VOL: 98, ISSUE: 02, PAGE NO: 31
Ray Rowden, RGN, RMN, MHSMChancellor Gordon Brown commissions a report on funding from a former banker and prime minister Tony Blair asks an ex-director of the Confederation of British Industry to look at structure and management. Alan Milburn, the real boss, suggests that The NHS Plan is here to stay, despite these noises from the sidelines.
Chancellor Gordon Brown commissions a report on funding from a former banker and prime minister Tony Blair asks an ex-director of the Confederation of British Industry to look at structure and management. Alan Milburn, the real boss, suggests that The NHS Plan is here to stay, despite these noises from the sidelines.
The good news is that senior ministers now accept that the NHS is underfunded. It will continue to be funded largely through taxation and provided free at the time of need, regardless of ability to pay.
In a pilot that aims to reduce waiting times, Bupa will use one of its hospitals in the South East to do elective NHS work. And patients will get more choice in elective surgery, such as going to another NHS trust, an independent hospital or elsewhere within the European Union. Also proposed is that independent sector management might move services into the NHS to tackle its lack of capacity.
The NHS is being reshaped. While most health care will be funded by the taxpayer, it need not be provided by the NHS. This will allow trials with companies prepared to use spare capacity for NHS work.
In the short term we will see change at the margins of the NHS, but what about the longer term? NHS consultants do most elective surgery in independent sector hospitals. If this increases, they will have less time for NHS work. There are only so many doctors and the NHS does not have enough of them.
The same issues arise in workforce planning. More than 100,000 nurses work outside the NHS. If the trials take off, that figure will rise. Where will these nurses come from? Some from abroad, but many will come from the NHS.
The independent sector is like any other part of the economy: some parts are excellent, others dire. What about differential terms and conditions, such as holiday and sick pay, pension rights and trade union recognition? These are real issues for nurses.
Will the public mind? I suspect not. Faced with a year-long wait for NHS surgery or six weeks for Bupa, the choice is clear.
What constitutes the NHS community could look very different in five years' time. Planning between the independent sector and the NHS is crucial to ensure a workforce that delivers quality services.
What part will new providers play in educating students? Will independent service providers recognise trades unions as NHS stakeholders? Will pensions and other rights be protected if services transfer out of the NHS?
Unison and the GMB are opposed to some of these changes. Many RCN and RCM members work outside the NHS, but where will they stand if there is a greater range of NHS provision? To prevent the NHS becoming an ideological battleground and to ensure that the public gets a better service, 'jaw jaw' has to be preferable to 'war war'.