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Editorial Monday 31 October 2011: Liberation from bandage - Health Secretary Andrew Lansley vs. the RCN on nurse downbanding

The Secretary Of State For Health has a way with letters, if not with words.

Well, he does if the said letters' absence gets mentioned in the Commons chamber.


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That is what happened during last week's Opposition Day debate on the NHS. Mr Lansley (saviour, liberator)'s non-answer to Rosie Cooper's follow-up on her inquiry to Mr Lansley (saviour, liberator) about nurse down-banding during the last health select committee evidence session came up.

Health select committee chair Stephen Dorrell had also written to Mr Lansley, as follows:

"When  you gave evidence to the committee on expenditure issues on 11 October, you were asked about the incidence of down-grading, or down-banding, of posts in the NHS and specifically whether it was an issue that had been raised with you by representative organisations. You told us: “I am not aware—my colleagues may be—of what you describe, that is, trusts who are seeking to manage their costs by the downgrading of existing staff. If you are aware of that, then, by all means, tell us, but I was not aware... I have talked to the Royal College of Nursing and this is not an issue for the Royal College of Nursing. I talk to them regularly... They have not raised it with me.”
[From your answers to questions 127 to 129]

"Subsequently it has been reported in the news media that the RCN disputes your statement. Nursing Times, for example, has reported that “RCN executive director of nursing and service delivery Janet Davies said the union had ‘raised the issue of down-banding with the Secretary of State on a number of occasions’.”

"I am therefore writing on behalf of the Committee to ask if you wish to add anything to the answer that you gave on 11 October. I also ask you to give your view on the appropriateness of down-banding as a mechanism for reducing costs, as in written evidence to us it has been raised as a significant concern by both the Royal College of Nursing and Unite.

"Rt Hon Stephen Dorrell MP

The non-receipt of a reply was mentioned in the Commons debate - and as if by magic, a letter appeared.

Its text is as follows:

"Dear Stephen / Rosie,

"Thank you for your letter of 12 October concerning the evidence I gave to the select committee on 11 October.

"In respect to my answer on 'downbanding', I do not wish to add anything to the answer I gave other than to say that I do not have any record or recollection of the RCN raising the issue with me in any of our recent meetings. I met with Peter Carter of the RCN on 5 April 2011, and again on 13 September 2011. I agreed to provide the meeting notes from these meetings - they are attached to this letter.

"On the wider issue of changing skill ix, I recognise that local organisations will in some cases have to make difficult choices about staffing changes in the coming years, although Trusts should as a matter of course review their staffing levels to ensure that they provide the right skill mix to ensure effective clinical governance. In making any changes I expect them to ensure quality and safety of care is maintained or improved.

"Where organisations are planning or experience changes, including changes to the balance and skill-mix of the workforce, this must be safety and quality assured so that there is no adverse effect on patients. The process should include clinical involvement, leadership and sign-off. Medical and nursing directors must be involved and agree any major changes to the way in which a service is delivered locally.

"In addition, the Job Evaluation Handbook, which is freely available on the NHS Employers website, provides specific advice to the NHS on dealing with mergers and reconfiguration of services. It advises that any reconfiguration should be conducted in partnership with staff side organisations and involve conducting a jobs audit to see which roles are needed by the organisation, before designing a new job structure. It also contains advice ion the evaluation of new and changed jobs.

"All matching or evaluation panel members have to be trained in job evaluation, the principles of equal pay and the avoidance of bias. The job requirements will determine the banding of the job and panels are clear that predetermining which bands jobs should be in before they have been put through the process should be avoided.

"It is for the NHS locally to decide on the number and payband of the staff they need to provide high quality, safe and effective services for patients and I believe that the NHS has the tools to ensure that these decisions are made properly.

"I am placing a copy of this letter in the Library of the House of Commons.

"Yours ever,

"Andrew Lansley"

So there we have it. Don't we?

Well ... maybe not. The letter's text was put to an RCN spokesperson, who said, “The RCN has made the issue of down-banding or down-grading a central part of its Frontline First campaign.  Evidence of the problem was included in the first interim report on the campaign published in November2010; in more recent press statements shared with the Secretary of State’s office and in the RCN’s recent submissions to the Health Select Committee.

“The issue was also raised directly by members attending a listening exercise event with the Secretary of State during RCN Congress in April. The RCN does not issue minutes of its frequent meetings with the Secretary of State, Ministers or officials but the subject of down-banding and down-grading has been raised regularly in conversations and meetings with parliamentarians of all parties since July last year”.

His evidence to the select committee shows that Mr Lansley has a view that down-banding "is not an issue" for the RCN. Interestingly, it is a view which the RCN itself clearly does not share.

Mr Lansley is, after all, a liberator. Perhaps down-banding is a form of liberation?

Mr Lansley is also absolutely right. Isn't he?