Along with the obvious challenges presented by the restructuring of the NHS1 and the £20 billion productivity gain (the Nicholson Challenge), the NHS also faces a number of other issues. Demographic changes towards an ageing population mean that people are living longer, and more people are living with long-term conditions. Social changes mean that families are more dispersed, resulting in older people being more isolated; more single people living farther away from home with less family support; high levels of per capita income and educational attainments have increased expectations, and people want more personalised, patient-centred care. Better diagnoses and treatments have improved the health of the nation, and will require further funding in the future.

The Royal College of Nursing (RCN) has long known that the key ingredients for facing these challenges are to invest wisely in frontline staff and to constantly review service provision, to ensure that the health service is responsive to and adapts to meet …