The RCN Congress can be relied upon to provide a bit of entertainment every year. By and large, the basic premise is that more, better-paid nurses are needed.

They are not necessarily wrong, as this US study finds. Nurse prescribing has been evaluated as broadly safe; and nurses deliver significant amounts of chronic disease management in primary care (making good money for GPs via the QOF). Nurses' important role in appropriate workforce substitution has been know for a good while now.

Nurses matter to good-quality, cost-effective healthcare.

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At times in the past, the RCN has bitten off its nose to spite its face in the approach to lobbying its cause.

However, this year, their approach is a bit shrewder than some of the previous sawn-off shotgun venting. The RCN's 'Frontline First' campaign team have made in-depth study of 21 trusts, and found that 54 per cent of nearly 10,000 posts due to be cut are frontline clinical posts. They also state that nursing posts account for 46 per cent of identified workforce cuts.

The focus on a smaller sample of trusts, and going into more depth, allows the RCN's figures to seem more credible.

The DH's response, in the person of NHS Supreme Soviet Chair Comrade Sir David Nicholson, has been to say, ""There is no excuse to cut back on services that patients need when the NHS will receive an extra £11.5bn of funding. The NHS does need to become more efficient, but savings must not impact adversely on patient care. We are clear that every penny saved from efficiencies will be reinvested in patient services. We also have 2,677 more nurses now than we did in 2009".

A DH spokesperson added, "the government is getting rid of bureaucracy and clinically unjustified targets so that nurses are freed up to do what they do best – taking care of patients. We are also protecting the NHS, ploughing in an extra £11.5 billion of funding".

Mmm. And inflation is taking out how much of that £11.5 billion?

There is a case for change in how care is provided, and providing care in the future exactly as it has been provided in the past is not the answer.

Yet the ongoing failing to make the case that care must be configured differently to improve patient outcomes (and, probably, the working lives of staff) leaves this goal wide open.