1. Jane Salvage
Chair designate, Queen’s Nursing Institute
Editor, NMC Review
Visiting professor, Florence Nightingale
School of Nursing, KCL
work@janesalvage.me.uk
1
Date of preparation: May 2011. [AXHUR102574m] 1

2. Session objectives
1. Summarize key changes in the NHS
2. Highlight the implications for practice nursing
3. Discuss how practice nurses can face the
challenges and make the most of the
opportunities
Date of preparation: May 2011. [AXHUR102574m] 2

3. “There is nothing around us to reverse the
direction of development and change … thus
we are posed with the question of being the
master of these changes or their servant.”
Mo Im Kim 2003
3

4. Government proposals and timescale
• Equity and Excellence: Liberating the NHS published July
2010
• Health and Social Care Bill presented to Commons,
January 2011
• Secretary of State announced two-month ‘pause’, April 4
• Critical report by Commons health committee, April 5
• Government launched 'listening exercise’, April 6
• Government promises to amend Bill
• Bill now at committee stage, House of Lords
Date of preparation: May 2011. [AXHUR102574m] 4

5. The rhetoric
• The White Paper set out the government’s long-term vision for the future of the
NHS
• It says its vision builds on the core values and principles of the NHS – a
comprehensive service, available to all, free at the point of use, based on need
not ability to pay
• The government says it will:
– put patients at the heart of everything the NHS does, and make the NHS
more accountable to them
– focus on continuously improving the outcome of their healthcare
– empower and liberate clinicians to innovate and focus on improving services
– free staff from excessive bureaucracy and top-down control
Date of preparation: May 2011. [AXHUR102574m] 5

6. Key proposals
• Power and responsibility for commissioning services devolved to
GPs, working in clinical commissioning groups (60% of NHS budget)
• Local authorities to lead joining up NHS, social care & health
improvement
• Independent NHS Commissioning Board to lead on quality & access
• All NHS trusts to become foundation trusts with greater freedoms
• Many more employee-led social enterprises
• Monitor to become economic regulator
• Care Quality Commission inspectorate role strengthened
Date of preparation: May 2011. [AXHUR102574m] 6

7. Employment issues
• Implementation of Boorman report on occupational
health
• Service providers to pay education and training costs
• Individual employers to determine local pay
• Pay frozen for 2 years for those earning over £21,000
• Pensions review
• Review of regulation to reduce burden and cost
Date of preparation: May 2011. [AXHUR102574m] 7

8. Health and Social Care Bill 2011
• Establishes an independent NHS board to allocate resources and
provide commissioning guidance
• Increases GPs’ powers to commission services on behalf of their
patients
• Strengthens role of Care Quality Commission
• Develops Monitor, the body that currently regulates NHS
foundation trusts, into an economic regulator to oversee aspects of
access and competition in the NHS
• Abolishes 152 PCTs and 10 SHAs by 2013
Date of preparation: May 2011. [AXHUR102574m] 8

9. The context: ‘Cutting bureaucracy and improving efficiency’
•Government promises small real-terms rise in NHS funding
•Spiralling costs, rising inflation
•The ‘Nicholson challenge’ – up to £20bn efficiency savings in
NHS in 2011–2014
•45% cut in management costs, 2011–2014
•Thousands of job losses, including front line
•Demand for skilled care outstripping supply
•Massive reorganisation & abolition health bodies
•Department of Health NHS functions will focus on public
health, inequalities, adult social care
Date of preparation: May 2011. [AXHUR102574m] 9

10. Timetable – subject to change!
NHS Commissioning Board established in shadow form as a special health
Authority; statutory body in 2012
NHS Outcomes Framework fully implemented by 2012
PCT commissioning and provision separated by April 2011 > ‘any willing provider’
Comprehensive system of GP consortia in place in shadow form during 2011/12,
taking on increased delegated responsibility from PCTs
Following passage of Health & Social Care Bill, consortia to take on responsibility
for commissioning in 2012–13
NHS Commissioning Board to make allocations for 2013–14 directly to GP consortia
in late 2012
GP consortia to take full financial responsibility from April 2013
Local authorities’ new functions – no date given
Date of preparation: May 2011. [AXHUR102574m] 10

11. NHS Future Forum report, June 2011
People accept need for change but ‘want the changes to be the right
ones and to feel ownership of them’
The current model of care cannot be sustained
GPs ‘must be required to obtain all relevant multi-professional advice
to inform commissioning decisions & the redesign of patient
pathways’ – ‘strong role for clinical and professional networks’ –
establish ‘multi-specialty clinical senates to provide strategic
advice’
Competition should be a tool supporting choices, promoting
integration and improving quality’ – not an end in itself
The pace of the reforms must ‘vary’
More time is needed to get workforce education and training right
Date of preparation: May 2011. [AXHUR102574m] 11

12. Government response, June
Promises key changes – some but not all require Bill amendments
NHS Constitution upheld + NHS free at point of use
Greater assurance that commissioning will ‘involve’ nurses, patients etc
Every clinical commissioning group to have governing body with decision-making
powers, with at least 1 RN, 1 medical specialist, 2 lay members
PCTs cease to exist next April, SHAs to be clustered then abolished
All CCGs to be established by then, but can only start commissioning when they
are ‘ready and willing’
Clinical networks to be strengthened, with stronger commissioning role
Formal role of clinical senates in authorising CCGs
‘Any Qualified Provider’ unchanged, just slowed down a bit
Safeguards against privatisation
Most trusts to be foundation trusts by April 2014
More work to be done on education and training esp CPD
Date of preparation: May 2011. [AXHUR102574m] 12

13. The implications for nursing – negatives
• Unprecedented change
• More to do with fewer staff and less resources
• Damage to nursing leadership, at least in short term
• Fight to maintain and enhance nursing voice at all levels
• Threat to specialist posts
• Much will depend on local structures and relationships
Date of preparation: May 2011. [AXHUR102574m] 13

14. The implications for nursing – positives
• Unprecedented change
• Much will depend on local structures and
relationships
• Opportunities to be seized
• Growing recognition of the need for skilled care,
especially for long-term and complex conditions
Date of preparation: May 2011. [AXHUR102574m] 14

15. Preparation for change and delivery of future services
• Understand policy-making
• Effective leadership in senior roles
• Networking
• Mobilise grass roots
• Alliances with communities and patients
• Developing our evidence base
• Creating and sharing good tools and processes
• Better processes to thrash out differences and present united front
• Need to be more proactive and savvy
• Put nursing on the radar – policy with us rather than about us
• Alignment with overall health policy
Date of preparation: May 2011. [AXHUR102574m] 15

16. Face the challenges, seize the opportunities
We must become policy activists and entrepreneurs:1,2
• Position yourself to influence policy
• Bring together problems, policies and politics into a novel
amalgamate: new policy
• Soften up the system by presenting participants in the network
(visible and invisible) with alternative representations of their
realities
• This leads to opening a window of opportunity – potential for a
truly new policy perspective
References
1.Kingdon, J.W. (1995). Agendas, Alternatives and Public Policies; 2nd ed. Harper Collins College Publishers, New York
2.De Leeuw E. Five books that shaped my view of health policy, Reviews of Health Promotion and Education Online,
2003. http://rhpeo.net/reviews/2003/1/index.htm
Date of preparation: May 2011. [AXHUR102574m] 16

17. Which kind are you?
• those who watch things happen
• those who wonder what happened
• those who make things happen
17
Date of preparation: May 2011. [AXHUR102574m] 17