Andrew Lansley - vote of no confidence from Nurses

[wideawakenurse]

here

Watching this with much interest.

Really hope the nursing unions get this right this time, and don't just roll over and take this.

On earlier threads about health service reforms, I posted links to the BMA's statements about what was wrong with the current proposals. It's an interesting aside to note how much less attention they got than this episode.

And dont start me on the bloody BMA...

Mellow - I'm not sure having his office expenses met - qualifies as 'in the pocket of'.

The last government brought private companies into the NHS to try and improve efficiency.

On the news at the moment - the Welsh NHS cut backs - their NHS spend isn't 'ring fenced' like the English health service.

Folly, I think the belief in reform benefiting nurses is about ensuring we provide staff with a work environment which promotes best practice and also allows staff to improve skills and knowledge

There are massive concerns that private supplied health care would not offer student nurses a suitable learning environment and would not be in line with nursing schools values.

Jackstarb I don't know enough about different systems but anecdotal evidence of friends suggests that if there was a choice between the US system and the French system, then the French one is better. I do like the idea of being able to go straight to a specialist (that you choose) although in France they overprescribe on drugs and it is wasteful in other ways. I've also heard stories of incompetence in hospitals (leaving in swabs) so nowhere is perfect.

But the NHS is unique and precious and it would be far better that they abandon the Bill completely than have some mash-up that causes irrevocable damage. It was not in the manifesto, has no popular support and no professional support either. It's a monstrous failure.

Sorry - I feel the need to clarify some numbers. According to the NMC (registration body for nurses) there are 660,000 nurses and midwives on the register, so for the RCN to have 400,000 nurses and HCAs they have a pretty big 'share of the market'.

Muminlondon - no system is perfect. Although, the French health system is said to be the best in the world. The US system is too reliant on health insurance - which massively inflates costs (and can be hard on the uninsured).

I think people who are saying the RCN are not the voice of nurses based on the proportion of nurses in the NHS seem to be confused about the NHS. There are many professions in the NHS not represented by the RCN eg physios, speech therapists, sonographers etc. The RCN may not be the voice of the NHS, but it IS the voice of nurses.

Oh and I'm afraid I don't see the NHS as precious - at least not the reality of it. The original idea was great in it's day - but it's not sustainable in today's world. Tbh - I really don't know if the Lansley proposal is the answer - but change is needed at some point.

The NHS is still the envy of many countries - it is precious in terms of the expertise and dedication of the staff, and also because it would be easy to damage it beyond repair. It was set up during a unique period of consensus in history. I understand the growing demands on the NHs - ageing population, rise in long-term health problems, etc. But Lansley's proposals are a dishonest, back-door privatisation without proper consultation or endorsement.

I think Badger is confused. Some of her comments on the RCN are a bit like saying that, because the CBI does not have all businesses in membership, that it does not speak for business.

Which is just a bit thick really.

And if there are 650,000 nurses and midwives on the NMC register and the RCN have 400,000 on their books then rememberthat midwives will be in the RCM rather than the RCN. So that means that there is an even greater percentage of registered nurses who must be in the RCN.

As far as I can see the RCN is like a professional body that has responsibilities for training, publishing best practice guidance, CPD etc. Like the Royal College of Sugeons. That's quite different from, say, Unite. Would there have been this discussion if it had been the Surgeons? Or is there still some snobbery about their status?

muminlondon - remember how, when Obama was introducing his healthcare reforms a couple of years ago, the spectre of creating another UK style NHS was used by his Republican opposition? It didn't feel like the NHS was the 'envy of the world'.

Granted - much of the criticism was unjustified. But the way our health care is rationed (especially by age), waiting times are managed, and resources are poorly utilised, is not the envy of the world. Rather it's something all subsequently developed national health systems have attempted to improve on.

I see Lansley's proposals as an extension of what Labour were doing, but without the luxury of piles of extra cash to soften the process. I do agree that his proposals won't work without wide spread support.

Niceguy the vote today was in relation to NHS reform, not pay or conditions.

That's not how the article you linked put it. The very first sentence states:

Britain's leading nursing union will also move a step closer to balloting on industrial action over a pay freeze on Wednesday

That was reported from the BBC. I am telling you what I know as a RCN member.

muminlondon I agree with you around the snobbery, I doubt very much if such a debate would be taking place if this was coming from the RCS.

To be fair wideawake - some of the nurses interviewed seemed confused about what they were voting against. A couple talked about cuts - when NHS spend has been 'ring-fenced'.

Another NHS employee here.

I am really very very pleased that the debate is being held in public rather than in the secretive closet of the department of health - where the policy to deliver these changes is still being developed on the hoof.

Just because something is perceived to be a 'union' speaking doesn't immediately mean that everything that group says should be ignored because it's all self-interest. In hospitals, nurses and other groups of staff don't necessarily get listened to above other clinicians and staff (admin, management, support etc). This conference is a wonderful way to get across the messages about the reality of working in the NHS, and a wealth of experience all saying they are worried is getting air time.

Well said, muminlondon. The RCN is not a traditional union - it's a Royal College akin to the Surgeons or Physicians. The RCN is so backwards in coming forwards they never even put a figure on pay claims (unlike the BMA and other medical associations).

Btw, for those confused about the cuts - the government is cutting £20bn from the NHS budget over four years. They claim the budget has been ring-fenced but what they are actually doing is quite different. And they are quite open about that within the NHS, just not to the general public. Have a look at the minutes of your local PCT's board meetings if you want to check - they should be available online. Even if it was 'ring-fenced' there would still be cuts because inflation in healthcare runs ahead of RPI/CPI thanks to growing demand from an ageing population, new drugs and new technology. Go and look at the King's Fund website - the savings demanded of the NHS are unprecedented and far more extreme than anything Thatcher did.

The vote is a vote of no confidence in the reforms and government policy, it's not about pay. And the reforms are extremely scary for patients. The current plans will strip away all accountability to patients - it's entirely up to the GPs whether or not the new consortia will bother to have any patient representation at all. The new Health Watch will be funded by councils (whose budgets are being slashed, so don't expect HW? to have any money to do any substantive work - they won't be able to afford to consult the public) yet is suppose to hold councils to account for their role in health wrt to public health and GP consortia. Yeah, right...

And these consortia, with no patient representation or responsibility to involve patients, will have the power to decide whether your local A&E or maternity services are closed.

Badgers also seems to misunderstand the NHS workforce and how representative, democratic organisations work. Representatives attend the AGM and vote on behalf of their members. That's standard practice in every representative organisation. You can't have a meeting with 400,000 people attending in the flesh, fgs! And there are 1.4m working in the NHS but guess what? They ain't all nurses. The RCN represents the majority of nurses by an extremely long chalk.

I'm not a nurse, btw, so not biased - merely an observer of the NHS.

"Even if it was 'ring-fenced' there would still be cuts because inflation in healthcare runs ahead of RPI/CPI thanks to growing demand from an ageing population, new drugs and new technology."

Edam - Exactly, the last government increased spending dramatically year on year - it is this halting of extra cash which is causing the pain, as costs continue to rise. Cuts will need to be made in some areas to pay for unavoidable increased costs in others. I thought the total overall NHS spend was not being reduced (allowing for your point on health inflation) at least that's what I've read.

But - no government could continue to keep pace with the demands of funding the health service. If Lansley's plan is rejected - something else equally dramatic will need to be done at some point.

I find the (to me) sudden public lack of confidence in GP's and the implied boosting in status of NHS senior management interesting.

No lack of confidence in GPs here, Jackstarb - far from it. But they didn't train as managers or commissioners of services, did they? How could they have time to do both jobs well?

As far as NHS management is concerned, all that really concerns me is that they should not be paid hugely inflated salaries. Also, I can remember when the NHS suddenly seemed to acquire a lot of managers who seemed to invent work to keep themselves in a job (10 or so years ago). Now their jobs have become so unwieldy they need two managers to cope with what used to be done by one ...! Sorry if I'm being unfair - it's just my impression.

What matters to the patients is the nurses, doctors and consultants, the cleaners and auxiliaries. Clearly they need a certain amount of management, but maybe they could be made more effective? (Sorry to anyone who is a NHS manager). I doubt that cutting the managers is the answer, not when the elderly population is rising at such a rate. One job lost is one too many, imo.

Why should the NHS be so difficult for the government to fund? If given the choice, wouldn't you prefer the bulk of your taxes to go on hospitals, schools and universities, rather than into the pockets of bankers?

The NHS is so difficult to fund because its become a bottomless black hole. Labour threw billions at it and the improvements were not great. On top of that they simply asked for more. We cannot simply keep throwing money at the problem stating "Wouldn't you rather spending money on hospitals?"

I'm not entirely convinced about the proposed changes but I am convinced there is a need for change and that continuing throwing more money at the NHS isn't a viable solution in an era where the rest of the economy is bordering on meltdown.

Disagree, NIceguy. The more people there are, especially older people, the more money is needed for the NHS. The amount of money needed will continue to increase year on year as the population grows - although I'm sure some efficiency savings can always be made.

Mellow - more money needed doesn't equate to more money available. Our children aren't going to want most of their tax revenue swallowed up by the NHS. Rationing and setting priorities are already a feature of the NHS - they will just become more so.

Sorry, I disagree again, Jackstarb. I am very happy for most of my taxes to go to the NHS - and whatever we pay in taxes is so much less than it would be if we had to take out private health insurance, as they do in the USA. I can't think of anything more important than health. Obviously setting priorities is important, even rationing if necessary - and preventing people getting ill in the first place, etc.

I have often wondered if the governments' policies over the past 10/15 years of closing small, local hospitals is a good idea. I know it is always done in order to save money, but ime small organisations are so much easier to run efficiently. Also having local hospitals means the nursing staff can be helped by relatives coming in and doing basic tasks - washing, feeding, toileting, especially of old people and children.

For example in Edinburgh, the Royal Infirmary was closed down and sold to developers who knocked part of the beautiful old buildings down and made them into flats and shops ('The Quarter Mile'). So a presumably publicly owned building was sold to a private company. Meanwhile, a mega-huge new hospital was built out of town, a good bus ride away for anyone who lives in the city. The new buildings are hugely impressive, and must have cost millions and millions. Clearly lots of jobs in the construction industry were provided in the process, but you really do wonder if any money was saved for the NHS.