NHS radical reform!


Simpler days - a fresh faced Staff nurse sets out to change the world (back row 2nd from Left)

Simpler days – a fresh faced Staff nurse sets out to change the world (back row 2nd from Left)


In my life, 1979 saw two important events, firstly it was the year in which I started my nurse training at Hollymoor Hospital in Northfield, Birmingham and secondly, Maggie Thatcher became Prime Minister.

In so many ways, life seemed simpler back then – for example, you knew where you stood with politics and politicians.

My early political understandings were informed by Clash lyrics, the NME and the Anti-Nazi League. Down the road from me, Red Robbo was stirring up the Car workers at Longbridge & UB40 were composing their first album ‘Signing off’. I remember a feeling of pride about working for the NHS.

In the opposing corner was.. Maggie

At least with Maggie you knew where you stood. The Tories were the party of privatisation, anti-Union and we all knew that given the chance they would have liked to run down the NHS. Of course, even Maggie didn’t manage to do away with the NHS, despite attempts to boost the influence of private medicine etc.

Nowadays of course, things are not nearly as clear.

White paper tag cloud1

 (Tag cloud made from White Paper ‘ Equity & Excellence: Liberating the NHS’)


Apparently the NHS is safe in Conservative hands and they were keen to point this out before the election.

 “We are the party of the NHS today because we not only back the values of the NHS, we back its funding and have a vision for its future.” (Conservative Party Manifesto 2010)

David Cameron has previously stated that the Tories were wrong to weaken the NHS and has been keen to distance his party from it’s percieved anti NHS bias. If you really want more reassurance see  Hector from Abingdon who had never voted for the Conservatives before but was doing so now to protect the NHS.

In common with everyone involved in the NHS we have been talking about the implications of the proposed NHS reforms. Amongst the proposals are plans to hand control of NHS budgets to GP consortia to spend on behalf of patients whilst cutting Primary Care Trusts and strategic health authorities. According to the DOH, the reforms  will ‘Liberate’ the NHS leaving it  ‘streamlined with fewer layers of bureacracy’.

Why am I so worried?

This is what I think is really going to happen:

  • Look out for an increase in Private involvement in the NHS (see Tag cloud reference to ‘consortia’ & ‘choice’)
  • Private companies have to prioritise the interests of their share holders therefore..
  • NHS Job losses
  • Skilled workers increasingly replaced/ supplemented by unskilled workers (this blog details this really well)
  • Foundation Trusts opting out of the NHS, local pay & conditions, reduced entitlement to leave, reduced redundancy payments, pensions etc
  • An increase in (profitable) patients recieving private medical care
  • A decrease in care for less profitable patients, i.e. long term conditions, people with mental health problems etc (see White paper “begin to introduce choice of treatment and provider in some mental health services from April 2011, and extend this wherever practicable”)

I could go on but like to keep posts short – feel free to add your own to the list though.

The RCN campaign ‘Frontline first’ is an attempt to defend patient care – one of the speakers in the launch says that ‘when nurses speak, people listen’ 


What should we be saying & is anyone really going to listen? I am not so sure they will – hope I am wrong. 

Any comments?



3 thoughts on “NHS radical reform!

  1. G.P. Consortia! Where have I heard this before?
    At the centre of this White Paper are proposals to sweep away the “Top Down” superstructures like SHA’s PCT’s.
    G.P’s were King almost 20 years ago and what a mess that was,and were reported both through the Community Health Council and Mencap where findings in 1994/95 revealed G.P’s removed around 30,000 patients from their lists (“G.P RID LISTS” as Brindle coined the phrase). Not surprisingly these patients had learning disabilities,mental health needs and were seen as high cost,and took too long to treat.The White Paper states in 4.5 “Our model is neither a recreation of G.P Fundholding nor a complete rejection of practice-based commissioning..” “G.P consortia will have a duty to promote equalities,particularly in relation to health and social care…and in relation to safeguarding”, the White Paper goes on to say.However,I am not quite so optimistic as G.P consortia practices,however you dress this up,will result in rationing of services for those who are likely to be excluded.The patient’s voice will be lost under those who shout loudest – Milburn got rid of Community Health Councils and The Patient’s Charter,and so far the Care Quality Commission has yet to adopt any teeth to represent the patient’s experience of health care. What do you think??

  2. The influence of business and commercial practices on healthcare can be pernicious and counter-productive. All but the most hardened political ideologue can acknowledge that services must be paid for, but it is the perspective of those who administrate those services that is so crucial to service delivery.

    Available perspectives might be best conceptualised on a continuum. At one end would be the view, “We MUST do this, and hang the cost” and at the other would be, “How can we avoid paying for as much as possible?”

    That view might seem unduly cynical, but from personal experience I have found it to be literally true. Nevertheless, as one would expect, these poles are radical positions. Healthcare managers at one end need to accept that there will be differences of opinion with regard to what ‘MUST’ be done, and those at the other need to accept that there will be expenditure that really is unavoidable.

    The key to remaining future-focused, organisationally, is to find compromise and consensus. Of all people, it was Otto von Bismark who coined the phrase, ‘Politics is the art of the possible’, way back in 1867, and that sentiment still holds true today. I guess for the most part those of us who work in healthcare err towards the ‘what must be done’ end of the spectrum, and those in the budget-holding management chain err towards the ‘what can be avoided’ end, but the path forwards can only be somewhere between those two poles.

    Sadly, however, current governmental direction seems to indicate a pan-departmental, cultural paradigm shift toward the ‘what can be avoided’ end of the spectrum. Those of us who advocate for the ‘what must be done’ lobby ought not to be too downcast, however. We are going to have to compromise and ‘cut according to our cloth’, but it is probably a worthwhile and cultural cathartic exercise in the long run to look at what we’re doing and be challenged about our preconceptions about priorities.

  3. the NHS is reforming this is true paitent lists are getting smaller doctors are about to take the big issues of running practices doing the donkey work as i call it but what about mental health there have been no reforms there and this is quite a big thing maybee they should look at reforming the mental health services i egaly await to see this is something big and i think they should have a good look into it

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