NHS England is in the middle of losing its infrastructure and developing a new framework, one which is opposed by many informed individuals and organisations, such as the Royal College of General Practitioners, (RCGP), the Royal College of Nurses (RCN), the British Medical Association (BMA) and the Royal College of Midwives (RCM).
The truth is that there are now few people left who have the courage to speak out against popular opinion. And, although I disagree with these bold and well-intentioned people, they have my respect as it is a tough business publicly speaking out against the majority view of the day.
My frustration and dismay is that the current health reforms - enshrined within the Health and Social Care Bill - are causing widespread anxiety and chaos and, most worryingly, are totally at odds with the position taken by current, highly-respected international management experts.
The advice our management gurus offer is simple and sounds reasonable to me; in fact, I am convinced. To put it simply, the line is not to mess with the structures as this takes energy away from delivering on the purpose of the business.
Instead, focus all skills and intelligence on improving the behaviour, competence and performance of the people doing the job. The very reverse is happening right now in NHS England. Whole-scale restructuring is taking place, organisations are being stripped of their talent, and little resource, let alone motivation is left to ensure that the NHS’ human potential is achieved.
Patients experience front-line nurses at an intensely personal level. This crucial relationship is the fundamental and the most important aspect of our NHS.
Patients do not meet the chief executive or director of finance within the organisation providing care, but they certainly interact with nurses while being looked after.
Patients and their carers, for the main part, judge the service they receive according to the competence and attitude of the nurses, doctors and other clinicians who they come into contact with.
It is heartwarming to hear from satisfied patients about how kind the nurses were, their knowledge and competence being taken for granted.
The truth is that when we are ill, suffering and frightened we yearn for nurses who respond with compassion and consideration, who demonstrate that in our hour of great need they are able to ease discomfort with skill and humanity. Excellent management serves patients well, but the quality of nursing is what is felt by patients and observed, with huge gratitude, by their families.
We all know that the NHS is facing great challenges. Less cash and higher demand, making the coalition government call to totally reorganise the NHS even more bizarre. It would be a far more simple and less expensive task to merge primary care trusts and strengthen practice based commissioning.
Time and time again this option has been pointed out to the Secretary of State for Health, Mr Andrew Lansley, who in turn has decided to reject the ‘common sense’ approach and instead hurtle down the road of confusion and uncertainty.
NHS England is losing talent in both commissioning and provider organisations. Such talent cannot easily be found or rapidly nurtured. Which brings me back to the state of community nursing and the complete lack of succession planning.
In many areas experienced practice nurses are declining in number and proving impossible to replace. The same can be said of district nurses, leaving a much diminished level of nurse leadership, and problems for the patients and those inexperienced nurses working hard to keep fragile services going.
There is a huge amount of work to do if we are to successfully develop community nursing capacity and capability. The tragedy is that we would have more hope of success if it was not for the ferocious demand of certain politicians to turn our NHS upside down and inside out.
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