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How to greet the fact that the Royal Colleges of Nursing and Midwifery want your reforms completely stopped.

Filed Under (Health and Social Care Bill, Narrative of reform, Reform of the NHS, Secretary of State) by Paul on 20-01-2012

Yesterday we woke up to the main item on the 6 o’clock news on the Today programme being the fact that the Royal Colleges of Nursing and Midwives both  want the Government NHS reforms stopped completely. The newsworthiness of this announcement was that in the past the nursing colleges had had criticisms of the Bill – but now they were completely against it.

My immediate thought was – why is this news? It’s been pretty obvious that this was going to be their position for some time, so is it news when something you know is going to happen actually happens? But my second thought is that my first thought is probably an insider’s thought. Most of the people who heard that news item will not have not spent years of their lives steeped in the ways of various professions wanting to stop various reforms.

For nearly everyone in the country it is news that the nursing colleges want to completely stop Government reforms. So my third thought (please bear with me on this – for 7 years of my life I heard these stories not as an interested bystander but as someone who worked on these sort of issues in Government, so I tend to have a rush of immediate thoughts when this sort of thing happens) is how will the Secretary of State deal with this. What will he say and how will he say it?

What happens next is a return to the Government’s real long term problem. This rejection of the Government’s reforms by nursing colleges takes place against the backdrop of the Government not having established a compelling narrative of what they are trying to do with the reforms. If they had such a narrative Government reaction to everything, including this opposition, would fit in with it.

So when I come to look at the BBC news I am interested in how Andrew Lansley is going to explain this important opposition.

Andrew Lansley chose to do something really odd. He began his explanation for why the RCN and RCM were against his reforms by treating the BBC news watcher to an explanation of what Royal Colleges are.

He explained that actually they have two functions. On the one hand they have professional interests including the important improvement of patient care. On the other hand they acted as trade unions for nurses and were looking after issues such as nurses’ pay and pensions. When the nursing colleges announce that they are opposed to the Government’s reforms it is, so he said, the second of these concerns – nurses supporting their own interests – that is overcoming the first – their professional concern.

They wanted to give the Government a bit of a kicking because of concerns about their own pay and pensions. So they are using the attack on the reform programme to better negotiate their pay and pensions.

Let’s pause for a moment and think about the average person watching this at 7.05 in the morning. The Secretary of State chooses this moment to explain the conflation that exists within the nursing profession of guild organisations that grew in other professions in the 18th century with trades unions that grew up in the late 19th century.

Is this the right time to engage in what is admittedly an interesting disquisition on the nature of nursing organisations?

If people don’t ‘get’ this they will be very confused about what Andrew Lansley is going on about. This of course will add to the general feeling that they have about these reforms – which is that Andrew Lansley can’t really explain what he is doing. So another opportunity to explain what is going on drifts past the Secretary of State – like all the others.

But there will have been a few people watching the TV who know the difference between the nursing colleges defending nurses’ own rights and their professional concerns for patients. Those people will have been the nurses who are preparing for work or just coming back off shift.

They will see the Secretary of State telling the world that nurses are much more concerned about their pay and pensions than about patient care. That they are not really concerned in their own right about NHS reform but it is their concerns about pay and pension that override their concerns about NHS reforms.

This is patronising your opponents. The fact is the nurses are against the Government Bill for a whole range of reasons that are coherent within their world view. They are not opposing the Bill for underhand personal reasons. They are against it because they disagree with it.

So by 7.10 yesterday morning the Secretary of State had confused most people by treating them to a history lesson on the British Constitution and had made a lot of nurses angry by saying that they weren’t really against his reforms for professional reasons but because they were concerned about their pay and their pensions.

More of the same there then.

So what could he have said on the BBC news?

“I am really sorry that the nursing colleges are against the Government reforms. This is partly my fault because I have failed to successfully explain to the nursing profession why the NHS needs these reforms to improve our care for patients.

I have seriously failed in this communication task because I am convinced that these reforms will empower nurses to have a greater say over how the NHS works with the patients whose welfare concerns us all.

When the reforms are passed there will be real opportunities for nurses to take much more power in directing the NHS in patients’ interests. When nurses are actually offered these increased powers I am convinced that what are serious disagreements between us at the moment will disappear. They will take up the new powers being offered and help create a better NHS.

So what do I learn from this? That I must do much better in explaining what we are trying to do and how much better these reforms will be for nurses and patients.”

The reason for taking this line is that it is not a good idea to concentrate on the passage of the Bill as if that is the totality of reform. As I have posted this week, the Bill will come and go. Then it will be a matter of the partnership between the Government and its reforms and professionals in the NHS and their organisations to develop a better way forward. The more time thinking about that and the less on lobbying for and against the abstraction of the Bill, the better.


6 Responses to “How to greet the fact that the Royal Colleges of Nursing and Midwifery want your reforms completely stopped.”

  1. In my view, Paul, this has been a spectacular own goal. The Nurses will be absolutely livid that he has conflated the two issues, and I think the Bill will limp onto the statute book thanks to the supineness of the Liberal Democrats, and the Government will feel the full force of the disapproval of Nurses, Midwives and Doctors.

    Very bad policy making. Very bad public relations. Very bad politics.

  2. “But there will have been a few people watching the TV who know the difference between the nursing colleges defending nurses’ own rights and their professional concerns for patients. Those people will have been the nurses who are preparing for work or just coming back off shift.”

    And a lot of non-medical but intelligent & concerned laypeople! Beware being patronising too!

  3. forgot to click notify

  4. His bedside manner is somewhat lacking, although his image hovers above every bed..

  5. Hi Paul,
    im a nurse and last April nurses at RCN congress voted against this bill, long before the issues of our pensions arose. Andrew Lansley has patronised nurses throughout this rejection of the bill. he has told nurses, in April last year that we dont understand what he means. We told him clearly we do understand what he means, we are also users of services as well as providers. we know he wants to privatise the NHS. many of us work for the NHS because we believe in working for the good of the many, not the few who can afford to pay us privately what we really deserve in terms of remuneration. so to have to listen to Mr. Lansley partronising me is a disgrace. He has now brought our pensions into the fray to make it look as if that is the problem we have with him. and has probably upset the pension reforms now too, as many nurses were probably going to accept what they were offering. im hoping that now listening to him, he has angered them enough that they will refuse to accept the pension reforms too. The government has plenty of money to go to war and give to other countries, therefore it has enough to give me my pension that i have worked for all these years.

  6. At the RCN congress last year, when confronted with a 98% no confidence vote, Lansley tried (as only he can) your proposed tactic. He started by saying “I am sorry if what we are trying to do has not communicated itself”. It was shifty and patronising.

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