Worker's co-ops in community nursing?

[Guest guest]

Did anyone else catch this?

http://news.bbc.co.uk/1/hi/uk_politics/8515949.stm

They must be bonkers to suggest placing all community nurses and

their managers in such 'social enterprises'. It's essentially a form

of privatisation at local level with small groups of staff having to

negotiate commissioning and providing services from outside the NHS.

Staff would presumably lose their terms and conditions and pension

rights gradually, much as those already moving into such service

models already do? Not the smartest career move if you have a

family, a mortgage or career aspirations, but some people have had

years of oppressive or incompetent management in the NHS and will be

tempted to sell out and flee. Maybe there are even a few buccaneers

who positively fancy the idea of freedom?

Now, I admit I've wanted the chance to sack several of my former

managers and I've even dreamed of a more robust response to poor

performance in a few deserving cases. Who hasn't? But it's hardly

the point here.

Moving community nursing out of the NHS into any kind of small local

co-op implies that they're able to operate like a massive

organisation such as the Partnership. This is a massive

corporate body and a far cry from a local team of community nurses.

In fact, they'd be closer to a small local community hospice which

has to rely on NHS commissions and funding to survive. Our small

local hospice gets just 27% of its service costs met by the NHS, so

they fundraise constantly and they're totally dependent on the

population they serve. If they didn't have charitable donations,

they'd only be able to offer a fraction of their services and would

have to lay off staff, close facilities and withdraw services from

patients. I doubt if they'd be able to offer as much as 27% of

current services, since there are such diseconomies in small local

services.

I know that nurses & many hospitals used to be part funded by charity

and there were fetes and flag days all the time. But who'd run such

fundraising, even if it were constitutionally OK for social

enterprises to do so? They'd be competing with hospices, Red Cross

and every other voluntary sector body in town and wouldn't have the

expertise or time to do so.

Even if you think future enterprise-driven community nurses under a

Conservative government would be content to do without their current

terms and conditions and their protected public sector pensions,

there are still problems with the proposals. What about training new

highly skilled staff to replace current nurses & others and funding

pricey university post basic & specialist courses? What about

negotiating decent prices for community equipment and consumables?

And what about offices, clinic premises, support and clerical staff,

IT, cars, etc?

I daren't try to imagine this in relation to current debate about

long term care of the elderly. Politicos are notoriously vague about

what 'community nurses' comprise. This vagueness comes with the BUPA

membership and plump pension pots. Maybe it's also about health

visitors, CPNs, learning disabilities. midwives, school nurses &

assorted specialists too?

I reckon the silly season has started early this year...

H