Janice Smyth Director, RCN in Northern Ireland Royal College of Nursing

1. Janice Smyth Director, RCN in Northern Ireland Royal College of Nursing

2. DevolutionOne RCN in Four Countries Northern Ireland Assembly Scottish Government Welsh Assembly Government

3. 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.

4. 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

5. 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

6. Scotland in the UK Different politics, different priorities, different health structures BUT many of the same problems as the rest of the UK

7. 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.)

8. 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)

9. Scottish health spending 2010-11 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

10. 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.

11. 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 2008-2011 • Additional £126 m cut for 2010-2011 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

12. 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 2010-2011: 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

13. NHS Scotland's challenge 2010-11 • 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

14. Key issues in Scotland 1 • Slight rise in 2010-11 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)

15. 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?

16. 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).

17. 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?

18. 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