i. This article will discuss key elements of RCN policy, those relating to nursing entrants requiring a degree, and a support of relatively high ratios of trained staff to care assistants. The RCN’s links to UK and international institutions that seek to influence nursing policy will then be considered.

ii. Analogies will be made to ‘Animal Farm’ – a novel written in 1945 by George Orwell that depicts events leading to the Russian Revolution of 1917, and events following it – as such, a brief synopsis of this novel is given: Major, a boar who lives on Manor farm, has a dream, and calls a meeting in the barn to tell the other animals of it. He has dreamt of a ‘golden’ future in which animals will not be oppressed by humans. He teaches them a song that expresses his vision, called ‘Beasts of England’ – ‘Beasts of England, beasts of Ireland, Beasts of every land and clime, Hearken to my joyful tiding Of the golden future time’. After Major’s death, the animals defeat the farmer, and run him off the farm. Three young pigs – Snowball, Napoleon, and Squealer – assume leadership of the animals, one of whom, Boxer, a cart-horse, particularly dedicates himself to the cause of ‘animalism’, and adopts his maxims, “I will work harder”, and ‘Napoleon is always right’. Under the new regime the pigs alone make all of the decisions – for the good of every animal – and any animal who opposes Napoleon’s leadership will meet instant death at the teeth of the farm’s dogs. But Napoleon begins to act more and more like the displaced farmer, sleeping in a bed, drinking whisky, and trading with other farmers. Squealer, Napoleon’s propagandist, justifies every action to the other animals, in terms of Napolian has their best interests at heart, despite the fact that the other animals are hungry and overworked. Then, Boxer is missing. Squealer explains that he has died after having been taken to hospital, praising Napolian with his last breath. In fact, Napoleon had sold Boxer to a glue factory in order to get money for whisky. Years pass, and the pigs become more and more like humans, carrying whips, and wearing clothes. The original principles of their revolution, written on the side of the barn, become reduced to a single phrase – “all animals are equal, but some animals are more equal than others”. Napoleon invites a human farmer to dinner, and tells him that they should unite against both the animal and human working class. The animal workers look at this party through the window, and can not tell which are the pigs and which are the humans. Animal Farm has become a society in which the powerful determine who gets what rights. The workers exist only to serve the aims of their leadership, to provide them with glory, and to support their luxurious lifestyle. The pigs abuse language to control the workers – their propaganda aimed at drowning out dissenting opinion. How many ‘voices’ critical of RCN policy are given expression in such RCN publications as the Nursing Standard, Nursing Management (‘FOR NURSING LEADERS EVERYWHERE’); Nurse Researcher; Nursing Older People; Mental Health Practice; Primary Health Care, Nursing children and Young People, and Emergency Nurse? Do RCN members have influence within the Nursing Times?

iii. The views of ‘ordinary’ nurses, students, and care assistants will be considered, so as to provide a ‘counter voice’ to those of high-ranking RCN members who purport to represent them. Themes emerging from a study of 150 blog entries made between September 2011 and September 2013 will be given by way of representing these ‘counter voices’, which are taken from both the NHS and the private care home sector, as the former seems to dominate debate at the expense of the latter, despite it accounting for the majority of elderly care, and its costly ‘care’ devastating the lives of many families.

iv. Do nurses require a degree? One argument that they do gives credence to the role of nursing assistants in providing the ‘basics of care’, whilst pointing out that they will not be able to recognise such things as skin condition or facial paralysis. This is not necessarily the case: I have worked with nursing assistants who were particularly good at such observation, and newly qualified nurses who were not, unsurprisingly so, given their frequent contact with a simulation dummy.

v. Moreover, the skills of nursing assistants are being increased and recognised in a number of American States, so the demarcation between the nurse and assistant becomes blurred. This is obviously a threat to the RCN, who mostly represent the more equal, yet their protestations are only valid if they can prove the nursing assistant is inferior to the ‘degree nurse’ in making an initial observation which requires further investigation. To object to a person other than a nurse being responsible solely on the grounds of them not being a nurse is done so to protect a vested interest, not the patient.

vi. Graduates of the ‘Florida State Nursing Assistant Progam’ would argue that they were well prepared to identify signs and symptoms that may indicate further investigation. Such facilities as the Erwin Technical Centre (erwin.edu) offer 165 hours of instruction: ‘The Nursing Assistant Program combines classroom theory and over 20 hours of clinical experience that prepares students to take the Florida State Certification Exam and to pursue an entry level position in a nursing home. All nursing assistants working in long term care in Florida must be certified by the State of Florida’. They state: ‘Nursing Assistants are an important liaison between the residents and nurses. Nursing Assistants are trained to notice changes in residents and report pertinent information to the nurses in charge so adjustments in care can be made. In addition, nursing assistants help residents perform activities of daily living such as bathing, grooming, eating, and toileting. Nursing Assistants are the eyes, ears, and hands of medical professionals keeping residents comfortable, clean, and fed. The courses are held over either two days a week for two months, or two evenings a week for four months. Graduates are informed that: ‘The U.S. Department of Labor lists Nursing Assisting as one of the fastest growing occupations, and the need is expected to grow by 18% over the next six years’. This reflects the current emphasis on budgetary constraint, a ‘tide’ which it will be useless to swim against, and one which will inevitably encroach further on roles traditionally performed by the nurse.

vii. Florida nursing assistant graduates are given a career pathway: ‘Nursing Assistants often advance to become patient care technicians by acquiring additional training in phlebotomy and EKG’s. Also, Nursing Assisting is an excellent launching pad for people pursuing careers in other health care arenas’. Nursing assistant courses stress the importance of a compassionate attitude to would-be entrants. They also stress the importance of education: Vision Statement: “Erwin Technical Center will: Empower students to take ownership of their education; educate students to be highly-trained, productive members of society; and provide an environment for the achievement of higher education, focusing on technology, job preparation and personal growth”.

viii. The average pay in 2010 of Florida nursing assistant graduates was £7.15p per hour as of currency exchange rates applying 0ctober 22, 2013. The annual rate of pay for a patient care technician in the USA as of May 2013 was $15,866 – $42,644 for those with between one and four years experience (www.buzzle.com).The median rate was $26,240 (www.payscale.com/ ). This equates to £16, 240 per annum. The highest rate ($42,644) equates to £26,380 per annum. Newly qualified nurses in the UK typically start at £21, 000 per anum (nursing.nhscareers.nhs.), which roughly equates with the starting salary for a qualified teacher (point M1): £21,588 (ibid.). Generally, a patient care technician would, on average, expect to earn 80% of the wages of a newly qualified nurse, with nursing assistants expecting 66%. Obviously, as the newly qualified nurse progresses through pay scales, the relative ‘affordability’ on nursing assistants and nursing technicians increases. According to figures from NHS Employers, average pay in the NHS in 2012 – including basic pay plus additions such as overtime – was £30,564 for a nurse, £109,651 for a consultant, £47,702 for a manager and £36,130 for a qualified paramedic.

ix. This is the ‘economic tide’ which the RCN, in its call for high nurse to nurse assistant ratios, is trying to hold back. It is claimed that £500 million of wage costs are equivalent to 15,000 nurses (Donnelly, 2013). It follows that a great deal more staff could be ‘afforded’ if care was given by a different balance of nurses, nursing assistants, and nursing technicians. The danger here is that a more ‘economical balance’ of staff would not necessarily bring about a higher staff to patient ratio, because the logic inherent in running the NHS as a business might result in the same number of staff being employed, with a lesser number of nurses.

x. There should be a statutory minimum staff to patient ratio, and, if there is not, then all calls for good patient care are hollow. These minimum staff ratios should apply to both the NHS and private care homes, with any nurse in charge of the latter having a statutory duty to report ongoing staff shortages to the CQC, who would be given the power to send agency staff to the care home. Such ‘interference’ in the ‘market’ is, however, unlikely, given that the main political parties of the UK are wedded to it.

xi. The poor care given at Orchid View Care Home, where one nurse and two assistants were expected to give good care to 30 patients, is one example of the business needs of an organisation riding roughshod over the needs of patients (Rush 2013). Private equity firms, which borrow large amounts of money to fund their acquisition of care home groups,see this blog, seek to maximise profits by running on minimum staffing levels, which are comprised of a high percentage of foreign nurses and nursing assistants, who are considered more ‘flexible’ and ‘cheaper’ than their UK counterparts (ibid.). The ‘training’ received by overseas nursing assistants in the UK is of a derisory nature, stipulated by the NMC. As one European recruitment agency states: ‘Looking to Employ Care Staff? We may be able to help. The carers we source from the ten east Europe EU countries such as Hungary, Poland, Romania, Czech Republic, Slovakia, Bulgaria etc. … are hard working reliable individuals looking for work as a carer, they may not have care experience but will undergo the normal 2-5 days training as required by care home providers’ (easterneuropeans.co.uk). The NMC merely rubber stamps EU migration of labour policy.

xii. Why is it not a statutory requirement for all NHS wards and private nursing homes, who care for elderly, chronically ill patients, to have to provide a staff/patient ratio of 1:5; one nurse and five nursing assistants to care for 30 patients? What is the stance of the RCN on this matter? Within the private care sector it is one that ‘recognises the business goals’ of care providers (whoownscarehomes). There seems to be an obvious conflict of interests here; a desire to increase membership of the RCN, which is set against the needs of patients. That is, the RCN, as Napoleon, collude with business interests. Squealer (any RCN spokesperson) explains to poorly paid and overworked foreign nurses and assistants that Napoleon (the RCN) has their best interests at heart, and, in return for their subscription fees, will negotiate the terms of their slavery. Of course, in the worst possible example of adulterated English, the private equity firms will be called ‘leading players’ or ‘stakeholders’, or other such absurdities that do not necessitate thought – to repeat: The pigs abuse language to control the workers – their propaganda aimed at drowning out dissenting opinion. This is not to say Napoleon is the root of all evil, for he merely serves a greater elite, as will be explained.

xiii. Private equity firms give a guaranteed ‘return’ to their investors, regardless of profit or loss considerations, this return being stripped from fee income. The question of who these ‘investors’ are is highly problematic, being clouded in secrecy. A sceptic might suggest that the UK government could claw back some care costs by investing in private equity firms, but, surely, such a level of deceit could not be perpetrated on the British electorate? – not without at least a 45 minute warning.

xiv. It is not a case that poor nursing care is solely the result of ‘economic’ staffing levels. To add to the apocrypha of the uncaring nurse and knowledgeable nurse, on a recent visit to a NHS ward a colleague was told by a patient that she had told a nurse that her catheter was “leaking”, to be curtly informed that “it could not be”. Nursing is thus reduced to the level of a ‘Carry On’ film.

xv. This is an example of ‘care’ in the public domain of an NHS ward (and yes, many examples of good care can be given), but what of care in the ‘private’ world of the care home? There are numerous reports of poor care: ‘Seven care workers arrested after ‘dungeon’ found at care home. The unheated, locked room at Veilstone Care Home contained only a blow-up mattress, light bulb and CCTV camera’ (Gregory, 2013). ‘Concerns have been raised in the wake of a series of scathing inspections at residential homes for the elderly across north and west Cumbria. Malnourished, unwashed, dehydrated, unclean and poorly staffed were just some of the issues raised by the Care Quality Commission at nine homes in six months’ ( Parsons, 2013). A respondent writing: ‘The CQC needs to look at a whole picture working in a care home is not just caring. There is laundry, cleaning … just let us do the job we are paid to do “CARE” (ibid.). ‘Staff at a care home which has been closed down by health inspectors gave elderly residents sleeping tablets when they didn’t need them. The revelations come as health watchdog the Care Quality Commission today announced it had cancelled the registration of the home with immediate effect due to its poor standards. Inspectors found: One resident struggling to eat soup with their fingers for 15 minutes (Howell, 2013). Will the government extend its proposed legislation to criminalize neglect of the elderly in the NHS to cover private sector care homes? If not, why not?

xvi. What relevance has this to the NHS? It is its future. Foundation Trusts will be hived off to private equity companies, or other forms of business, in an insidious process which seeks to hide privatisation from public view: Virgin Care run more than 100 NHS services, from radiology departments to GP clinics, all run under the NHS logo. The van comes to take Boxer away. The animals rush to the yard in time to see it leave. They wave goodbye to Boxer, but Benjamin is very agitated, and tells them to read the letters on the van, which describes it as being owned by the local horse-slaughterer. The animals try to warn Boxer, who tries to kick his way out of the van, but he has no strength left after his heroic efforts on Animal Farm. Three days later, Squealer announces that Boxer died in hospital. He makes a moving speech in praise of Boxer, explaining the sign on the van by saying that the veterinary surgeon bought the van from the horse-slaughterer, and had not yet replaced the sign. ‘Nurses of England, Nurses of Ireland, Nurses of every land and clime, Hearken to my joyful tiding Of the golden Virgin time’.

xvii. To return to the question of who should do what in nursing: Providers of training, such as the Erwin Technical Centre, do not see themselves as imparting a scant level of training, one not fit for purpose. It could be argued that the level of clinical skills attained by students undertaking a three year ‘generalist’ degree, culminating in a chosen speciality, are not always of a level that enables them to ‘hit the ground running’ as a newly qualified nurse; a reason cited by employers for preferring experienced nurses.

xviii. The training of nurse assistants and technicians could be highly focused to specific areas of nursing, eradicating the superfluous content of much of the nursing degree. A constant theme of blog entries is that patients are not concerned with a nurses aptitude to discuss philosophical nuances of care. Of course, some nurses will need to know the ‘science behind the condition’, but not all; as not all doctors need to be brain surgeons.

xix. Such courses can be offered in all areas of nursing as an entry level to nursing itself, with nursing assistant graduates who become patient care technicians being eligible to apply for a shortened degree course, which credits previous learning experience; the number of these ‘degree’ nurses to be matched to the number of job vacancies which hospitals have to offer.

xx. What of the the ‘voices’ of nursing assistants? Themes that arise from blog entries are: A lack of recognition of their skills. Being overworked because nurses are busy doing drug rounds and care plans, etc., so cannot assist with routine care. Not having a clear pathway to a career in nursing that credits their experience and skills.

xxi. What of the voices of nursing students? Themes that arise from blog entries are: Many feel inadequately prepared in clinical skills. Too emotionally immature to cope with the demands of nursing (young students). Mature students have difficulty fitting in academic work with family commitments. Trusts give few jobs to qualifying students. The NHS has an uncertain future. Poor public perception of nursing students inflamed by the media. Training should return to more traditional methods. Patients want students who care and are not bothered if they are not academic geniuses. Staff morale is low in some schools of nursing.

xxii. These issues are inter-dependent. The NHS Future Forum, the advisory panel set up by the Government to examine the NHS, says there is “almost universal concern” about the “huge variations in quality” of education and training for nurses and midwives across the country. This is strongly reflected in student blog posts. There is also a variation in the content of training, with the NMC allowing universities to chose the components of their nursing degrees. This is analogous to ordering a new car, to be told that the ones made Friday differ from those made Monday. In the same way, employers are faced with a variable (nurse graduate) product, which contributes to Trusts giving few jobs to qualifying students.

xxiii. ‘The NHS Future Forum reported that NHS hospital managers are failing to take responsibility for the poor quality of some nurses. It also accuses nurse training schools of failing to recruit the right type of student to ensure patients receive a good standard of care. The report adds to growing concerns that nurses’ training has become too academic to prepare students properly for the realities of the job and makes them less willing to carry out practical care. Prof. Steve Field, a GP and chairman of the forum, said that nurses needed to be “more than a set of GCSE and A-level results”. Patients’ groups who had argued that nurses’ training had become too academic welcomed the report’ (Adams, Smith, 2012).

xxiv. Let us now look more closely at the aims of the RCN as an organisation, and the groups it is affiliated to. The RCN in June and July of 2013 advertised for a Parliamentary Officer, stating: ‘With a membership of over 410,000, the RCN is the largest professional association and union of nursing staff and students in the UK. We’re proud to be a leading player in the development of nursing policy and practice, with an influential voice at home and abroad. We have a vacancy for a full time Parliamentary Officer based in the RCN’s multi award winning External Affairs and Member Communications team. Working to influence UK parliamentary audiences, as Parliamentary Officer you will monitor and analyse UK parliamentary activity, identifying where issues will impact upon, and provide opportunities for, the RCN. Sharing information with colleagues and key RCN staff, you will also be responsible for providing briefings and information for parliamentary stakeholders. … You will have the ability to spot opportunities to promote nursing within the parliamentary system, and ensure that key RCN staff are aware of political developments’.

xxv. Thus, the RCN, as a ‘leading player’, seeks to influence government, so as to further its own ends. Their Parliamentary Officer must ‘spot opportunities to promote nursing (aka the RCN) within the parliamentary system. This is nothing remarkable; the UK parliamentary system is riddled with lobbyists, and many unions will have a vast flotilla of staff paid out of their members’ subscriptions that are far removed from the ‘front line’ of representation. This imperative to influence, in the case of the RCN, is not confined to the UK: ‘RCN membership of international organisations enables us to exchange information and share best practice amongst a much larger audience than we would be able to reach on our own. Through membership of international alliances the RCN works collectively to influence decision-makers in governments and institutions across the world to improve the health of communities’ (rcn.org.uk, 2013). Some of the RCN’s partners are:

xxvi. The International Council of Nurses.’The International Council of Nurses is a federation of over 130 national nurses’ associations (NNAs), representing nurses around the globe. … The International Council of Nurses (ICN) believes that profession-led nursing. … The title of “Nurse” should be protected by law and applied to and used only by those legally authorised to represent themselves as nurses and to practice nursing. … Reserving the title “Nurse” for those who meet the legal standard enhances public protection by allowing the public to distinguish legally qualified nurses from other care providers’ (www.icn.ch). Again, there is nothing remarkable about the RCN allying itself to an organisation which seeks to define what nursing is and exclude others from it, as the medieval guilds sought to protect their trades. Yet, it is a stance that is anathema to corporate capitalism, which eulogises the virtues of a multi-tasking ‘flexible’ and cheap (zero hours contracted) workforce. As all three main political parties in the UK openly support the dominant role of corporate capitalism in the economy, as utility providers, etc., with substantial regulation of them being as unlikely as their re-nationalisation. It would be a uphill struggle to oppose this creed. I would suggest that the RCN is not so blind to its self interest as to do this; it would be as a martyr not renouncing their faith in the warmth of the flames.

xxvii. The European Federation of Nurses Associations (www.efnweb.org). ”The European Federation of Nurses Associations (EFN) represents the nursing profession and its interests to the European Union institutions. It focuses mainly on nurse education, the mobility and protection of health care professionals, and EU health policies. EFN is the independent voice of the nursing profession in Europe, representing more than a million nurses from national nurses’ associations in 30 countries. … As European citizens, this means having the right to choose where to receive medical treatment across the EU, and to be reimbursed for it. The EFN believes that this Directive, aiming to clarify citizens’ rights to access healthcare in another EU Member State, and to facilitate their access to healthcare services, guarantees the principles of universality, access to quality care, equity and solidarity. Therefore, if a patient is to receive medical treatment in another EU country, he/she will have the same rights as a citizen of that country, and the treatment will be subject to the same rules and standards. … The EFN believes that a transparent system for automatic recognition is needed to deal with the migration of professionals in a practical and efficient way and to ensure that a certain level of health protection for patients and consumers of health care in the EU is maintained. … ENSA goes for a new governance structure to actively lead the nursing students’ movement … The European Nursing Students Association (ENSA) elected five new board members … The new board, coming from Norway, Greece, Sweden, Turkey and Germany opted to work closely with the EFN to make nurses and nursing stronger in the EU. … The EFN General Secretary therefore believes that more students should join ENSA, so that it covers at least one student from each EU Member State’. (My italics).

xxviii. This association, I suggest, is highly problematic to the RCN. I will address the question of whether the RCN should be the national nurses’ association anon. Their affiliation to an organisation which believes in ‘medical tourism’ is not remarkable, as this relates to medical tourists from affluent countries who will be treated as private patients, and will pay their medical costs, typically for dental treatment, cosmetic surgery, or fertility treatment. They are not to be confused with health tourists, whose intent to pay for treatment is not certain. Governments see ‘medical tourism’ as a lucrative source of revenue. The RCN’s affiliation to an organisation that supports migration of professionals might be a cause of concern to some. There is most definitely a shortage of people engaged in caring in the NHS. There are widespread shortages because NHS trusts freeze vacant posts in a bid to save money. Trusts routinely freeze posts whenever staff retire or move elsewhere, creating widespread shortages. Is the answer an increase in the number of nurses, or in the number of nursing assistants? A majority of patients would probably opt for the latter, as would those in charge of budgets, though it is not certain that there will be increases in staff of any kind; staff will be told to adopt Boxer’s maxims, “I will work harder”, and ‘Napoleon is always right’, but their fate is the glue factory. When the government state that every NHS ward will have to make public the number of nurses on a ward on all shifts, so that these numbers can be compared with recommended minimums, a great sleight of hand is being dealt, for the majority of ‘physical’ care given in any elderly care setting is by the ‘Boxers’ (nursing assistants) of this world, not by nurses busy dispensing drugs or filling in care plans.

xxix. As for student nurses, blog after blog reports of the majority of newly qualified nurses not being given jobs, with those that are being offered half time hours on fixed term 6 month contracts, which are unlikely to be renewed. This is cheaper than employing experienced staff, and is a continuous process of repeated 6 month preceptorships; rather like employment schemes that take on a new batch of trainees every time the old batch is about to qualify for a permanent (higher waged) job. There is not a shortage of nurses in the UK, but, rather, a shortage of jobs for them, for both those who are newly qualified and those on part time contracts who would like full time work.

xxx. It may seem of little importance that the RCN is affiliated to a group that supports migration of professionals if there are no nursing posts for them in the NHS. This may not always be the case, for such as Bulgarian nurses may agree to work for the minimum wage; and with reports of some Bulgarian nurses earning as little as £200 per month, the prospect of the minimum wage may be alluring to both them and potential employers. An important point is missed if it is claimed that such rates of pay are disallowed under NHS pay agreements, which will cease when the privatisation process is complete.

xxxi. A vision of the future is provided by those hospitals that fail to achieve ‘Foundation Trust’ status, which must find an alternative solution, one of which is to operate under private enterprise management, as in the example of Hinchingbrooke Health Care NHS Trust, run by the Circle Partnership. Currently, staff employed by the organisation remain as NHS employees, and are paid NHS rates. This may not always be the case, for what is exampled here is a vision of the evolution of the health service as entertained by the private sector mouthpiece, Camclegg Miliband.

xxxii. The dismantling of the NHS is introduced so gradually so as to alarm by degrees, not to shock into opposition. It is as if nails are being driven into the NHS coffin one by one, and, when the final one is in place, those running the PHS (privatised health service) will call for pay ‘flexibility’, and the right to set their own levels of pay; to be ‘competitive’; to give the tax payer ‘best value’, etc., which will herald a migration of professionals. Nurses trained in the UK will be as scarce as Saville Row suits; foreign manufactured ‘off the peg’ ones will be the norm. Either this route, or that of the nursing assistant as patient technician, beckons, one in which the RCN and other unions will seek to recruit membership, from whoever is doing the caring, called by whatever name, for, unless we are to witness a heroic and principled ‘last stand’, the lure of membership subscriptions will be king. Workers will look on at the party between workers’ ‘representatives’ and big business through the window, and will not be able to tell one from the other; they only exist to serve the aims of their leadership, to provide them with glory (a seat at the table), and to support their luxurious conference and committee-attending lifestyle.

xxxiii. There will be wholesale transfer of hospitals to the private sector. Hurrah! some may say, let us put the NHS under the management of efficient and successful private companies. It may surprise them to learn that Circle made a pre-tax loss of £32m. in 2011 and raised £46m. through the issue of 68m. new shares to institutional investors. The firm said that funds raised would be used to bid to take over the management of further NHS trusts, and paying off a £14m. loan from James Caird Asset Management, for which Circle was paying an interest rate of 25% a year. The company made pre-tax losses of £38m. in 2010. What sort of company would borrow money at 25% interest? – a desperate one, and what sort of company would give it them? – one that thinks the business is a high risk. Napoleon is always right, remember, but when his propagandists say that efficiency is the preserve of the private sector, they do so in the face of fact, with no mention of the debt-driven failures of companies speculating in health care.

xxxiv. Circle told investors in 2011 that it had identified eight health trusts which it considered to be an “NHS growth opportunity” of more than £8b. (www.hsj.co.uk/news/policy,hsj.co.uk/news/finance). The majority holding of circle is held by private equity companies,* which include Lansdowne Partners, co-founded by Paul Ruddock and David Craigen, who have donated more than £300,000 to the Conservative Party, the majority since David Cameron became leader; and Odey Asset Management, run by Crispin Odey, another donor to the Conservative Party. Circle’s potential losses are capped at approximately 0.7% of the NHS funds it will manage. The UK government thus facilitates a ‘bet to nothing’. The National Audit Office reported that Circle made an operating deficit on its contract of £4m. by September 2012, forcing Circle to make savings by cutting several hundred jobs and closing two wards. (It can be supposed that the RCN opposed any job cuts imposed on any of its members). Hinchbrooke has plummeted in a patient satisfaction survey undertaken in August 2012 (www.hsj.co.uk/news/acute-care/hinchingbrooke). Circle operates a equity incentive program under which consultants and GPs are offered equity in the company in return for a share of the consultants’ private work (www.competition-commission.org.uk). Pigs at the trough.

xxxv. *Private equity firms that control the vast majority of care homes in the UK already recruit heavily from Bulgaria, as stated, with the RCN (and UNISON) vying for the right to represent these workers (collect their subscriptions). How does this stand in relation to the RCN’s role in protecting the rights of their UK members? When it is said that worker migration is a central tenet of European Union policy, and has to be complied with, a lie is being told; France only allows migrant professionals to take a job if a suitably qualified local applicant is not available. It must be said that being affiliated to an organisation does not necessarily mean agreeing with its every policy, and the RCN may be actively lobbying within the EFNA to safeguard the rights and interests of its UK members. Pigs may fly.

xxxvi. The Commonwealth Nurses Federation (commonwealthnurses.org). The Commonwealth Nurses Federation (CNF) is a federation of national nurses’ associations in Commonwealth countries. It aims to influence health policy throughout the Commonwealth; enhance nurse education; develop networks; strengthen nursing leadership; and improve nursing standards and competence. … Membership of the Commonwealth Nurses Federation (CNF) is open to all national nursing and midwifery associations in Commonwealth countries. Members associations of the CNF are divided into six regions: Atlantic Region; East, Central and Southern Africa Region; Europe Region; Pacific Region; Asia Region; and West Africa Region. …The CNF’s current work programme includes the following: collaboration with other international nursing and health bodies, participating in and contributing to Commonwealth Health Ministers’ and Heads of Government meetings, participating in and contributing to Commonwealth Health Ministers and other Commonwealth meetings.

xxxvii. The European Health Management Association (www.ehma.org). Active since 1982, the European Health Management Association (EHMA) is a membership organisation open to all organisations and individuals committed to improving health and healthcare by raising standards of health management. With over 170 members in 38 countries our members represent all levels of the health system … OUR CORE AREAS: Policy: translating EU policy to the organisational level and influencing the EU policy agenda bottom-up. Research: engaging in cutting edge research with some of the top research associations in Europe, including on health professional mobility and quality of care. Management improvement: supporting healthcare delivery to be as good as the best in Europe, through networks, events and projects. Management education: joint European accreditation of postgraduate health management courses with FIBAA (Foundation for International Business Administration Accreditation). OUR KEY CONSTITUENCIES: Senior managers who need to network and share information and intelligence in a rapidly changing health sector. Policy-makers who want to exchange ideas and debate policy, both across Europe and at the EU level. Academic institutions and educators who want to participate in research and share learning amongst their peers across Europe. Its members include:

xxxviii. 1.The Centre for Innovation in Health Management, University of Leeds. 2. David Peat Solutions Ltd. David Peat: ‘Current: Non Executive Director at North West Ambulance Service NHS Trust, Partner at David Peat Solutions Ltd, Honorary Fellow at Manchester Business School. Past: Chair North of England at Community Health Partnerships Ltd, Director Commissioning Development at NHSNW. Education: University of Leeds. … David was involved in the NHS LIFT (Local Investment Finance Trust Initiative) from the start in 2002, recognizing that this provided 20/25 years investment in a 5 or 6 year timescale, but more importantly could rid the East Lancashire area of poor old health care buildings and provide new flexible 21st century buildings’ (www.davidpeatsolutions.co.uk/). 3. Department of Health Social Services and Public Safety, Northern Ireland. 4. Goodwin Hannah: ‘We have led the creation of new inter-organisational partnerships such as academic health science centres in London and Merseyside; and facilitated the acquisition of hospitals by NHS Foundation Trusts. … We currently hold chair and non-executive roles in regional and national organisations in the NHS and sector. We have an extensive board development practice and we have also undertaken confidential and sensitive inquiries into adverse governance issues within boards, clinical services and across health systems. Our work with Manchester Business School has included developing and delivering programmes for current and prospective non-executive directors of NHS Foundation Trusts. These programmes were accredited by Monitor, the NHS FT economic regulator. Our work with other business schools, such as Ashridge Business School in Hertfordshire and Cass Business School in London, has included developing and delivering leadership programmes for directors and senior managers. … Our clients have included almost all types of NHS organisations across England and Wales: hospitals, mental health and community services providers; commissioning organisations; and NHS regional headquarters. We have also worked with the English Department of Health, the Welsh Assembly Government and the Cabinet Office. … We work with boards, executive teams and the emerging NHS clinical commissioning groups to help them identify the … leadership and people challenges they are facing, and to translate them into meaningful, practical action plans for team, personal and organisational development’ (www.goodwinhannah.co.uk). 5. Health and Europe Centre. 6. King’s College, London. 7. King’s Fund. 8. NHS Confederation. 9. Royal College of Nursing. 10. Stockport Metropolitan Borough Council. 11. The Nuffield Trust. 12. University of Birmingham – Health Services Management Centre. 13. University of Durham. 14. University of Manchester, Manchester Business School. 15. University of Surrey – European Institute of Health & Medical Sciences. Individual Members: Prof. Jim Buchan, associate fellow at the Kings Fund. Policy Adviser at Royal College of Nursing. Ms. Pippa Gough. University of Leeds profile: Pippa has 14 years experience of providing consultancy in organisational and leadership development and policy research, initially whilst working as Senior Faculty at the Kings Fund. She has held a number of senior health positions, including that of Director of Policy at the Royal College of Nursing. (www.cihm.leeds.ac.uk). It may seem to some that the RCN support the notion of an increase in the number of jobs for nurses whilst being bedfellows of those who make sure this will not happen.

xxxix. European Public Health Alliance(www.epha.org). ‘The European Public Health Alliance (EPHA) represents over 100 non-governmental (NGO) and other not-for-profit organisations working in support of health in Europe. It aims to promote and protect the health interests of all people living in Europe and to strengthen the dialogue between the EU institutions, citizens and NGOs in support of healthy public policies. The European Public Health Alliance runs projects which receive financial support from the European Commission. The views expressed in this website do not necessarily reflect the official views of the EU institutions. EPHA is a change agent – Europe’s leading NGO advocating for better health. We are a dynamic member-led organisations, made up of public health NGOs, patient groups, health professionals, and disease groups working together to improve health and strengthen the voice of public health in Europe. EPHA is a member of, among others, the Social Platform,* the European Public Health and Agriculture Consortium (EPHAC), the Health and Environment Alliance (HEAL),** and the EU Civil Society Contact Group.***

xxxx. *Social Platform: ‘We fully support the initiatives aimed at promoting and developing social economy and social enterprises across Europe. However, we warn about the danger that member states could disengage themselves from their public tasks, as well as from the provision and funding of public services, in particular in the social and health sector. Therefore, we work to ensure that an adequate legal and financial framework is in place to support the development of social economy and social enterprises. **HEAL: (www.act4europe.org ). Beginning in 2003 as the environmental ‘wing’ of the European Public Health Alliance (EPHA), HEAL was created to bring the health voice to the centre of a wide spectrum of EU environmental policies, and to integrate environmental concerns in public health decisions.***The EU Civil Society Contact Group brings together eight large rights and value based NGO sectors – culture, environment, education, development, human rights, public health, social and women. The members of these sectoral platforms are European NGO networks. They bring together the voices of hundreds of thousands of associations across the Union, linking the national with the European level, representing a large range of organised interests, including Green 10:

The Green 10 are ten of the largest European environmental organisations/networks. They coordinate joint responses and recommendations to EU decision makers. Membership of the Green 10 alone is more than 20 million people. The informal platform of environmental NGOs is composed of the following organisations: European Environmental Bureau (www.eeb.org ), BirdLife International European Division (http://europe.birdlife.org ), Climate Action Network Europe (www.climnet.org ), European Federation for Transport and Environment (www.t-e.nu/), Friends of the Earth Europe(www.foeeurope.org ), Friends of Nature International (www.nfi.at ), Greenpeace European Unit (www.eu.greenpeace.org), WWF European Policy Office (www.panda.org/epo), Health and Environment Alliance ( http://www.env-health.org), CEE Bankwatch Network, c/o Friends of the Earth Europe (www.bankwatch.org ). The accusation that the RCN solely allies itself to business interests is refuted! RCN members will be heartened to learn of their leadership’s connection to such as Greenpeace and Friends of the Earth, and to an organisation that warns governments not to disengage from funding public services!

xxxxi. The European Federation of Public Services Unions (www.epsu.org). The European Federation of Public Service Unions is a federation of independent trade union organisations for employees in public services in Europe. It covers various industries and vocational categories within the public service sector including health. It liases with the ETUC and the European Institutions to establish suitable industrial relations structures with public sector employers at EU level to reach collective agreements on employment issues. A core activity of trade unions is negotiating, on behalf of members, with employers. EPSU’s affiliates concentrate on good pay levels for public service workers at the workplace, the sector and national level. Good working conditions are just as important. The health and social services sector is a large and diverse sector, including many different services such as hospitals, child care, community health services, social work and homes for older and disabled people. We represent 3.5 million health and social services workers across Europe, and are engaged in a wide range of issues on their behalf. The categories of workers range from social worker to doctor to hospital cleaner to medical secretary to nurse. EPSU is the recognised European social partner organisation for workers in the hospital sector throughout the European Union.

xxxxii. The following excerpt of Dennis de Jong’s article, ‘the trade union movement at European level’ (Dennis de Jong, 2010), shows the difficulty facing any trade union that seeks to influence policies on a national level. National policies are dictated by multinational corporations who demand that their puppet governments create a ‘flexible’ and cheap workforce. There are only slight variations in this choice, whatever the name of the UK political party or parties fronting the multinationals.

xxxxiii. ‘Since the mid-1980s, Brussels has been associated first and foremost with Europe’s neoliberal policies. The trade union movement in Europe appears to have been taken in by Brussels’ institutions and thus rendered harmless … (There is a) blue print for a neoliberal Europe: a clear run for unbridled competition, even if this should be at the cost of social rights, market rules for the public sector, and ‘flexibilisation’ of the labour market (for which read: getting rid of protection from dismissal), to name just a few examples. The multinationals got their wish. … The trade union movement plays no role in this scenario. … I would put the blame for the movement’s scant influence on the EU primarily on three factors: (1) lack of sufficient personnel; (2) infection of representatives in Brussels with the EU virus; (3) a complete absence of militancy on the part of the trade unions themselves. … If you compare this to the major corporations’ enormous lobby industry, it’s no wonder that the trade union movement doesn’t get much of a hearing. … To stay critical of European policies, you must be sure to maintain close contact with your supporters, because everything in Brussels is designed to take you in and win you over. … The European Federation of Public Service Unions … does raise important criticisms regarding the continuing introduction of market methods into the public sector.

xxxxiv. Developed in the framework of the Lisbon Agenda, which was to make Europe’s economy the most competitive in the world by this year, this idea included accepting that workers could no longer be offered effective protection against dismissal, and that instead you should direct yourself towards guaranteeing employment in a general sense. Pity if you find it agreeable to work for the same employer for any length of time, because after a few years you’ll have to go looking for another job. And a shame if by coincidence there happens to be a crisis on and there are absolutely no other jobs to be had. But the trade union movement believes that ‘flexicurity’ is good for everyone. Yet this isn’t about ‘modernisation’ but rather an attempt to allow employers to dictate matters. So it’s unbelievable that the unions have adopted such an idea.

xxxxv. In the last few years there have been moments when the trade unions did indeed make a fist of things. This occurred in the response to the Port Services Directive and to the Services (‘Bolkestein’) Directive. Here were two instruments which would have led in each case to extremely adverse effects on the position of workers. The rank-and-file wasn’t prepared to put up with this and offered massive resistance: tens of thousands of dockworkers demonstrated on Rotterdam’s Coolsingel against the Port Services Directive, while it also proved possible to organise large-scale protests in Brussels and Strasbourg. The visibility of so many angry workers meant that the European institution could no longer ignore their interests. The Port Services Directive was withdrawn and the Services Directive amended.

xxxxvi. So, it can be done! And that’s why it’s important to strengthen contacts with the trade union movement in Brussels. At the same time it’s necessary to ensure that pressure on union representatives in Brussels is exerted from within and without: don’t let yourself be seduced by the Brussels institutions, but listen to the rank-and-file, and listen well! Also – invest time and effort in European and international contacts. It will never be financially possible to defeat the multinationals’ lobby, but if you can resist or force changes to legislation in Brussels, it will save you an enormous amount of work on the national level.

xxxxvii. Some may disagree with Dennis de Jong’s optimism. UK unions are not going to call for an end to the hegemony of multinational corporations, and of puppet governments in their pay, for, to do so would be to advocate revolution, and to attempt to overcome military oppression. Unions will continue to engage in peaceful protests, and in pleading for concessions from their masters, and their masters may humour them for a time, throwing them a few scraps fron their whiskey-laden tables, but this will cease when subjugation is complete, and workers are told that they should be grateful for their two slices of daily bread, for they could only be given one, and this will be conveyed to them by their ‘unions’, as subscription-gathering representatives of slaves. It does not matter whether the union is called the RCN, UNISON, or UNITE; same beast. Russell Brand is correct, what is needed is a revolution, a sweeping away of the dictatorship dressed as democracy model of oppression, and of all its representatives, ‘unions’ included. This is very unlikely to happen. You will be fed just enough.

c. Lenin Nightingale 2013



Adams S, Smith R (2012) Nurses are ‘losing their sense of compassion’, The Telegraph, 9 November




Dennis de Jong (2010) http://www.spectrezine.org, 16 March

Donnelly L (2013) NH employees make plea for a pay freeze to secure jobs, The Telegraph, 23 September





Gregory A (2013) Seven care workers arrested after ‘dungeon’ found at care home, The Mirror, 23 October

Howell D (2013) Residents at St Andrew’s Lodge, Basford. were given sleeping pills when they did not need them, Nottingham Post, 22 October



nursing.nhscareers.nhs.uk/why/ pay_work_conditions/pay_comparisons


Parsons E (2013) Ticking Timebomb of Cumbria’s Care Homes, newsandstar.co.uk, 21 October

Rush J (2013) A manager who oversaw “institutionalised abuse” at care home where pensioners died of neglect was handed new job by firm that took over, Daily Mail, 22 October


About leninnightingale

A nurse who for decades challenged the nursing establishment, echoing the voices of the silent many- the downtrodden nurses, students, care assistants, patients, and relatives that the 'system' overlooks. This site will present issues that many fear to engage in, prefering to believe what they are told by the Government's 'Ministry of Truth' (i.e. 'Lies').
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  1. carol Dimon says:

    We all need to consider alternatives on behalf of PATIENT care, whether in the private or NHS sector , regardless of the affect on our own aims eg membership figures or reputation. “Listen to the voices” ie ordinary voices of public or staff. Deal with issues- do not wait until it is the trend.

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  3. carol Dimon says:

    This analysis of course needs taking further .Hopefully somebody will dare to do this.
    The RCN has committee members who are members of seemingly conflicting organisations for example one that promotes strikes or one that promotes the import of overseas nurses to the UK ( European Federation of Nurses Association ). There may well be hidden rationales for this such as trying to infiltrate committees and thus influence policies but it gives an odd picture of the RCN .
    The RCN link to the Manchester Business school is of extreme concern- churning out members who sing the RCN song. Could this be to the detriment of alternative union members or they who oppose some general RCN views? A quick search will reveal that most conference /national committee members/authors are indeed top committee members of the RCN. Is this not highly dangerous? The RCN as any union, primarily exists to support their members. Yet many RCN projects are government funded- does this indicate political links?
    Noticeably alternative union members are missing from NMC committee membership or others. Why indeed, is it the RCN who are required to be committee members of the ICN- to whom only the ICN will speak? Why are alternative unions not acting regarding this? This is not meant to attack the RCN but to explore the many political underlying issues regarding nursing. Do we need an absolutely independent union for nurse and for student nurses?

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