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Summary of key proposals in the Department of Health's document, Health Reform in England: update and commissioning framework, and an outline of critical issues for nurses and nursing.

This is an extensive programme of reform. The OJEU notice is a controversial element but it is critical to see it as part of the broader agenda. Some aspects of this are potentially just as challenging, such as competitive tendering and demand management, whilst others, like the focus on standards and clinical leadership, present opportunities. Overall many of the key principles informing this agenda are ones the RCN would support, however critical questions still remain about what the Governments "end game" is. As always the real test will be the translation of policy into practice and this is a process nursing and the RCN mist play a leading role in.

For further information, please email papa.ukintl.dept@rcn.org.uk