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Future looks brighter for the NHS, but what about now?

Lynn Young
Primary Healthcare Adviser for the RCN

The national media is currently having a field day on the issue of England suffering from a chaotic health service due mainly to massive overspends and the demand to make urgent financial savings. Schemes such as Choose and Book, payment by results and the setting up of national tariffs are looking pretty shaky. At the same time, major reconfigurations in the primary care trust and strategic health authority world are receiving more attention from NHS managers than the development of better services for patients. Basically, the NHS is in the deep red, and while many of us are genuinely delighted to read of a number of aspirations described in Our Health... it is difficult to see how they can possibly be achieved while the order of the day is to save loads of money.
And the irony is, of course, that if the aims of the White Paper did become a reality, savings could be made - through reduced hospital admission and greater personal independence, which should theoretically result in less dependence on healthcare services. Many people would be in a stronger position to enjoy a much improved quality of life should we make the White Paper happen.
The NHS is, in my view - and that of a vast number of well-informed people - suffering from a horrible dose of gross overpoliticisation and an unhealthy zeal for annual reform. Successful businesses do not grow as a result of the chief executive and the company board deciding to implement radical change each year - as one business guru once stated: "Implementing change takes the eyes and ears away from the real purpose of the business." Take a look at the mayhem currently going on within PCTs - how many managers are truly able to concentrate their precious energy and skills on patient care while they have possible redundancy staring them in the face?
Politicians like reform: it demonstrates that they have a function, and they also like big ideas, which, when accompanied by seductive rhetoric, encourage us to go with the flow and play our part in making changes that do not always serve the public interest.
For example, how many Nursing in Practice readers really understand the purpose and detail of the proposed payment by results, national tariffs and practice-based commissioning initiatives?
The new demand to put community services out to tender is bound to create more administration costs, with little evidence to support the notion that the extra funding needed to activate the process will bring benefits to patients. A significant number of senior people will be exercised in writing business plans, proposals and tenders, while directors of finance struggle to ensure that the books balance. Commissioners will have the job of redesigning services, so they are closer to people's homes, making sure that public health stays in the spotlight and that services are both effective and in line with public preference. Personal preference, in terms of how and where people wish to be treated, is key, as well as a public that is well informed, self-caring and working in partnership with clinicians to keep as healthy as possible.
The British government currently believes that social enterprise models have much to offer community health. Local government has been investing in this approach for many years now, and healthcare is advised to learn from colleagues who are experienced in this field. Housing associations are a wonderful example of how social enterprise has been shown to improve lives.
The one certainty that community nurses have is that the future is uncertain. Our Health, Our Care, Our Say has prised the lid off traditional general practice and NHS community services. As time goes by we will see, without doubt, a number of different service models develop - many of which will certainly be led, managed and designed by talented and able nurses.