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White paper will reduce the NHS to a mere brand name


Throughout the general election campaign, the Conservatives and the Liberal Democrats promised the NHS would be safe in their hands. There would be no more top down decisions, we were told by the leaders of what is now the coalition government.

Yet, just a few weeks after the May election, the government published a white paper on the future of the NHS in England. It contains wide ranging reforms that will result in a major upheaval for our NHS, including a number of changes in neither the Conservative nor Liberal Democrat manifestos.

I cannot for one minute believe that this white paper was the work of a few weeks. The ideas must have been in place for some time and only needed fleshing out.

Our nurses and nursing leaders are responsible for delivering the overwhelming majority of quality patient care. Yet the 20,000 nurses who work in primary care hear that their organisations are to be abolished via this white paper. Commissioning is being handed over wholesale to GPs. There is no guaranteed place for nurses, midwives or health visitors in this process.

‘GPs are encouraged to stop offering procedures that do not have “appreciable benefits”. Will it mean that practice nurses will stop doing routine tests or giving advice?’

Don’t get me wrong - I would welcome GPs playing an active role in commissioning, but that doesn’t mean that we should throw away completely a system we have built up that works.

And I worry whether GPs or GP consortia will be held properly to account when PCTs and strategic health authorities are abolished and the Care Quality Commission has been asked to drop its annual health check reviews.

The government has said that fewer staff will be employed as a result of the changes, so all those guarantees about protecting the NHS are worthless.

Plans for local autonomy over pay, training and workforce planning could lead to fragmentation and disintegration of standards. This autonomy also poses a threat to UK wide collective bargaining and the role of the NHS pay review body.

As nurses, we work in a caring and compassionate environment, but this white paper seems to be designed to reduce the NHS to little more than a brand name for the system. Care and compassion will give way to hard nosed business decisions about what is affordable and the removal of the private patient income cap could result in NHS patients being pushed to the back of the queue.

When money is tight, GPs are encouraged to stop offering treatments or procedures that do not have “appreciable benefits”. Who decides what that is? Will it mean that the practice nurse will no longer be carrying out routine tests or giving advice on diet, exercise and other healthy living activities? This could also cause a conflict with the GP’s role as healthcare advocate, something we are sure will concern many of them and their staff.

The government has signalled that it will be ruthless in not bailing out overspends on budgets or taking failing hospitals back into the NHS.

Accelerating the approval of foundation trusts will mean that managers will be concentrating on preparing for that, rather than on patient care. That is bound to affect all staff and patients; we saw what that emphasis did at Mid Staffordshire. Sir Robert Francis, in his report on the trust, said: “If there is one lesson to be learnt, it’s that people come before figures.” Have we forgotten this already?

The cost of the changes is likely to run into billions of pounds and huge transactional costs, as more than 500 GP consortia take over the commissioning jobs of 152 PCTs. All that money will be stripped from where it is most needed - that is, on the frontline, allowing nurses to care for patients.

As head of nursing for Unison, I will make sure that we speak out for our profession. Nurses and nursing leaders will be feeling demoralised and threatened by yet another massive reorganisation - the worst for 62 years - that will completely change the ethos of our NHS.

Many heard through media reports that their jobs are to go, yet they will be expected to carry on nursing, to deliver efficiency savings and to help implement these sweeping reforms. Oh, and by the way, could they kindly turn off the lights before they leave the building?

The Prime Minister’s Commission on the Future of Nursing and Midwifery clearly articulated this year how important nursing and midwifery leadership is to high quality care. What better way to stifle their views and opinions than to take away their jobs?

There is no opportunity for us to consider the implications of these proposals as the consultations are on “how” not “if”. So much for democratic accountability and services reflecting the needs of patients and staff.

That’s why Unison has lodged a legal challenge to the proposals, specifically that there is full consultation with patients, public and staff. Unison wants to ensure that everyone understands the full implications of the white paper and is able to at the very least make their views known and hopefully influence the process.

Unless we can persuade the government to think again, nurses, the NHS and, crucially patients, face a great period of instability. The only winners will be the private sector.

Gail Adams is head of nursing at Unison


Readers' comments (12)

  • The people who will suffer the most under this new reform will be the patients, especially the old and the socialy disaffected - did the Black report tell us nothing?
    Many trusts are undergoing the Transforming Community Services - introducing a form of skill mix to justify reducing the wages bill, but more importantly shedding staff with expertise, knowledge and skills essential to basic care in the community not just gold standars care. This at a time when acute trusts are closing beds and discharging "sicker and quicker" into the community for PCT staff to lookafter.
    As to midwives and health visitors I hope that David Cameron will looks at this group of vital staff with a bit more respect after the birth of his daughter

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  • The Government has seriously underestimated the up-front and hidden costs of this reorganisation. Unless serious amounts of money are pumped into the NHS the reorganisation will lead to major cuts in the short to medium term.

    Perhaps in the long term there will be advantages, but by then a new Government will be in power, who will want to change it all again!

    Politicians are bad for the NHS's health.

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  • In the 8 years that I have worked for my current PCT we have "reorganised" 4 times! I am a clinical nurse specialist and I am so tired of being "reorganised", I am taking early retirement and getting out of healthcare. What a waste of years of expertise and knowledge! I am not alone! There is a mass exodus of experts spewing out of the NHS already. GP's holding he purse strings will always think they can do our jobs on the cheap.
    All I am concerned about now is; what on earth will be the state of the healthcare system when me and mine need help and care?
    Goodbye and good luck!

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  • I totally agree with Gail's opinion. I am not a Tory supporter, but in honesty a lot of this was set in place by the previous government. I worked for an organisation that was downgraded to a social enterprise and Unison and the RCN were powerless to stop it. And like the commentator above has said - there was an exodus of senior nurses. NHS will be a brand, I think the government has openly said that for some time, small organisations will deliver care on behalf of the NHS - this is not to do with patients, but to reduce staff costs, sickness, salary, pensions. I think GP commissioning is a crazy idea.

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  • 'As to midwives and health visitors I hope that David Cameron will looks at this group of vital staff with a bit more respect after the birth of his daughter'

    That will depend on whether he saw good practitioners. To be brutally honest there are plenty of muppets on the register and we need to weed out the dross [and preferably prevent them qualifying in the first place!].

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  • As to muppets on the register that could be said of all nursing areas and include AHP
    and of course GPs
    Who wants to be managed by them - GPs. They will try and provide services on the cheap then complain that there patient visits have increased. That will be because all of the sensible, hightly skilled and competent nurses have either been down graded and are working to grade - or have left either by choice or via back door redundancies

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  • I am not a tory or a supporter of the con-dem alliance. But come on get real, ok we are pre-occupied with performance targets but we needed something to demonstrate our effectiveness and number crunching fitted with a certain agenda. We will move to outcome based quality measures but this will take time to negotiate and get through the automated resistance of NHS staff.

    Improving and modernising an NHS does not automatically mean protection of any one professional group based on it having a romantic history.

    Let the debate begin

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  • Whilst I would welcome any debate that will bring about improved patient care I feel ver uneasy about the proposed changes to the NHS. As mentioned in the article non of these proposals were mentioned in the pre election campaign.
    I am a rheumatology Specialist nurse and the lives of many of my patients have been transformed by hte use of biologic agents, many remaining in work and continuing to maintain their roles in society Rheumatology has always been a cinderall speciality and I fear for those patients not yet diagnosed with inflammtory joint disease as GP's have little experience with it. Patients with R/A are no longer occupying hospital beds as better understanding and early aggressive therapies are being used but I fear this could change if the new proposals go ahead.

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  • I quite agree with Gail Adams about what is happening to the NHS because of this iniquitous White Paper. It's the next stage on the ever-shortening journey to privatisation of the entire system,following world-wide trends in that direction - where health is seen as a saleable product rather than a basic human right.

    My understanding is that many of these changes have to go through Parliament as changes to primary legislation. We need to get a letter writing campaign going to all our MPs. They need to be educated and alerted to what is happening and if enough of them get enough letters from their constituents then it's possible to stop this destruction of the NHS.

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  • The NHS supposedly enshrined in British constitution. Who the Hell do these politicians think they are!

    They consult with nobody least of all the public or people who work within the NHS.

    What gives them the right to systematically dismantle and sell off the NHS?

    Labour started this sick joke and the tories will just speed it up.

    When your services are no longer there..when you're on a 12 month waiting list for an operation, when your ambulance turns up after 30 minutes, when you've waited in A&E for 6 hours...when your relative dies for lack of resources and staff remeber who's fault it is. Politicians (the true scum of our society).

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