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Lack of accountability on staffing in England has put the NHS back years, RCN chief tells MPs


Legislation to address the shortage of registered nurses and nursing staff in England is now vital to ensure patient safety and deliver the government’s Long-Term Plan for the NHS, Royal College of Nursing Chief Executive Dame Donna Kinnair told MPs.

Giving evidence to the Health and Social Care Select Committee’s enquiry into the consultation process on Tuesday (30 April), Dame Donna said:

“Successive Secretaries of State have taken decisions which mean we cannot deliver the long-term plan. The lack of accountability on staffing has put us back years, so there needs to be an explicit accountability for the workforce with the Secretary of State.

“There is no delivery of the long term plan without investment in the workforce.  We cannot go on thinking we can have the same number of nurses and just move them around and feel we can deliver a safe, quality NHS. This is why we need a commitment for accountability.

“We are talking about accountability to Parliament for the workforce of our biggest treasure, the NHS.”

Responding to NHS England and NHS Improvements’ engagement on the Long-Term Plan, the RCN has reiterated its call for explicit accountability for ensuring a sufficient number of staff across health and care to be enshrined in law.

The RCN’s evidence also stressed that the government’s drive to move more care from acute A&E hospitals into the community will be impossible without substantially more nursing staff.  Integrated Care Providers should only be formed if it can be demonstrated that there will not be an adverse effect on the pay, terms and conditions of any staff involved, or on patient care and safety.

The RCN submission also calls for reassurance that increased deployment of the Integrated Care Provider contract will not lead to a diminishment of the nursing voice within services.

Dame Donna also added:

“To create an integrated health and care system that operates on evidence rather than political calculation, opportunities for data collection and reporting must be enhanced, and not diminished, through any structural changes to NHS provision.”

The RCN is calling for organisations throughout the system to be given specific duties and legal powers related to the workforce, and to be held accountable for the decisions they take.  Specifically:

  • The Secretary of State for Health and Social Care to be accountable to Parliament for making sure there are enough health and care staff, with the right skills, in the right place, at the right time to care for patients, based on population needs.
  • NHS England and NHS Improvement and other national organisations including Health Education England (HEE) to be given powers develop and grow the health and care workforce, including responsibilities for workforce planning and supporting the system to implement them.
  • Providers of publicly funded health and care services should held accountable for demonstrating their corporate accountability for decisions about workforce planning to deliver safe and effective services, underpinned by evidence

NHS England and NHS Improvements have proposed changes to the way in which services are procured within the NHS, to be replaced by a ‘best value test’.   In its response, the RCN has asked for: further assurance that this test will not have adverse effects on the workforce; that any new approach won’t lead to increased likelihood of the cheapest provider being selected on the basis of cost alone; and that contracts will not now be awarded to those who do not have experience of managing clinical risk.

The engagement on proposed amendments to the law to help the NHS deliver its Long Term Plan closed on 25th April. The RCN’s full written response is at www.rcn.org.uk/professional-development/publications/007-644

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