The RCN opposed the Health and Social Care Bill before it became the Act, which created NHS England. While we welcome NHS England’s focus on improving health outcomes, patient-centred care and service transformation, we argued at the time that this would not be achieved by the proposed reforms. When Royal Assent was given for the legislation, the RCN made it clear that we respected the democratic process and that we would work with NHS England to assist the implementation of the reforms to ensure that the NHS provided quality care to patients.
Among our key concerns was the importance of maintaining a clear line of accountability for NHS-funded services between the general public and national politicians. We believe that the role of the Secretary of State for Health must be clearly articulated, showing how and when they will intervene in the event of local variations in the availability or quality of care. NHS England has a key role in this and must work together with the Secretary of State to ensure the promotion of a comprehensive health service provided free at the point of delivery.
The RCN believes that NHS England is in a unique position to promote the universality of health care standards and prevent the so-called “post code lottery” that has developed over recent decades, which goes against the NHS’s founding principles. The new CCGs have the opportunity to meet the health care needs of their populations in new and more efficient ways due to their local knowledge and increased clinical involvement. However, there is the risk that in some areas there could be fragmentation of services, leading to local variation in service provision and care quality. NHS England will design the NHS standard contract with provider organisations, and this is an important way that national standards and guidelines can be promoted. For example, NICE quality standards could be included so providers would be required to deliver against these.
NHS England must have strong and clear relationships with all the other organisations and agencies in the new NHS system (for example, with national bodies like Monitor, CQC, Public Health England and Health Education England, but also with local structures such as health and wellbeing boards and local education and training boards) so that the system is “hard wired”. Responsibilities must be well defined, everyone must work towards the same goals, and nothing must be allowed to “fall through the gaps”. The National Quality Board, which brings together these national organisations, provides an opportunity for this to be delivered.The RCN has welcomed the mandate’s promotion of safe, high quality care, and the aim to prioritise mental as well as physical health. We also welcome the Chief Nursing Officer role and directorate within NHS England itself. As the professional body for nursing, we believe it is essential that NHS England has this nursing leadership with the power to make a difference to patient care throughout the NHS. We would support all efforts to make the directorate’s role as robust as possible.
An early challenge for NHS England was to authorise CCGs, and it will continue to monitor them. The RCN believes that this process must be robust and transparent so that the public can be confident that funds are being properly used on their behalf, and so that commissioners can be held to account. The RCN is monitoring the role of nursing in CCGs to make sure that commissioning at all levels is truly clinically led, with a multi-disciplinary focus. We called for nurse involvement to be a requirement for authorisation.
The RCN is concerned about the potential loss of expertise from existing clinical networks, as the progress that these networks have made should be built on in the new system. NHS England has yet to clarify in detail how these functions will be delivered in the future. In its role as part of the Social Partnership Forum, the RCN is raising these concerns with NHS England.