It was the biggest set of changes to the NHS in England since its inception in 1948. First unveiled in a white paper back in July 2010, then turning into the Health and Social Care Bill at the beginning of this year, the planned NHS reforms have gone through more twists and turns than the plot of a Hollywood film.
They have been controversial too, with real concerns raised about the scale, speed and depth of change.
This represents a real win for nursing. The unique knowledge, skills and experiences nurses bring to the NHS will now play a part in the commissioning of services
Many organisations, including the Royal College of Nursing, voiced serious apprehension about the scale of competition in the plans and the new role of Monitor.
Competition in the NHS isn’t something that frightens the RCN - it’s been around in one guise or another for many years. However, when promoted inappropriately, the bid to reduce costs can drive down quality and ultimately impact negatively on the care provided to patients.
There was also a strange and concerning lack of nurse involvement, with the term “nursing” appearing just once in the original white paper. A significant - and I believe naive - amount of faith was placed in GPs to commission vital services used by patients. I have a great deal of respect for GPs, but no single profession could, or should, handle the complexities of NHS finance, making critical decisions and deciding what funding goes where.
Then, only a week before RCN Congress in April, the government decided to “pause, listen and reflect” on the bill, kick‑starting a process it called the “listening exercise”. There were some who were sceptical of the exercise, dubbing it nothing more than a PR stunt. The RCN did not subscribe to this opinion.
The only option before us was to actively engage in the process and influence the reforms for the good of nurses and patients everywhere. So we did.
During the 10-week process, the RCN took part in three listening exercises, held meetings with the health secretary, deputy prime minister and prime minister, and was rarely away from the media spotlight, citing our concerns and getting the nursing voice heard.
Only last week, the NHS Future Forum published its response to the listening exercise and, within 24 hours, the prime minister had unveiled significant changes to the reforms. GP commissioning consortia became clinical commissioning groups and, importantly, the boards of these groups would have to have at least one registered nurse at the table. This wasn’t something set out in the original plans and is a direct result of RCN lobbying and the A Seat on the Board campaign led by Nursing Times.
This represents a real win for nursing. The unique knowledge, skills and experiences nurses bring to the NHS will now play a part in the commissioning of services, something that will only benefit patients.
The proposed role of Monitor has changed dramatically too. The RCN and others raised serious concerns about the planned role to promote competition and this has now been dropped. Instead, Monitor will actively encourage “integration” and improvements in the quality of care, a far cry from the original plans.
There is, of course, much more to do. We still await the details of what the new reforms will look like and how they will be implemented on the ground.
That said, nursing can look back and be genuinely proud that it not only influenced the proposals but it changed them significantly. Nursing spoke with one voice and it was heard, we proved how powerful we can be and we made sure that we changed these plans not for us, but for our patients.