Presentation on theme: "Janice Smyth Director, RCN in Northern Ireland Royal College of Nursing."— Presentation transcript:
Janice Smyth Director, RCN in Northern Ireland Royal College of Nursing
Devolution One RCN in Four Countries Northern Ireland Assembly Scottish Government Welsh Assembly Government
The Scottish Context Scottish National Party minority Gov since 2007 Next elections May 2011 Block grant decided by Westminster (Barnett Formula) but allocated to priorities by Scotland Policy and legislative authority in Scotland for almost all health and social care issues Scottish health service delivered by 14 unified geographic health boards, 7 special health boards to: *5 million people - inhabiting 40% of the UK landmass - 90 inhabited islands.
The Welsh Context Labour/Plaid Cymru Coalition since 2007 Next Assembly Election May 2011 Block grant decided by Westminster (Barnett Formula) but allocated to priorities by Welsh Assembly Government Policy and legislative authority with Welsh Assembly Government for almost all health and social care issues NHS delivered by 7 Local Health Boards
Northern Ireland Context Power-sharing Executive since 2007, dominated by Democratic Unionist Party and Sinn Féin Health Minister - Ulster Unionist Party Block grant determined by Westminster (Barnett Formula) allocated to priorities by N I Executive Policy and legislative authority in N Ireland for almost all health and social care issues Service delivered through five integrated Trusts, a Health and Social Care Commissioning Board, Public Health Agency and Patient and Client Council
Scotland in the UK Different politics, different priorities, different health structures BUT many of the same problems as the rest of the UK
Wales in the UK Different politics, different priorities, different health structures BUT many of the same nursing issues as the rest of the UK (e.g. shift to community) Significantly poorer economically with higher levels of ill health. This links to lower levels of public funding for services (Holtham’s £300m underspend is not when calculated on need but when calculated on same funding formula as England spend.)
Northern Ireland in the UK Different politics, different priorities, different health and social care structures, different political parties All-Ireland and cross-border health and social care agenda BUT: many of the same problems as the rest of the UK and some far worse (historic under-funding, particularly in mental health, estimated to equate to £600 million by 2011)
Scottish health spending Health and wellbeing dept received 1/3 of Scotland's £30bn+ budget roughly 70% of NHS Scotland budget on staffing costs Nurses make up around 40% of the workforce So nurses becoming the easy target for saving money
Challenges to public spending in Wales There will be cuts (£2 bill over next few years) Public sector employment bedrock of economy – not enough private wealth created 22 local authorities – recognised as too many Higher Education sector will shrink substantively.
Northern Ireland Health and Social Care Budget Health and social care budget of £3.6 b, more than 40% of total N Ireland Executive budget £700 m in “efficiency savings” to be secured Additional £126 m cut for announced by Executive, Further cuts widely anticipated Continuing rising demand estimated to add a further £50 m to these pressures Greater part of the budget allocated to salaries: little room for manoeuvre... debate about local pay
Pressures on nursing Nursing comprises around 40% of the HSC workforce, the largest staff group RCN has already successfully challenged previous plans to axe 722 nursing posts 2% payroll reduction announced for : DHSSPS estimates this equates to 1300 posts Pro-rata, this could entail the loss of around 500 nursing posts Vacancy freezes (BBC estimates up to 16% in some areas) and curtailment of overtime, bank and agency staffing
NHS Scotland's challenge Core revenue funding for 14 geographic boards: £7.5bn Estimate of savings need to break even: £260m (c.3.5%) WTE nursing posts predicted to be lost this year: 1,523 NB: These pressures on money and jobs are coming whilst still (technically) in time of plenty
Key issues in Scotland 1 Slight rise in NHS Scotland budget, BUT: Boards forecasting cost pressures (e.g. drug costs) will outstrip this increase Boards focusing on making significant cuts in workforce, BUT: still inefficiencies, waste, duplication in other areas (but harder to tackle quickly than workforce cuts...) Scottish policy of no compulsory redundancies, BUT: emerging pattern of non-strategic decisions to cut numbers (e.g. vacancy freezes; using specialist nurses to fill gaps on wards)
Key issues in Scotland 2 Comprehensive workforce planning system for nursing supported by Gov and unions, BUT: anecdotal evidence of workforce plans bypassed to cut wage bill and not all workforce plans agreed and published for this year Opportunities to re-examine skill mix in some areas, BUT: Some boards using skill mix to replace not enhance registered nursing workforce without evidence of risk assessment (e.g. Greater Glasgow & Clyde) Successful formal Scottish partnership process has delivered through consensus, BUT: can this survive the economic downturn?
Key issues for Welsh NHS There will be cuts (£1.9 bill to NHS alone over next 5 years) 3% cut at Band 5 and above every year for 3 years? 650 nursing jobs to be cut every year for 3 years? Shift to community Skill mix or risk of downgrading of posts (especially risk of registered nurses being replaced by HCSWs).
Key issues in Northern Ireland (1) Ensuring that service realignments are conducted appropriately, proportionately and with consideration of the impact on nursing and consultation with RCN Identifying local impact of cuts, particularly on nursing posts Challenging loss of nursing posts Resisting calls for local pay agreements Use of skill mix to enhance care, not to cut costs ? Sustainability of current HSC structures?
Key issues in Northern Ireland (2) Sustainability of Trade Union Partnership and Regional Partnership Forum Need for strong nursing role in commissioning process Development of nurse-led services as a template for the future Efficiency, safety and patient outcomes Workforce planning