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Can private investment ease NHS cutbacks?

Like many a NiP reader, I awake to the radio every morning. Have you noticed that not a week goes by without some headline news story or national report highlighting the plight of healthcare in Britain? "NHS in financial crisis"; "Massive overspends in healthcare"; "NHS costs spiralling out of control"; "NHS must make savings to survive". Be it on the radio, in the national or local press or in strategic health authority (SHA) and trust boardrooms up and down the country, the message is clear - the overspends in the NHS must be controlled. That means cutbacks - whether in the services trusts provide, new investments in buildings and technology, or in staff numbers - there is pressure to rein in spending and review services to make them more efficient. And as taxpayers, we want reliable, efficient and cost-effective care.  

October 2006 heralded the biggest NHS cost-saving initiative of recent times with the reduction of 304 PCTs to 102. PCT management and professional executive teams (PECs) have been merged, with the loss of a significant number of posts and experienced staff. A director or lead in nursing near you will have had to compete for the fewer posts now available. It means savings - and the potential for reinvestment into patient services is massive. This NHS reorganisation has been planned and worked towards for some time. It is certainly not a knee-jerk reaction. Using the huge NHS infrastructure, it will be closely monitored and outcomes will be measured.

I wish I had the same confidence in the reduction of training budgets that are being announced by the new merged SHAs; they say it is a temporary measure. SHAs have had their training allocations from the government cut, yet need to balance the books, and there have been major overspends in their area, these reductions are being made midway through the financial year - when operational training plans, courses and services have been planned. Cutbacks in education can be a short-term solution but may bring longer-term problems. Yes, we save now, but what will the gaps be in the years ahead? Student nurse numbers, postregistration specialist qualifications and nonmedical prescribing courses are having funding withdrawn to address overspends. These may seriously exacerbate a workforce shortage in the following five years.

Continuing professional development (CPD) generic funds have also been cut. Yet didn't Agenda for Change require all staff to have an appraisal and CPD? This was to follow the Knowledge and Skills Framework - ensuring core skills and a career pathway are supported. It all feels a bit shallow now. In future, CPD opportunities will need to become more imaginative. E-learning, interactive webgroups and CD-Roms are becoming widely available; work-based learning and mentoring from a local specialist supports role expansion and knowledge; and pharmaceutical companies have financial and expert links they are willing to make available to develop the workforce. Indeed, for GPs and doctors, pharmaceutical industry support has been a traditional resource for learning - and a fine meal!

NiP exists because pharmaceutical and equipment companies purchase advertising space to cover the production of the copy you now hold in your hand. The free NiP Events (see page 84), increased free NiP online access (coming soon), the free NiP email bulletin and future initiatives will be developed through this support. Increasingly, new learning resources are being developed by private and NHS healthcare organisations and the industry.

In this new world of private and independent providers holding NHS contracts, could the NHS forge a formal training partnership with the supplies and pharmaceutical industry on a national scale? We are cash-strapped, they are very willing and able to invest - it's a pragmatic combination that we may need to consider if we value lifelong learning. What do you think?