Health and Social Care Bill

Memorandum submitted by Julie Lord (HS 69)

I am a community commissioning matron and work for a PCT in the North West, one that I hasten to add, is well managed and in financial balance.

I have worked for the NHS for 30 years.

I came into this commissioning role in June last year after a career in nursing, predominantly as a ward sister and later managing community services. I am one of those people that this government refer to as a PCT pen pusher despite my own and many other PCT staffs background in frontline clinical services.

I have worked through an endless succession of NHS reorganisations.

I wish to comment on the health and social care bill and I will articulate my views from my perspective as nurse, manager and commissioner.

You may find some of my comments to be a little bit emotive, I make no apologies for that, there are many logical arguments for and against this bill but I speak as someone who cares passionately about the NHS, who believes in the founding principles of the NHS and know that this bill will destroy all that is good about the NHS.

Firstly, despite the fact that this bill is only on its second reading PCT’s are already being instructed to make staff redundant in readiness for the implementation of this bill, is this a done deal? Despite the fact that the bill is not yet law? We are supposed to have a democratic form of government; the way this is being handled does not represent a democratic process. In addition these changes are having a significant effect already on the functioning of commissioning as well as on staff performance.

Secondly, NHS staff at the frontline of care delivery and commissioning have had no say in this bill no one has consulted with NHS staff with regards to the best way forward.

Thirdly, the current government lied about NHS reorganisation and Andrew Lansley must have been developing this bill for some time but failed to make his intentions explicit that constitutes deception towards the general public and NHS staff.

This bill is hailed as one that puts Doctors and nurses in the frontline of decision making.

There is nowhere in this bill that gives nurses any say in commissioning decisions or a place on commissioning boards, and these words are pure rhetoric.

The long term effect of this bill will almost certainly mean that the government will shed its responsibility as an employer of NHS staff with the scrapping of PCT’s and the creation of foundation trusts who will be able to set their own employment terms and conditions and the increased participation of private providers.

Nurses are currently subject to AFC terms and conditions.

Nurse have in the past been poorly paid, AFC represents a decent pay structure that is fair and offers opportunity to progress within a fair pay system, even so, nursing is acknowledged to be a stressful job, both physically and emotionally demanding. Remove the pay structure and terms and conditions of employment and the government runs the risk of ensuring that nursing becomes a less attractive career option.

This bill could therefore contribute to a future nursing workforce shortage. Combine that with the number of experienced senior nurses who will be made redundant or who are in their fifties and will be retiring soon and I predict a shortage of nurses in the years to come.

This bill proposes scrapping PCT’s and these organisations have been much maligned by the government in the past few months, these could easily be retained and re-organised and merged.

This would save money , maintain safe services and systems and would prevent disruption to NHS provider services for this not to be even considered and dismissed as an option does not make good common sense, therefore, this plan to scrap PCT’s must surely be the result of extreme right wing ideological thinking.

The bill proposes the use of any willing provider, I see at first hand, in the area that I work, the variation in standards between private providers, often the governance arrangements are very poor in comparison to NHS standards, qualified nurse staffing ratios are often poor, examples are one trained nurse to fifty patients, and that will remain poor with providers who aim to make profits from healthcare.

We will end up with a patchwork system of providers and it will be a nightmare to police standards and to achieve joined up seamless services.

Over the years I have seen deterioration in standards and an increase in costs and administration with the introduction of the internal market and NHS trusts with increased costs and salaries payable to chief execs and trust boards and the introduction of general management, where nurse management roles were displaced to make way for non-clinical managers.

This latest health and social care bill and the proposed change in how the NHS is administered will not improve matters. It is the 2010 version of the emperor’s new clothes and a prime example of politicians believing that they know how to fix the NHS, that, as most of us who have worked in the NHS for many years know, is just an illusion.

March 2011