NHS reforms in England

Midwives magazine: Issue 5 :: 2011

Let me kick off with an apology. I usually try to report on political goings-on from each part of the UK, but this time I have to concentrate on England – and the NHS reforms that have been the focus of intense political machinations in recent days and weeks. So, to midwives in Scotland, Wales, Northern Ireland and elsewhere, let me say sorry.

RCM members may not be aware, but the general secretary and many other key staff have been working almost flat out trying to influence key policy-makers on the reforms. That time has been well spent, as we have now heard back from the NHS Future Forum panel, the group of clinical experts, including a South Coast head of midwifery, that was set up in April to ‘pause, listen and reflect’ on the content of the health bill.

In total, the Forum’s 45 members have spoken to 6700 people face to face; 25,000 people have sent their views to them by email, and a further 4000 have sent private comments, completed questionnaires or given website responses.

The good news is that the coalition government has responded to the Forum’s resulting report, accepting almost all of its findings. The health bill before parliament will now be amended accordingly.

Let me run through what, at first sight, we like about the changes proposed by the Department of Health. We welcome the suggestion of a stronger role for networks – including maternity networks – in commissioning, and the establishment of new clinical senates. These are both designed to give expert advice to the NHS Commissioning Board and the clinical commissioning groups. In fact, we do not just welcome this change, it was one of the main recommendations we made to the review of the reforms. We believe a ‘beefed-up’ system of maternity networks is crucial.

This is reinforced by a strengthened duty on those commissioning care (a task currently undertaken by local primary care trusts) to secure professional advice to inform their work. And it is probably not too surprising that we welcome the specific recommendation that the new national commissioning board should develop close links with the royal colleges. We are pleased by the promise of more openness and transparency in the system, and the removal of the hard deadlines by when existing structures had to be swept away. We also like the proposal to develop a ‘choice mandate’, which will be about choice of NHS care and information to support those choices.

However, there are areas where we want more clarification and assurance. An example of that would be changes to the role of Monitor. This is the body that currently regulates foundation trusts, but is set to be granted greater responsibilities and powers under the reforms. Under the original plans, Monitor would have had to promote competition as an end in itself; under the changed plans, it should still use competition, but only as a means to improve care. Will this mean anything different in practice?
We need to look further at this.

The proposed new laws have a long way to go on their parliamentary journey. The RCM will continue to work hard to make them work for midwives and maternity care. 

Stuart bonar is the RCM public affairs officer.