7. Transformation or not?
Essex Branch
(R) That this meeting of RCN Congress calls on Council to denounce downgrading under the guise of service transformation.
Result
The resolution was passed.
For: 464 (97.68%)
Against: 11 (2.32%)
Abstain: 4
Debate report
Samantha Neville, Essex Branch, proposed the item and referred to RCN Frontline First reports of vacancy freezes, job losses and downbanding and said doing all this was a “cynical way of cutting costs”. This view was supported by Tessa Woodcock, Bedfordshire Branch who said that the cuts to services and pay have been dressed up as ‘transformation’. She urged trusts to acknowledge that transformation is not about cutting staff’s terms and conditions.
In a passionate and extended debate, members drew from their own experiences and Lisa Crooks, Gloucestershire Branch asked “when are we going to pause, think, take stock and use our common sense?” Many members spoke of downbanding in their workplaces with John Hill, Scunthorpe Branch saying he is currently fighting the downbanding of 18 nurses and that 48 had already been downbanded.
Half way through the debate, a change of agenda item wording was proposed and subsequently agreed by the proposer.
Denise Chaffer was one of a minority of delegates to support transformation plans saying that the status quo is not an option and that it is a missed opportunity to take a leadership role in changes. She went on to say that with big workforce challenges, there is a need for “flexibility to be able to lead from the front and make sure our voices are heard”.
Catriona Forsyth, UK Safety Committee commented that the best service re-design has staff “at the heart of planning and implementation” and that RCN representatives need to ensure they’re at the table of re-design discussions.
Some members spoke of the dangers of losing not only experienced, skilled staff but also newly qualified staff who cannot find jobs and Marianne Smith stated that money was “being saved in the wrong places”. Jane Bovey, Wiltshire Branch said we downgrade at our peril and called on the RCN to use “our muscle” to fight transformation.
Background
Throughout its Frontline First campaign, the RCN, has warned that short-term savings to wage bills, through vacancy freezes, post losses and ‘down grading’ (also referred to as downbanding), are putting staff under increased pressure and is leading to concerns over the safety of patient care.
In England, the ‘Nicholson Challenge’, to save £20 billion over five years, means NHS trusts must find ways to ‘do more with less’. The King’s Fund (2011) has published guidance for commissioners in England, arguing for a health service focused on health promotion rather than the management of acute episodes. This includes preventing diseases from developing through lifestyle changes, and the better management of existing long term conditions to avoid deterioration and expensive unplanned admissions. The integration of acute, community and social care is an important part of this process as developing coordinated treatment pathways means trusts can avoid duplication, identify problems before they get worse and improve the overall patient experience.
In its recent report on public expenditure, the Health Select Committee (2012) expressed concern that efficiency savings were being met by short-term cuts in England, with existing services being ‘salami sliced’ by trusts, rather than organisations working together to sustainably change the way care is delivered. Evidence gathered by the committee suggests short term cuts being made now will make effective service transformation more difficult in the future, and recommended that more needs to be done centrally to incentivise effective service transformation and integration. These findings echo the intelligence gathered by the RCN (2011) through its Frontline First campaign.
NHS boards in Scotland are undertaking significant service redesigns to manage costs while responding to policy pressures to increase service delivery in the community, improve integration with social care and increase investment in activities to prevent ill health. The RCN in Scotland has campaigned hard for the Scottish Government to commit to making health boards provide evidence of the use of nationally agreed nursing workforce and workload tools and produce detailed clinical risk assessment plans before any workforce plans are agreed and implemented. This includes workforce changes arising from service redesign.
In Northern Ireland, the RCN has consistently stated that it will support service transformation towards the community, provided that nurses are involved from the very start. We would also want to be sure that any changes that are made promote safe and effective patient care, not simply the cutting of costs. Proposed changes would also need to be underpinned by robust evidence-based service planning and appropriate workforce development.
In Wales, an ambitious reform programme has already been initiated. There are now seven health boards that organise all local services. Staff on these boards include GPs, pharmacists, acute and district nurses - working together with social services as part of a single ‘integrated’ system.
References and further reading
House of Commons Health Committee (2012), Public expen’iture: Thirteenth report of session 2010-12, London: HMSO. Available at: www.parliament.uk/business/committees/committees-a-z/commons-select/health-committee (accessed 02/03/12).
King’s Fund (2011), Transforming our health care system: Ten priorities for commissioners, London: King’s Fund. Available at: www.kingsfund.org.uk/publications (accessed 02/03/12).
Royal College of Nursing (2011), Frontline First November 2011 update, London: Royal College of Nursing. Available at: www.rcn.org.uk/publications (accessed 02/03/12).
