Item 16: NHS Ltd - worth the price?

Matter for discussion submitted by the RCN Greater Liverpool and Knowsley Branch

That this meeting of RCN Congress discusses the impact of a finance-driven, business-orientated NHS on patient care

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Suzanne Butler from the RCN Greater Liverpool and Knowsley Branch asked Congress to discuss the impact on patient care of a finance-driven, business orientated NHS. She reminded members that during 2009/2010, £104 billion has been promised for primary care trusts in England. She asked if this money was being seen by nurses. Suzanne thought not. She expressed concern that the money was being used by managers to progress applications for foundation trust status rather than being spent on patient care.

She asked members to share their experiences of what is happening in Wales, Scotland and Northern Ireland and asked if the NHS in England should follow the business example of companies such as Tesco. Suzanne emphasised that she thought caring for patients is a very different business to buying a can of beans and urged members to consider what happened in the Mid Staffordshire Hospital where a Healthcare Commission report found that more emphasis was put on saving money than providing patient care.

Mike Hayward from the Croydon Branch told of how he applied for a job earlier this year. He felt the recruitment process concentrated on how he could help the organisation achieve foundation status, rather than how he could improve patient care.

Dave Dawes highlighted the difference between 'finance driven' and 'business orientated" and said that whilst there was no place for work being 'finance driven' in health care, being business-like could be very positive. This opinion was shared by Christopher Butler who advised that a business model can mean doing something in a better way and he encouraged member to get involved in business planning at work.

Ian Rodger described the situation in Scotland and urged nurses to continue seeing the person and not the patient. He spoke movingly about his personal experiences of deaths of family members, which he attributed to health care service failure.

Other members continued to emphasise the importance of focusing on patient care rather than finances. This was summarised helpfully by Kevin Takooree who asked for a show of hands of members who had asked for a budget to improve patient care but had their request declined. The large number of hands shown in the auditorium proved his point clearly.

Background

This year the NHS Primary Care Trusts (PCTs) will receive £104 billion funding for 2009/10 - a threefold increase on 1997 figures. Media and public debates have highlighted concerns about how these monies are spent, and what, if any, difference increased funding is making to the quality of outcomes for patient care. Across the UK, however, the commitment to an NHS funded from general taxation remains a key principle, and is enshrined in the newly launched NHS Constitution.

There have been several initiatives in NHS England aimed at making services more productive, with regular reference being made to learning lessons from 'successful customer focused businesses' such as Tesco, Toyota, and Marks and Spencer, while NHS Scotland, Wales and Northern Ireland have all stated an intention not to rely on market style forces to drive the design and delivery of health and social care. However, all UK countries face similar challenges; creating the right policy levers to develop health care systems that are efficient, effective and which consider value for money.

The Welsh Assembly's consultation paper, Delivering the new NHS for Wales, clearly describes the abolition of the internal market and talks in terms of an holistic national and local planning framework. The Scottish Government opposes private sector competition within the NHS, having rejected the concept that markets in health care represent a means to incentivise improvement. Meanwhile, the Northern Ireland Executive has adopted a public services collaborative model, implementing a significant efficiency programme - with a focus on achieving cost controls and sustainable delivery - within the Comprehensive Spending Review (2007) framework. Many of the proposed controls, including a new tariff for procedures - similar in some respects to Payment by Results (PbR) in NHS England - are now being introduced. In NHS England there has been a much more obvious spotlight on finance, costs, productivity and efficiency, and initiatives such as Service Line Management, PbR, and the Productive Ward are obvious examples of this trend in policy.

Recently there has been a widely held belief that the emphasis has been too much on finance, and not enough on patient views and clinical engagement. Bodies such as the RCN, Healthcare Finance Management Association, Monitor, and the Audit Commission have recognised this fact and worked collaboratively to address the issue of clinical engagement.

The RCN's position on the role of finance and business style strategies in the NHS is clear. The RCN does not oppose their use in principle, but does insist that they are evidence-based and designed to assist - rather than distract - clinicians in planning and delivering excellent care. In a recent survey of members working in NHS Foundation Trusts in England, many respondents saw the benefits of adopting a more business like approach to organisational development and service management but expressed concern that where there was a disproportionate focus on costs, this had a detrimental impact on staff morale and clinical engagement.