- Conservative election poster 2010
A few recent news articles about the UK’s Conservative and Liberal-Democrat coalition government – the ConDem’s – brutal attack on the National Health Service.
GP leaders have hit out at the government over its handling of the implementation of NHS reforms and warned even enthusiastic GPs were now being driven away.
GPC chairman Dr Laurence Buckman condemned the government’s failure to scrap plans to offer successful clinical commissioning groups (CCGs) a ‘quality premium’ bonus payment.
‘We are not going to have one. It is in the Bill still – it should not be, it is an inappropriate use of public money.’
Dr Buckman said the quality premium was ‘ethically dubious’ and not acceptable, suggesting that if the government had spare cash to hand out, it should ‘give it to the poor’.
‘We think it is utterly immoral to take some of the money out of patient care and give it to GPs.’
GPC negotiators questioned the logic behind growing pressure on CCGs not to form around small population sizes, and warned that the government was rapidly pushing the NHS back into structures similar to the ones it had just spent billions of pounds to dismantle.
In addition, many experienced managers ‘who know how to run an NHS’ had been expensively laid off and lost to the health service.
He pointed out that the government had initially had a ‘laissez-faire’ approach to the establishment of CCGs but had now performed a volte-face and was dictating how they should look.
AT the Royal College of Nursing, we have been keeping a close eye on the Health and Social Care Bill, as it works its way through Parliament.
And despite reforms to the Bill, in response to a public outcry, it seems politicians still haven’t listened.
While MPs say the new Health Bill will reform the NHS and provide considerable efficiency savings, we fear these promises could prove hollow, and it will be the quality of care in the North East that suffers as a result.
Hospital Trusts throughout the North East are already struggling to make unprecedented budget cuts, after NHS CEO Sir David Nicholson demanded the NHS in the North East save £800m over four years, as part of a £20b national cost efficiency drive.
At the same time, we are facing the dissolution of our Primary Care Trusts and Strategic Health Authority, which are being replaced by a large number of untested Clinical Commissioning Groups.
Ironically, the administration costs of running this new system of CCGs is forecast to be more expensive, and more complicated, than the one it is replacing. And if we get the commissioning of NHS services wrong, the delivery of care will not happen efficiently.
What this will mean for patients is a worryingly uncertain future for healthcare provision.
At the RCN, we’ve already identified the Government’s efficiency savings will result in 40,000 frontline NHS jobs being cut. This will result in understaffed and overstretched wards and practice centres across the country.
On top of this, the new Health Bill would remove the income cap for private patients, meaning there will no longer be a limit on the amount of money hospitals can make from private patients.
As a consequence, the access NHS patients have to services could become more limited.
The Government also hope by allowing ‘any qualified provider’ to supply healthcare services, they will drive up quality through competition.
However, this new policy could end up being a race to the bottom, with private sector companies undercutting the approved service tariffs of NHS providers.
At the RCN, we believe it is vitally important the new Health Bill puts safety guards in place to ensure the quality of patient care is not harmed by forced price competition.
Unions may consider non-cooperation action against the government’s NHS reforms, a midwife leader has said.
Royal College of Midwives general secretary Cathy Warwick was asked about the prospect of action at a fringe event hosted by the Trades Union Congress at the Liberal Democrat autumn conference in Birmingham yesterday.
She said the organisation was still consulting with members about non-cooperation, although it was more likely to be in response to planned changes to pensions.
But she said: “It [non-cooperation] is something I think we maybe should be thinking about.”
Professor Warwick said the RCM was “close to thinking the only way forward is to ask for this [Health] Bill to be withdrawn”.
Her concerns include fragmentation of services and privatisation.
Ron Singer, a GP and Unite representative on the British Medical Association GP’s committee, said GPs were very unlikely to take action but it was becoming more likely in other health professions.
Health unions* are warning today (20 September) that a toxic combination of increasing demand, shrinking resources and the pay freeze, are putting staff under severe pressure. The impact of the proposed pension changes and the massive programme of NHS reforms in the Health and Social Care Bill, are adding even more to the stress felt by staff.
In their joint evidence to the NHS Pay Review Body, the unions, which represent staff including nurses, midwives, paramedics, therapists, porters, cooks and cleaners, highlight increasing concerns about how they can maintain the quality of patient care.
High inflation and the Government’s pay freeze have resulted in a big drop in the value of NHS pay over the last few years. Many NHS staff are suffering financial hardship and the £250 given to the lowest paid has been soaked up by the impact of changes to tax credits, childcare fees and the rising cost of basic essentials such as food and fuel.
Christina McAnea, UNISON, NHS Staff-Side Chair said:
“Stability is vital in any workforce – more so during a period of change. The current turmoil in the NHS is undermining staff morale and threatening the delivery of high quality patient care. On top of job cuts and ward closures, growing waiting lists and an attack on their pension, staff face a reorganisation on an unprecedented scale.
“By imposing a pay freeze for the second year running, the Government is adding insult to injury. Pay has never been generous in the NHS and, with inflation rising, many families are struggling to cover the costs of even basic essentials.
Josie Irwin, RCN, Staff-Side Secretary said:
“Coalition policy means that nurses face suffering a second year of pay cuts. This comes on top of unprecedented change and upheaval in the NHS – leading to low morale, uncertainty and insecurity. The RCN calls on the pay review body to recognise that further attacks on pay will only do more damage to recruitment and retention in the NHS.”
Stephen Austin, Head of Employment Relations for the BDA Trade Union said:
“For years the public have supported the workers in the NHS to get a fair rate of pay for the caring and committed work that they do and this was achieved by the last government, but the current government under the disguise of necessary cuts are returning health workers back into the position of being poorly paid”.
Rehana Azam GMB National Officer, Head of NHS said
“At a time when working people are dealing with their own deficits as the cost of living increases including the essentials like childcare, fuel and food. Wage stagnation and the position directed from Government to Pay Review Bodies is unhelpful and unfair.
“Public Sector workers are being attacked on a daily basis by this Government and the propaganda distributed about public sector workers with the attempts to put private sector workers against public sector workers will reveal that this Government’s only agenda is to undermine the hard working people of this country by making them pay for a deficit which was not their making. All employers in this country are expected to negotiate, consult and agree changes to employment terms and conditions and the bullying tactics applied by this Government in imposing changes to public sector workers terms and conditions will be challenged and stopped”.
Rachael Maskell, Head of Health, Unite, said:
” The Pay Review Body continues to play an important role in providing independent and robust evidence on the remuneration of NHS employees. The NHS workforce are facing unprecedented challenges to their pay, in the midst of mass re-organisation and cuts, in some cases losing 25% in pay as a result. These cuts to services and employment terms are causing morale in the NHS to fall significantly. We are hopeful that this year’s Pay Review Body will ensure that NHS staff are remunerated fairly to ensure that they stop falling behind other sections of the workforce and economy. Unite further hopes that the Pay Review Body will address the recruitment and retention challenges for pharmacists, and estates and maintenance workers in this year’s review.”
*British Association of Occupational Therapists, British Dietetic Association, British Orthoptic Society, Chartered Society of Physiotherpists, Federation of Clinical Scientists, GMB, Royal College of Midwives, Royal College of Nursing, Society of Chiropodists and Podiatrists, Society of Radiographers, UCATT, UNISON, Unite.