Ken Jarrold on NHS stability

The foundation trust process in England is highly significant, but it feels more like organisational development rather than structural change. England and Scotland have a real opportunity to spend their stability dividend. So, what to do with all that time and energy that might have been expended on major reorganisation?

Younger managers find it difficult to believe that there was no significant nationwide structural change from 1948 to 1974. A manager joining the NHS on 5 July 1948 and retiring in 1974 had lived in a familiar landscape for the whole of his or her career, not distracted by frequent reorganisations.

The cost of change is usually calculated in terms of early retirement packages, office accommodation leases and new signs. The real cost is much greater, including organisational paralysis, loss of performance and the personal costs of disrupted careers, lost opportunities for training and development, broken teams and relationships.

Even when jobs are plentiful, as in 1974 and 2002, the other factors still apply and there are the additional dangers of over-promotion: this is what happened to me and many others in 1974. TS Eliot wrote The Waste Land 26 years before the NHS was born, but his words have proved true for generations of managers: "April is the cruellest month".

The case for structural change is often compelling and widely accepted. I have met few people in Northern Ireland or Wales who see no need for it. However, it is expensive and not to be undertaken lightly, and the period of stability in England and Scotland is welcome. So how should the stability dividend be spent? Improving working lives is one priority. The rehabilitation of the professions, and most urgently of nursing, is important both to working lives and to treatment and care.

In recent years, the genuflection to multiprofessional working has extended to a distrust of the professions. I have been dismayed by the reluctance to provide unidisciplinary programmes in leadership and management on the grounds that silos will be strengthened.

Of course, multiprofessional team working is vital to patients, clients and carers. However, this needs to come from a base of strong and confident professions proud of their traditions and open to change.

It is vital to patient experience that treatment and care are delivered by competent and knowledgeable professionals confident in their role and proud of their traditions. Nowhere is this more true than in nursing, which is the most important process in care and plays a major part in treatment. High standards of nursing will deliver dignity, privacy and humanity in care.

I had the privilege to sit at the feet of nursing luminaries Dames Kathleen Raven and Muriel Powell, Trevor Clay and Christine Hancock. They taught me to value nursing professionalism at its strongest. Readers of this column may expect to hear more about nursing in the weeks ahead.