Scale and speed of reforms risk NHS future

Published: 03 October 2010

Responding to the NHS White Paper today (4 October), the RCN said that the scale and speed of reforms pose a significant risk to the future of the NHS.

The RCN welcomed the principles of the Government’s NHS White Paper ‘Equity and Excellence: Liberating the NHS'. However, it warned that if the untested proposals were pushed through without winning support from staff and adequate risk assessment, they could lead to aspects of the NHS breaking up, with a potentially negative impact on patient care.

The RCN said it welcomed the principles behind the reforms and supported key elements including the focus on outcomes, choice, patient involvement, professional freedom and removal of unnecessary bureaucracy.

In a survey of its members the overwhelming majority agreed with the principles of patient-centred care (85 per cent) and greater freedoms to staff (79 per cent) in the White Paper. However, just one in five (20 per cent) agreed that the White Paper proposals will result in better care for patients. The RCN believes that the Government still has a challenge ahead of it to engage with nurses and patients.

The RCN said today that the proposals, which will restructure the NHS, sit within a highly ambitious timescale and there are considerable risks to services at a time that the NHS is striving to make £20 billion of efficiency savings and management reduction costs of 45 per cent.

Today’s response warns that the proposals set out in the White Paper to increase competition are untested in the UK and introduce risks that cut to the core of tax-funded health care. Fragmenting services could result in the potential for greater health inequalities and unexplained variations in service, a reduction in collaboration and sharing of good practice across NHS services. The response urges that these proposals are piloted and evaluated before being implemented.

It also says that the role of nursing is noticeably absent from the White Paper. Without harnessing nursing leadership and using nursing expertise at all levels of the commissioning process and on the NHS Commissioning board, the reforms would struggle to meet the challenges of the future.

RCN Chief Executive & General Secretary, Dr Peter Carter, said:

“We have produced a considered and measured response and the RCN welcomes the principles on which these reforms are based – putting patients at the heart of the NHS, focusing on outcomes and empowering clinicians. However, they show a radical shift in the way healthcare is managed and provided, at a time when the NHS faces some of the biggest financial challenges of its history. The RCN is not opposed to change, but it is critical that reforms are tried and tested with a strong evidence base behind them that staff feel they can support. Furthermore, we are concerned that flexible local implementation of the reforms could result in the development of unacceptable regional variations in access to services or quality of care.”

The RCN’s response includes several assurances that must be met to ensure the proposed NHS reforms deliver a health service fit for purpose to meet the challenges of the future. These include:

• senior-level nursing must be represented in commissioning consortia and the nursing contribution to health care must be recognised in the proposals
• structural reforms should be piloted and publicly evaluated before phasing in
• there must be clear mechanisms to hold ministers and commissioners to account
• the Government must set out a blueprint for a system of effective checks and balances designed to provide for a level playing field for providers and commissioners, and prevent the fragmentation of healthcare
• the nursing contribution to the NHS outcomes must be explicitly recognised
• there should be no move away from national pay arrangements and NHS pensions must be protected and portable
• workforce planning mechanisms must be in place to ensure the nursing workforce is sustainable.

Other findings from the RCN’s member survey include that the overwhelming majority agree with the principles of patient-centred care (85 per cent) and greater freedoms to staff (79 per cent). Almost nine in ten (86 per cent) of those members who responded felt that nurses should have a central role in the commissioning of patient services in the future.

Dr Peter Carter, RCN Chief Executive & General Secretary continued:

“Nurses do not believe the NHS as it currently stands is broken. While there are undoubtedly areas that can be improved this can only be done by recognising and utilising nursing expertise. We have real concerns that the nursing voice is absent from the proposals and that there is a danger that nursing leadership will be eroded.

“To ensure the future stability of the NHS, the Government must engage with clinical staff at all levels and make sure they take NHS staff with them. We now look forward to working with the Government on the details of the proposals to ensure we get a sustainable NHS delivering the best care for patients.”