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Change and innovation in the NHS

Lynn Young
Primary Healthcare Adviser for the RCN

Many congratulations to the energetic and talented staff who work day in and day out for Nursing in Practice for the 50th edition! So many developments have taken place in primary care since NiP became part of our lives, which has endeavoured to keep us up absolutely up to date clinically as well as politically. And there have certainly been plenty of health politics to contend with in recent years.

Some initiatives seemed to have brought improvement to health and healthcare, and others clearly have not. Lots of trouble and effort with little to show, apart from exhaustion and frustration from the highly committed staff who strive to achieve improved health and healthcare.

This column attempts to highlight some of the major changes that have taken place and which have been referred to in previous editions of this magazine. NiP has indeed flourished during turbulent times for primary care and community nurses. How many of you recall the NHS Plan - Alan Milburn's baby - and with it, the huge injection of extra cash for the NHS?

The NHS Plan was certainly a brave attempt by the government of the day to both transform and modernise the NHS. National Service Frameworks, the Modernisation Agency, NHS university, primary care trusts, modern and community matrons, as well as clinical networks and the development of practitioners with special interests and so much more … But how much improvement in healthcare was genuinely achieved?

The greatest NHS prize in the last decade must surely go to those people who have contributed to the significant reduction in waiting times for hospital care and treatment. On top of this, general practice has expanded and been embraced by the General Medical Services contract in 2004, making it an entirely different working environment than existed 20 years ago.

Evidence-based practice is well and truly an integral part of patient care and we have learnt to live with, and maybe even feel affectionate towards, the National Institute for Health and Clinical Excellence.

The development of advanced and specialist nursing has been spectacular since the inception of NiP. This has happened in both primary and secondary care, as a result of the nurses themselves who had the courage and talent to see how care could be better provided, but also because health policy gave them the opportunity to do so.

Such success makes the recent Patients Association report on poor nursing particularly disappointing and an acknowledgement that all is not well in the profession. Endless rounds of reorganisation within primary care have made us dizzy with change and disturbance of the status quo.

Most recently, the pronouncement of Transforming Community Services has created the greatest uncertainty in community health quarters. This is the big one and, while the aspirations and ambitions are quite wonderful, it is easy to see how they are causing uncertainty and confusion among staff.

This issue of NiP is being published at a rather profound time for nursing. The Royal College of Nursing has submitted its documentation on the state of nursing to both the government and the opposition. The vast sums of money allocated to the NHS during the financial feast are about to be diminished. Economic recession continues with the health problems that always accompany rising levels of unemployment and reduced
family income.

We know that nursing is brilliant in parts of healthcare but not all, and serious work needs to take place to help ensure a vibrant nursing profession in the future. I have written for NiP since its first edition and enjoyed doing so. With luck my regular column will continue for some time to come! l