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You'll never walk alone: the RCN is right behind you

Lynn Young
Primary Healthcare Adviser

The summer and autumn of 2005 will be remembered by community nurses for a long time - has there ever been such turmoil and upheaval in primary care? Not in my working life, which spans far too many years for a number of people's liking!
Basically community nurses need to know that three significant letters were distributed throughout the health service in England during the late summer, known as the Crisp, Bacon and Orford letters. The Crisp letter made a number of urgent demands; the Bacon letter that followed attempted to soften and slow down the changes; and the Orford letter called for public health to remain robust and not be diminished in any way as a result of cuts in service provision.
What a muddled time this has been and one of great anxiety for a huge number of nurses and healthcare staff. All of this could have been avoided with more reasoned and intelligent thinking, but we now have to put precious energy into limiting the damage as much as possible.
RCN response to this has been prompt, effective and hugely energetic! A number of RCN officers are now thoroughly immersed in helping nurses move forward in a positive way and building on what good can be found from these reforms, rather than giving up the ghost. Community services are far too important to be left to the politicians - we must act swiftly, with intelligence and humour (otherwise it is all too easy to lose the will to live!).
RCN action has so far included meetings with our Chief Nursing Officer, special advisers and ministers. A summit was held at RCN headquarters on 5 October that brought together 70 senior PCT nurses and a number of RCN officers involved with this work. An RCN helpline has been set up, and on 31 October the RCN made the difficult decision of taking out a judicial review of Commissioning a Patient-led NHS (CPLNHS) - an act which was taken following much thought and discussion. Making an application to the High Court for a judicial review is never taken lightly; it is truly serious business.
The RCN, although not a perfect organisation (I am yet to meet the perfect one!), cannot be accused of being luddite in nature or backward looking in any way. We are not anti-reform; we are passionately pro-reform if it can be seen to improve the public health and patient care. Indeed, there is good intention within CPLNHS and some moves that the RCN can wholeheartedly support. Healthcare requires more robust commissioning, so that redesign of services can be accelerated; some PCTs could be viewed as being on the small side, and nurses have argued long and hard for health and social care to be far closer than we have hitherto managed to achieve.
The case against CPLNHS is that the orders were called while a consultation via Your Health, Your Care, Your Say was taking place; local consultation was minimal, and the pace of change would cause chaos and distress rather than improvement.
It is also important to stress that many community staff are alarmed at the prospect of having no choice but to leave the NHS while being hived off to an independent provider of community services.
The notion of contestability has to be grappled with, and the RCN is exploring ways in which we can help nurses assess the contestability of any potential alternative providers. This work is currently being undertaken and will be made public when complete, and on top of this there are meetings, meetings and more meetings being held to help, sort and make better.
The RCN endeavours to keep interested nurses up to date with events, so here is another invitation to visit, where all will be revealed …