Nurses for Reform Blog

This article by Alex Nunns on the “patchwork privatisation” now underway across NHS provision provides a useful and comprehensive overview of what is going on in the service below the radar screen of daily politics.

Although written from a statist and socialist perspective this material nevertheless provides NFR and its pro-market supporters with great cheer. For as the NHS slowly nose dives into the sand it demonstrates that Labour politicians are now increasingly turning to market ideas for solutions. I believe Nunns is right when he says that the government wants to recast the NHS as a funder and a kite mark but no longer the owner of the facilities in which treatment and care is provided. But this is only a short term and limited victory for us. In the years and decades ahead it is vital that all healthcare funding is opened up to a highly diverse and competitive market and that state regulation is itself replaced by a system of bottom-up consumer driven reputation.

As such, the General Medical Council and the Nursing and Midwifery Council should loose their professional monopoly status. Monopolies are bad for consumers and are always propagated by elites seeking legislative favour and the short term politics of collective self interest. NFR believes they encourage elite professional conservatism and should be swept away.

Today, it is time for more enlightened nurses and doctors to point out that everyone would benefit from a world in which the seeking of legislative favour is treated with the cultural contempt it deserves. In reality legislation does nothing to protect patients and to further the de facto delivery of high quality services. As with any other business what matters are the incentives, resources and the focus on consumers. In the real world these are built bottom up – not top down or at the behest of a vote seeking politician standing at the dispatch box of the House of Commons.

For NFR healthcare is too important to be left to a government monopolist. That said, if you do happen to be one of those strange people who believe that healthcare needs to be underpinned by certain degree of monopoly then I would counter with the suggestion that just as the market delivers better hi-fis so in time it will deliver better monopolies.

In recent days a lot has been made about the on going collapse of NHS dentistry

Exposing the reality that the NHS cannot provide “all medical, dental and nursing care”, as promised in 1948, today’s chair of the British Dental Association – Susie Sanderson – has admitted that the system is now “failing both patients and dentists”. Providing an objective overview of the situation she rightly concludes that: “The future of NHS dentistry is becoming increasingly fragile”.

NFR welcomes this state of affairs and wants to see NHS dentistry totally collapse. We want customers to be angry at how little they are getting for their taxation and we want them to defect to a burgeoning private dental sector.

NFR is appalled at the NHS’s treatment of the poor, the low paid and the socially marginalised. That is why we will go on urging colleagues in the social enterprise sector to develop a range of private low cost alternatives. It is now time for mutuals, friendly societies, trade unions, charities, churches and others players in civil society to stop asking for more tax payers money and to deliver practical solutions for real people in real communities.

 
On Monday evening I represented NFR at reception hosted by the Social Enterprise Coalition.  Not only did this event see the launch of an excellent new report, Health Business: A Guide to Social Enterprise in Health and Social Care, but it was also addressed by the Secretary of State for Health, Patricia Hewitt.

She was delighted to hear about NFR’s progress and its supportive work favouring more business-oriented reform.

Mindful that NHS is itself built on an estate that before 1948 encompassed a wide range of independent for and not-for-profit providers, Hewitt and her colleagues are clearly eager to re-discover the mutual and charitable not-for-profit traditions under the rubric of Social Enterprise.

NFR passionately supports this agenda because it clearly has the potential to directly privatise a great deal of NHS provision over the years ahead.

In encouraging the rediscovery of a diverse range of not-for-profit private provision alongside other forms of commerciality people who work on the front line of healthcare will eventually be able to get away from centralised control and top down direction.

To compliment the social enterprise agenda however ministers must now end the outdated practice of national collective bargaining. They should also strengthen customers’ power by allowing a much more liberal health economy in which new and competing forms of advertising and information are made legal. After all, advertising, information and the building of sound business brands in health and social care is what will eventually overcome the parlous problems of consumer ignorance.

On Monday, Tony Blair gave an excellent speech on the introduction of ‘truly personalised’ services across the public sector – specifically in healthcare and education.

Signalling a commitment to the idea of the privatisation of provision across the NHS he said that people wanted services tailored to meet their individual needs and they wanted greater choice. Arguing that there should be a “much greater diversity” in provision he railed against the old, top down, monolithic state.

Blair clearly understands that a real market in health provision would not only encourage more private for-profit hospitals but also a wide range of mutual, co-operative and charitable institutions. In the future, private and voluntary sector organisations will be able to compete to deliver a wide range of services once the purview of the Department of Health and the Treasury. Already, the government is using the rubric of social enterprise to move this agenda forward and one can expect an even greater radicalism in the months ahead – irrespective of who the Prime Minister is.

With the NHS is being recast as a funder of healthcare but no longer the owner of the facilities in which its services are provided there are huge opportunities for nurses. It is no accident that the Prime Minister and his team at No.10 talk in terms of giving nurses the opportunity to expand their responsibilities and make certain prescriptions. Determined to introduce ever greater supply side reform the government wants to break down professional demarcations and so add value for patients.

However, for NFR, much more needs to be done. Not only do we need to get health and social care provision out of the public sector but we need to end national collective bargaining for pay. We have to encourage more information to patients through greater advertising and we need to encourage more private funding. In the long term we need to encourage private medical insurance, health savings accounts, private health cash benefit schemes and much more besides.

Crucially, instead of reactively winging about these changes we need to get the churches and the trades unions – including Unison, the BMA and the RCN – to positively engage this future and start thinking about what products and services they can offer in this market not only for their followers and supporters but others besides.

In writing this I am mindful that British trade union movement was not made great because of its commitment to nationalisation or beer and sandwiches at No.10. Historically, the trade unions became powerful and respected institutions because of the high quality friendly society services they offered their members and those in need.

Instead of asking for ever more tax payers’ money for a failed NHS, these institutions and their leaders need to reposition themselves for the twenty first century. They need to recapture the moral and intellectual high ground of the health and social care debate by taking practical steps themselves and in doing so stop passing the buck to politicians.

In embracing the reform agenda, healthcare professionals and their representatives should make it clear that they have a real vision for the future and not one that has its roots in the failed post war settlement of the late 1940s and a fully nationalised NHS.

I was interested to read that English nurses in the public sector are very restive over the Chancellor’s decision to split their pay award this coming financial year with 1.5 per cent being paid in April and a further 1 per cent being paid in November. He has been rather embarrassed by his own party’s policy of devolution whereby the Scottish Parliament has decided to overturn his parsimonious decision and to award Scottish nurses the whole uplift at the beginning of April, probably on the sensible basis that a 1 per cent uplift in November is the square root of nothing at the individual pay packet level. Devolution will have a marked effect on health and we will soon have four divergent health services with differential pay rates across the professions. Scotland has taken a sensible decision in the interests of its nursing profession.

In the private sector, pay is linked closely to performance, both at organisational level and personal level. This can often mean no pay rise at all, if the sales aren’t coming in. Yet in the public sector everyone gets the same and expects it, even if their Trust’s finances are three sheets to the wind. When I worked in the NHS, I always thought local pay bargaining was a good idea for the NHS. Now we have Foundation Trusts, they will re-instate the idea. Hooray for Foundation Trusts.

The fact of the matter is that this third-term Labour government is being hoist on the petard of its own centralism in England, and devolution out to the three countries. The pay uplift should be an allocation to Trusts and they should negotiate pay locally with their own doctors, nurses and allied health professionals, based on the Trust’s performance and a whole host of other factors to be considered locally. You wouldn’t have to scrap the Agenda for Change pay spines, but there would be local variation.

However, the centralising pay policy of Agenda for Change, always really meant agenda for short change. Bring back local pay bargaining for nurses.

Following recent reports in the national press, it is very much NFR’s view that NHS nurses in Scotland will only be able to have their full pay rise in April as a result of ongoing and wide spread subsidies from English tax payers.

While many nurses in England will no doubt be upset by this deeply un-egalitarian move they should not however be surprised by the actions of vote-motivated politicians in the Labour Party who clearly hope that this move will stave off the Scottish National Party.

Not only does the NHS fail patients but it has a long tradition of failing nurses. That is why NFR believes nurses should get away from such nonsense through the wholesale privatisation of all NHS hospitals and provision.

The NHS should simply be recast as a funder, alongside many private alternatives, but it should no longer be a provider of services or a direct employer of medical and health professionals.

There is no reason that the state should own any provision in UK healthcare or indeed have any say in nurses pay. In today’s world the idea of national collective bargaining for nurses is ludicrous. Pay rates should be set commercially and in response to local economic realities.

This will not only encourage healthy competition between providers but most importantly it will serve the interests of the people who matter the most – the patients.