2. Health care reform ― how far, how fast?

Resolution submitted by the RCN East Dorset Branch

That this meeting of RCN Congress supports the need for faster, more rapid change in the NHS

Report on this debate

Red light for faster NHS reform

BJ Waltho of East Dorset branch said her intention in proposing a resolution urging support for more rapid change in the NHS had been to provoke a more contentious debate than usual. And her wish came true, with most delegates speaking strongly against the resolution.

The outcome was a substantial defeat for the resolution - those supporting it were outnumbered by nearly six to one in the final vote.

BJ said there had been 20 major structural changes in the NHS since 1974 - but argued that what was necessary was to ensure each change was properly implemented, rather than slowing the pace of change. She thought nurses should support Lord Darzi's call for change.

But few delegates agreed completely. Dave Dawes argued that after any reform performance and morale tended to dip, but if the change was good there would then be an upturn. However, if not enough time was given, then this recovery would not happen. Lee Ranyard agreed, citing Agenda for Change and community matrons as examples of too-rapid change, not properly thought through.

Tom Murray said the most important consideration was not the pace of reform, so much as the amount of it. Linda Bailey said there had been three major reforms of the NHS in England in the past three years, and it was time to slow down.

Patricia Leung and Vinice Thomas did support the resolution, but with some qualification.

**Results of the vote**
For	53	14.6%
Against	310	85.4%
Abstain	0

**Results of the online poll**
For	4	5.4%
Against	70	94.6%

Background

There have been at least 20 major structural changes to the NHS across the UK since 1974 (Timmins, 2008). For local members and their employers across the UK countries, that number could be much higher as individual organisations and teams restructure and reform to meet local needs. In several surveys, policy overload has been identified by managers as a factor in distracting staff from the core business of delivering care. Despite this, there are many who have called for faster and harder reforms. Indeed, former Prime Minster Tony Blair has stated regret that he did not go further and faster with public sector reforms.

Identifying what drives reform is important to help analyse the prospects for success, and whether the pace is right. In reality there are often several drivers at work, and not all of them ― such as demographics and the global economy ― are subject to government control alone.

Deciding whether reforms are too fast or slow is difficult, and depends on the context. As an example, the public health needs of the nation have already been identified in reports like the Black report (Department of Health and Social Security, 1980) and Choosing health (Department of Health, 2004), yet in terms of demonstrable improvements policy progress in this field across the UK has been remarkably slow. In other areas ― such as acute and planned care ― too much speed in some areas of policy has created instability and uncertainty, and in some instances, particularly in England, has caused conflict with the objectives of other policies (for example, the impact of deficits on education and public health spending).

Across the UK, the pace and nature of the reforms has differed. The Scottish Government published its Better health, better care (Scottish Government, 2007) statement in 2007, underpinned by a commitment to keep the NHS in the public sector and create a ‘mutual’ NHS which is co-owned by patients, public and staff. The plan emphasises preventative interventions delivered in the community, and sets out to increase public involvement in NHS decision-making. The Welsh Assembly published Designed for life (Welsh Assembly, 2005), a strategy for reform of health care services in Wales. This sought to move the focus of health care funding and services away from acute and into primary and community care. The Welsh Assembly remains committed to this vision but emphasises investment into primary and community care before the removal of acute services. At the same time it is reducing health care organisations through trust mergers and the Confederation of Local Health Boards. In Northern Ireland, a review of public service administration has had a significant impact on the workforce and structure of health care.

Whilst policy themes across the UK appear to be similar, the solutions proposed ― and the pace at which these are implemented ― are quite different. In this respect, the RCN has campaigned for different things, at different levels, and in different ways, depending on the context of the reforms.