NHS plans: Unions move to 'outright opposition'


Howard Catton, RCN: "We cannot move ahead with new health bill"

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The unions representing nurses and midwives have joined others in stating their "outright opposition" to the government's NHS plans in England.

The Royal College of Nursing and the Royal College of Midwives had expressed concerns in the past, but said they were willing to work with ministers.

However, now they want the entire bill covering the changes to be dropped.

Health Secretary Andrew Lansley said the unions wanted to "have a go" at government about "pay and pensions".

The colleges' stance comes after a similar move by the British Medical Association last year.

It also mirrors the stance adopted by Unison, which represents a host of administration and support staff, such as porters.

But what impact this intervention has remains to be seen.

The Health and Social Care Bill is still working its way through Parliament, and the bill is in the Lords at the moment.

In many ways it is over the worst political hurdles and it seems the only way it could be stopped would be if the Lib Dems blocked it when it returns to the Commons - but that is considered unlikely.

On the ground, changes are already being made to pave the way for the new system to kick in, in 2013.

For example, while the doctors union is against it there has still been enough GPs coming forward to pilot the new plans in 97% of the country.


Under the plans, GPs are being put in charge of much of the NHS budget, while the health service is being opened up to greater competition from the private and voluntary sector.


The move by the two unions is unlikely to see the bill stopped in its tracks.

But it is clear the government's relationship with NHS staff is fracturing, possibly beyond repair.

Some inside government were saying the move by the royal colleges was being driven by their dissatisfaction over pensions.

That has undoubtedly played a role. So too has the drive to make £20bn of savings by 2015 - the equivalent of 4% of the budget a year.

This is putting more and more pressure on hospitals and waiting times in particular.

It means there is a toxic cocktail brewing inside the health service - and this spells trouble for the government.

It came to power saying - in private at least - that the NHS was its good news story, but all too often it is finding the headlines are negative.

In June the government announced a series of changes to the original proposals in the face of mounting opposition.

These included giving health professionals other than GPs more power over how NHS funds were spent, as well as watering down the role of competition.

The health unions initially gave the changes a cautious welcome, but they have been left disappointed by the finer details that have emerged during the parliamentary process.

One of the key developments was the news, which emerged just after Christmas, that NHS hospitals would be allowed to do 49% of their work in the private sector - something which could potentially mean eight in 10 increasing their private work 25-fold.

Peter Carter, general secretary of the RCN, which represents 410,000 nurses, midwives, support workers and students, said: "The RCN has been on record as saying that withdrawing the bill would create confusion and turmoil, however, on the ground, we believe that the turmoil of proceeding with these reforms is now greater than the turmoil of stopping them.

"The sheer scale of member concerns, which have been building over recent weeks, has led us to conclude that the consequences of the bill may be entirely different from the principles which were originally set out."

Cathy Warwick, of the RCM, said: "The government has failed to present sufficient evidence that its proposals are necessary. They have failed to present evidence that the upheaval will result in an improvement in services to the people of England.

"And they have failed to answer the concerns of the people who fear for the future of the NHS under these plans."

Savings plans

Andrew Lansley said legislation was "essential to give nurses and doctors clinical leadership"

Both unions also expressed concerns that the changes were compromising the ability of the NHS to make the £20bn of savings it has been asked to make by 2015.

Mr Lansley said that nurses had previously been "right at the heart" of the process of planning reforms to the NHS to deliver better care for patients.

"The only thing that has happened in the last few weeks that has led to this situation with the Royal College of Nursing, is that the two sides of the Royal College of Nursing have shifted," he told BBC Breakfast.

"They used to be a professional association that was working with us on professional issues, and will carry on doing that, but now the trade union aspect of the Royal College of Nursing has come to the fore.

"They want to have a go at the government - and I completely understand it - they want to have a go about things like pay and pensions."

Butr that last point was later rejected by the RCN.

Shadow health secretary Andy Burnham said it was time to scrap the bill.

"A reorganisation on this scale needs a professional consensus for it to succeed. A year since the bill was introduced, it is abundantly clear that the government's plans do have failed to build that."


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  • rate this

    Comment number 730.

    Who are you to judge marie what is essential and non essential treatment. I am and my wife have just gone through with ivf with success first time, and we wouldn't be able to have a child otherwise.

  • rate this

    Comment number 729.

    re 728 Steve in Devon. NHS managers deliver very good value based on what tangible metrics and/or deliverables please? Understand that c.7,000 have left the NHS so far and the consequential impact....zero.Better to invest the money in the front line medical teams rather than in the back office process experts.See figures in 708

  • rate this

    Comment number 728.

    NHS managers currently deliver very good value and are vital to the NHS. It is a huge myth that the private sector is always better at managing things than the public sector. I have worked in both. Remember the banks? Do we want private companies to be able to play loose and fast with our health care provisioning? The NHS can not be managed like private companies.

  • rate this

    Comment number 727.

    re 726 mike divers.NHS is imploding under the weight of bureaucracy and process sitting. See708. For those who object to private provision,can I suggest you do not use the high street retailer/pharmacist,your dentist et al.This is about equal access,based on clinical need and free.See http://www.sussexotc.nhs.uk/.Private provider to NHS under contract.Outcomes matter not who the provider is.

  • rate this

    Comment number 726.

    As Consultants we are constantly expected to practice evidence based medicine but here we have politicians not practicing evidenced based policy implementation. The health service is imploding and the sooner the NHS bill is abandoned the better.

  • rate this

    Comment number 725.

    Lansley is the most arrogant of this arrogant cabinet. If he says Unions oppose his bill as part of a pay and pensions dispute, he is either mad or deliberately malicious. What's at stake is a 2 tier NHS, with doctors commissioning big health companies to turn the NHS into the new Railtrack; assets built with our taxes being handed over to the privileged! More queues, more preventable deaths!

  • rate this

    Comment number 724.

    Healthcare professionals have to work in a way that reflects current evidence of best practice. Govt policy should also be based on evidence, be that valid statistics or expert opinions (including the rcn). Rather than blaming and alienating nhs workers, Lansley should be working with them to find better ways forward. The cuts aren't going to be easy, we don't need lowered morale before we begin.

  • rate this

    Comment number 723.

    @721 'Joyanblu'.

    Yes, I agree with everything you say. The NHS is in great danger from Andrew Lansley and his brief - lawyer/intent - not so far removed?

    I would suggest that Mr Lansley is seeking to obviate responsibility from himself as Secretary of State for Health and his Department on NHS reforms. Very thin ice. Indeed I'm surprised it's only the House of Lords that are challenging him.

  • rate this

    Comment number 722.

    @719 'marie'. Well said.

  • rate this

    Comment number 721.

    @720 Coram pupulo. True, just like in medicine and nursing with medicine, surgery, paediatrics, oncology, orthopaedics etc. Trouble is private hosps tend to deal more with surgery...in and out...and take the PROFIT! Not recurring chronic conditions like diabetes etc. the tail end charlies like geriatrics and expensive. Just forget them because they're not profitable? Thats what'll happen!

  • rate this

    Comment number 720.

    @713 'Joyanblu'.

    The Law is complex - and there are many specialities. Civil, corporation, family, criminal, employment, discrimination, human rights et al.

    However, there is always recourse to the 'spirit of the law' and how it is applied. If a Minister is forcing legislation against the will of the people, and their representatives are not consulting them - then surely that is illegal?

  • rate this

    Comment number 719.

    715 Hi David neither does the private health care - claimed to be nirvana by a few - cover the following:
    Emergency care, intensive care, highly specialised /pioneering types of treatments & surgery (eg brain surgey), dialysis, rehabilitation after head injury/stroke, mental health, paediatric medicine, oncology, treatment for chronic/ on-going conditions, care for the chronically sick /disabled.

  • rate this

    Comment number 718.

    Whatever they decide it's not going to work if the workforce haven't got belief in it as they're the ones who have to carry it out so it's doomed from the start. Lansley was almost boo'd off the RCN congress last year. All these MPs say they "listen" to people but my assessment is they have very selective hearing along with equally selective memory loss.Might need hospital tests-private of course

  • rate this

    Comment number 717.

    712. David Horton
    instead of the beancounting, target focussed service so beloved by Blair.
    As in education, I think constant re-orgs are a counterproductive distraction to the service. Sure the beancounting has to go, and the pcts cut back but as I say these reforms are about privatisation not efficiency.
    The private sector and health care are a dangerous combination...

  • rate this

    Comment number 716.

    The NHS is one of the most cost-effective and equitable health care systems in the world. It can be made more efficient by avoiding frequent reorganisation. The purpose of the Health Bill is to allow private companies to make profit, and it will INCREASE overall costs, in the way that rail privatisation did. Please contact your MP and sign epetition: http://epetitions.direct.gov.uk/petitions/22670

  • rate this

    Comment number 715.

    .No one but a wealthy elite.
    If the wealthy elite had any brains, they would have gone to the NHS in the first place. It's the same doctors & the same nurses. The difference is that they are a bit more tired, having just come off an NHS shift!!

    And of course, when private goes wrong..?
    Who you gonna call..?

    .they don't fill the post for 6+mths.
    Yep, sounds familiar!

  • rate this

    Comment number 714.

    708. Whatwedodefinesus
    Fact: NHS Information Centre.England figures..
    These numbers don't mean the existing structure is wrong. They may mean that admin numbers are too high and this should be addressed.

    The proposed reforms may make matters worse as functions will be decentralized to hundreds of gp consortia.

  • rate this

    Comment number 713.

    They used to say "the law is an Ass". but look how many MPs have legal backgrounds...or a degree in some esoteric subject that has no relevance to anything useful so it's understandable they don't really have a clue.Tony Blair for starters so it'a not just the Tories! They're all asses

  • rate this

    Comment number 712.

    704. David Horton.
    I agreed with much of your post - apart from your last line
    Would you settle for "Some sort of reform is necessary if only to rid the the NHS of the PCTs, Ambulance Trusts, Hospital Trusts and get back to a patient-focussed service instead of the beancounting, target focussed service so beloved by Blair?"


    (this '10 minute before next post' rule is so annoying)

  • rate this

    Comment number 711.

    705 I agree funding something non-essential with statistically low chance of success like 3 cycles of IVF seems wrong in our currently cash-starved NHS. Not when some health authorities are denying proven treatments to cancer patients.
    709 NHS managers jobs are always last to be cut back.Your wife will know cuts in clinical staff are good at being disguised - they don't fill the post for 6+mths.


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