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Commissioning: take your place on the board

Lynn Young
Primary Healthcare Adviser

The Health and Social Care Bill has been significantly delayed as 181 new clauses have been added following on from the 'listening exercise' - but there are a number of principles that nurses should understand if they are to play their rightful part in shaping the NHS.

The core recommendations (in a much abbreviated form) are as follows:

  • The rights of patients, as set down in the NHS Constitution, will continue to be promoted.
  • The bill must be amended so that the NHS will be freed from day-to-day political interference, although the Secretary of State must remain accountable for the NHS.
  • Citizens want to be equal partners in their care and be involved in the design of their local services.
  • The NHS belongs to 'us' and there must, therefore, be transparent about how public money is spent.
  • GPs, specialist doctors, nurses and other healthcare professionals state that there must be effective multiprofessional involvement in the design and commissioning of services working in partnership with managers.
  • Managers have a critical role to play in supporting clinicians.
  • The new commissioning groups should only take on full responsibility when they demonstrate that they have the right skills, capacity and capability to do so.
  • Patients want to have choice and control over their care.
  • Competition should be used to support choice, promote integration and improve quality.
  • Private providers should not be allowed to 'cherry-pick' patients and the government should not increase the role of the private sector.
  • Clinical leaders and managers agree that providing quality services and meeting the financial challenges are paramount, meaning that the NHS Commissioning Board should be established as soon as possible.

It is abundantly clear that there is much to do if we are to manage the finances at the same time as driving forward relentlessly to the happy land of 'quality care for all'. In the meantime, NHS managers and healthcare staff, including far too many nurses, are receiving notes of redundancy. However, by far, the greatest threat to nursing is not so much about being made redundant, but rather the failure to appoint the right nurses to vacant posts. Diminishing the workforce by stealth is a far more sinister concept and, ultimately, will be damaging to patient care.

The good news is that the health reforms in England now support the involvement of nurses in commissioning via the NHS Commissioning Board and the commissioning groups. It is most encouraging to hear how nurses are taking their place within the new commissioning arrangements. We need to remember, though, that commissioning is a tough place to be and the current drive is far more about decommissioning then commissioning new services.

It will be impossible to develop more and better community health services unless we successfully extract significant sums of cash from the acute sector.

Nothing about this challenge is new: Florence Nightingale called for hospitals to be closed, Nye Bevan wondered why there were so many hospitals in London; and Barbara Castle, Virginia Bottomley and many other health ministers demanded the expansion of community healthcare, thus diminishing the need for hospital beds. Basically, they all failed.