget in real terms year on year,” he said. “We have absolutely no plans to change this.”


Readers' comments (11)

  • Community Care was heralded as a way of 'personalising care, and moving away from institutionalisation, but some of us argued that it would results in real cuts to services. Now there is a welcome acceptance that prevention is better than waiting for hospitalisation. Local Authority involvement and joining up of health and social care planning should improve how services are targeted at those in greatest need... the catch is always that local authorities are given increasing responsibilities for caring for vulnerable people JUST before they have a major reduction in finance.

    On the issue of Nursing, if the current system changes, those who have a real desire to enter the profession would probably still sign up. However, would they need to be on a living wage when they are on placement? I just wondered, and found that this topic has been covered in a previous issue of NT 15 April 2015

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  • clearly the government doesn't value nursing- it will continue to be pay everything yourself whilst every year getting pay cuts

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  • michael stone

    NHS England seems - at least in end-of-life, which is the stuff of interest to me and therefore the stuff I read - to adopt very much a 'partnership approach' to things. For EoL, NHS England seems to form 'alliances/partnerships', and set out what I might term 'agreed objectives', but to very much rely on 'its partners' to deliver the improvements: so slashing the budgets of PHE, HEE, etc, is not exactly 'joined-up behaviour'.

    Although expecting genuine joined-up thinking, as opposed to 'hidden cuts' and headline announcements intended to suit media releases, from a Goverment, is probably naive.

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  • Michael stone perhaps you could be bothered to read the article and comment on that! That is the purpose of the commentary here.

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  • michael stone

    Anonymous | 19-Sep-2015 9:54 pm

    'But leading health think-tanks said government officials had indicated that the Treasury was defining protected health service spending as only NHS England’s £101bn budget for commissioning health services.'

    I read - and commented on - that, which is in the article. Perhaps you didn't read that bit ?

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  • Ooops, my secondment payments are at risk!

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  • There are many issues here: public health, education and research. It will be interesting to see how the government proposes to fund DoH funded organisations, having already started to cut the funding of the Public Health Budget (King's Fund). A discussion we had in HE the other day was related to Nurse Education and whether this should/could be in-line with other degree courses in the country i.e. £9000 a year. Would we recruit to the programmes? Would people be more committed if they had to pay? Would private providers of education charge what they wished? Actually, I believe this is already happening. The enormous NHS spending on agency staff in nursing as well as medicine - in the news this week - will continue unless the government decides to invest in the workforce. At present, we are training people who are getting 'burnt out' very quickly or go abroad. What a waste of talent.

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  • All RCN members should read this blog, you don't often hear another view on the RCN, is this why nothing in nursing ever changes?

    The Royal College of Nursing (RCN) represents most of the nurses employed within the NHS and has a membership of over 400,000. It started life as a ‘professional’ organisation for nurses, promoting excellence in practice, before registering as a ‘trade union’ in 1976. Scratch the surface of this grubby, conservative, false-flag operation, and you will see it is not a ‘trade union’ by any understanding of the term.

    I have previously written about nurses and industrial action during the pension’s dispute and defeat of 2011. Not a lot has changed in the last three years. Nurses are still being targeted because they are an easy touch and lacking anything resembling meaningful trade union representation.

    The RCN congress is taking place this week, in Liverpool, with ‘pay’ and ‘taking action’ dominating the debate. Against a backdrop of the growing anger of nurses, the RCN General Secretary, Peter Carter, had this to say:


    “The RCN has not called a ballot, and the unique role of nurse’s means that they should think carefully before taking such a decision. Think what going on strike really means. For a strike to work, it has to have a real impact on someone or something. If you work in a car factory, that means stopping the production line. But if you are a nurse, it means abandoning your patients, leaving those babies in the neonatal unit, cancelling that visit to an elderly patient in the community, walking out of the emergency department, or psychiatric ward.”

    He went on to say that it was important to protest by other means, including “writing to your local MP” and asking where they stand on nurses pay. If they agree with the government’s position, then nurses should “unseat the MP by voting for someone else”

    Peter Carters deceitful and cowardly speech was so absurd, that when I first read the transcript I had to double check that I had not accidentally downloaded it from Private Eye, or a spoof website.

    Firstly, Peter Carter says ‘The RCN has not called a ballot’. Of course they haven’t, because the RCN is structured in such a way that any decision to ballot for industrial action can ONLY come from the General Secretary (Peter Carter). I would wager that the vast majority of the nearly half a million nurses in the RCN have no idea that they have zero decision making power in terms of taking industrial action.

    Historically, the RCN had a ‘no strike clause’ up until 1995, when it was dropped. It was only dropped as it was a barrier to recruitment, not because of any ideological changes within the organisation. It is crystal clear that the RCN still operates a ‘no strike policy’, but does this via smoke and mirrors, and deliberately excessive bureaucracy.

    Peter Carters use of a car factory analogy is ridiculous. Why is he suggesting that the only industrial action is that of a full scale strike? There are many ways of taking action short of a strike, which he well knows. Nurses undertake many extra responsibilities that are not part of their job descriptions, work extra unpaid hours to support their colleagues, and undertake many other activities that could be described as ‘goodwill’… Nurses could refuse to engage in those activities, particularly those activities that pertain to the meaningless bureaucracy that swamps the NHS. Furthermore, there are examples throughout the world of nurses taking actual strike action, winning disputes, whilst not impacting on direct patient care.

    Peter Carters deceitful and cynical use of emotive language and examples of who would suffer during a strike is an absolute disgrace. Only a liar would suggest that striking nurses would literally ‘walk off’ a neo-natal unit, leaving babies unattended. His speech was a nefariously planned attempt to deceive nurses, the media, and the general public, into believing a nightmare vision of what ‘nurses on strike’ would look like, and lead to. Furthermore, if you took his examples at face value, you could then argue the point of how valuable the work of nurses is, and why they deserve to be fairly paid.

    Industrial action and patient care is an interesting subject. Patient care is not just instant, here and now, at the bedside. Nurses should be taking action over the wider issues of care provision. What is the RCN doing about thousands of nurses being made redundant, what did the RCN do about the Labour Party saddling NHS with £300,000,000 of PFI debt, what are the RCN doing about mental health beds being stripped away throughout the country, resulting in people being sent hundreds of miles away from their homes, what are they doing about national terms and conditions being attacked, what are they doing about the Conservative Party privatising the NHS? The answer is ‘nothing’, all they do is ‘talk’ and ‘negotiate’. Nurses and their union should be fighting for better patient care, not just accepting what is being handed down to them…. Nurses who want to take industrial action over issues that have a direct impact on patient care, should be applauded and supported, not vilified… How dare you Peter Carter, how dare you……

    Peter Carters solution to the dispute – “Write to your local MP” is so stupendously ridiculous and insulting; I won’t bother dignifying it with a rebuttal.

    Peter Carter and the RCN are obsessed with the public perception of nurses, and how industrial action may impact of that perception. This attitude is steeped in the historical snobbery and classism that runs through the RCN’s upper echelons like a stick of Blackpool rock. The RCN, a so-called trade union would rather have its members viewed as low-paid, over-worked, servile ‘angels’, than fairly paid, nurses, with self-respect and a backbone.

    Every year the RCN has its congress, nurses are said to be angry about pay, pensions, conditions, service provision, and patient care. Yet all Peter Carter and his lackeys can offer their 400,000 members whose work is absolutely key to the NHS, is ‘negotiation’. Anyone with a shred of analysis can see that ‘negotiation’ not underpinned by a meaningful threat of action is little more than a begging exercise, that has NHS bosses and the government laughing into their board meeting buffet.

    The cowardice and inaction of the RCN is not a new phenomenon. Since the day it became a trade union in 1976, it has operated as little more than a ‘corral’ or ‘holding pen’ in order to keep nurses on their knees, away from genuine trade unions. The RCN has proven itself to be perfect bedfellows for successive governments of all stripes.

    The RCN’s primary tool of recruitment is to gather up student members at University when they commence their nurse training. Students are offered a greatly reduced subscription rates, free pens, and diaries, if they sign-up. Once they have completed their training they inevitably maintain their membership for the rest of the career. For many, it is their first and only experience of being a member of a trade union, so expectations of the organisation are low or non-existent. Recruitment of students is not difficult. They either join the RCN or UNISON whilst at University, with many opting for the snobbery and elitism of the RCN, as they wish to distance themselves from ‘Healthcare Assistants’, who generally join UNISON.

    As part of the RCN’s campaign to dampen down any militancy within nursing, they produce the ‘Nursing Standard’, which sells 70,000 copies each week - with a much bigger actual readership. They also produce a series of monthly ‘specialty’ journals, which are aimed at nurses working within a variety of clinical specialities. Via their range of carefully produced publications, the RCN are able to drip their squalid propaganda into the homes and workplaces of hundreds of thousands of nurses each and every month.

    For the size of its membership, the RCN has relatively few stewards. I once worked in an organisation that had 1,000 RCN members, yet had no stewards whatsoever. The RCN are not troubled by this, as those members paid nearly £200,000 a year into the organisations coffers, for zero in return. The RCN are more than happy for the Unison mafia to run the staff side committees, and toady their way through embarrassing partnership arrangements, with their own members as passive passengers.

    Member involvement at branch and regional level is not much different. Some RCN branches are enormous, yet meetings are made up of five reps, who have never consulted their members on any issue. When I challenged an RCN full-timer about lack of internal democracy and general activity, I was told that:


    “The members are to blame if they cannot be arsed to get in touch or turn up to branch meetings”

    That particular individual never made any attempt to advertise branch meetings, encourage people to get involved etc… he, and others like him were more concerned about maintaining their own position of influence within the pecking order, than assisting rank and file members in becoming more involved. They ran the branch as their own personal fiefdom, wielding the influence of such a large branch membership for their own aims. Whilst they wax lyrical about ‘internal democracy’, in reality it is just a meaningless phrase, as the organisation relies on the apathy and historically ingrained passivity of its membership in order to function.

    If there ever was a situation in which the RCN politburo would sanction industrial action, then you have the nursing equivalent to the House of Lords, (NMC) to contend with. The NMC (Nursing & Midwifery Council) is the professional body responsible for the registration of all nurses and midwives in the UK. With its disingenuous strapline ‘Run by nurses for nurses’, the NMC threatened to ‘strike off from the register’ nurses who took part in industrial action (during the pensions dispute of 2011) as they would have been in violation the NMC code of professional conduct…. In response to this outrageous state sponsored threat, Unison made the token threat of legal action, whereas the RCN said and did nothing. A quick look at the crossover of personnel at the top of the RCN and NMC would reveal why.

    The RCN, without a smidgen of sarcasm, calls itself ‘The Voice of Nursing’. It is nothing of the sort. It is the voice of the establishment that thinks slow clapping a health minister at congress is ‘taking action’. The sooner nurses wake up to this state sponsored false-flag, drop the snobbery and elitism, and see the RCN for the scab staff association it is, the better….. Join another union, any union……

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  • *Applauds the last post*

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  • * applauding as well*

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