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Joint Future Briefing No 22
 

 

 

Joint Future Briefing

BACKGROUND

In October 2000 Susan Deacon, the then Scottish Health Minister, announced the Scottish Executive's response to the Royal Commission on Long Term Care (Sutherland Report).

Following this, the Community Care & Health Bill 2001 introduces a range of measures designed to meet the residential and non-residential care needs of Scotland's older population

Part 1 of the Bill provides for the introduction of free personal and nursing care of the elderly; regulation of charging for home care services; promotion of choice in care provision; and introduces a new carers' right to assessment for services.

Part 2 introduces measures to enable greater joint working between the NHS and local authorities. This part of the Bill is known as the Joint Future Agenda.

Part 3 refers to GP Lists held by Health Boards. It extends the Scottish Executive's powers to insist that all GPs providing personal medical services in Scotland, not just the principals in a practice, must be on a list maintained by the Trust, bringing them within the provisions of the NHS Disciplinary Procedures and the NHS Tribunal system.

The Bill was passed on 6 February 2002 and will receive its Royal Assent in 4 weeks.

JOINT FUTURE AGENDA

The Scottish Executive set up the Joint Future Group (JFG) in 1999 to improve partnership working between agencies and to secure better outcomes for service users and their carers. Recommendations published in 2000 included:

  • Rebalancing care of older people

  • Improving joint working

  • Planning financial and service management frameworks

  • Charging

  • Establishing good practice

To progress these objectives, Section 2 of the Bill aims at removing remaining obstacles to joint service delivery. For example, the creation of pooled budgets, the delegation of responsibility, and scope for financial transactions between the NHS and local authorities.

Agencies will also be able to delegate functions to one another, to allow, for example, one of the partner bodies to provide all mental health or learning disability services locally, avoiding two or more agencies providing similar services for the same group of people.

WHAT DOES IT MEAN?

There are six main areas where joint working will take place

Balance of Care means better assessment of whether an individual needs residential care or whether additional domicilary services would enable them to remain at home.

Single Shared Assessment means that one member of a multi-agency team, drawing on other professionals, as appropriate should carry out an assessment. All agencies involved in a particular project should agree who does the assessment and accept the outcome, including the budgetary implications.

Information Sharing. The JFG wants information sharing to be introduced across all agencies, leading to information systems integration. Care must be taken to reassure users that the information obtained about them will be treated sensitively following their consent being obtained. A protocol will be issued shortly to deal with this issue and ensure compliance with any relevant legislation, e.g. the Data Protection Act (1998)

Equipment and Adaptations Rehabilitations Services. Agencies are to jointly resource and manage equipment and adaptations services by April 2002, with combined storage facilities being introduced thereafter. A national Strategy Forum has been set up to review existing services and their interaction, to identify standards and make recommendations. This will impact on the work of occupational therapists and the role of OTs will need to be assessed as full integration of occupational therapy services is reached and OTs become more involved in management of the intensive care services.

Intensive Care Management

The current form of care management should be redefined as 'Intensive Care Management'. This service will be for people with complex or frequently changing needs. Staff from different agencies need to be trained to the required level within multi-disciplinary, multi-agency teams.

Joint Resourcing and Joint Management.

Every area/community care service/ individual care user group is expected to introduce joint resourcing and joint management of services for older people from April 2002.

Joint resourcing is about all resources at agencies'disposal

  • Staff

  • Buildings

  • Money

  • Equipment

In recent years there have been examples of joint working between NHS and local authorities. However, whilst there has been some joint resourcing, the Bill will now make it possible to actually pool resources and allow staff from either agency to develop packages of care for individuals irrespective of whether health or local authority money is used. A joint body/single manager, as appropriate will take decisions on the use of these resources.

Joint management brings together the relevant agencies local authorities (social work and housing) health boards and NHS trusts, Scottish Homes under a single manager who can come from any of the specialities listed above.

WHAT ARE THE STAFFING IMPLICATIONS?

An Integrated Human Resources Group has been set up by the Joint Future Unit to "design and develop a joint framework to facilitate the integration of staff as services integrate".

UNISON's Head of Health and Head of Local Government are both members of the group, which has recently held discussion workshops across Scotland to discuss the issues involved.

Several sub-groups have been created to take forward different strands of the HR strategy, who have been asked to report and make recommendations to ministers by the end of April.

Their remits include:

  • Integrated competencies for managers of all services involved

  • A system of secondments to allow opportunities for all staff to develop experience and knowledge in other organisations.

  • A staffing framework, including accountability arrangements to be agreed between the various agencies and the trade unions.

  • Alignment between the varying terms and conditions and pension arrangements, wherever possible

  • Joint training which will support joint community care plans

  • Professional training to reflect joint provision of services and effective teamworking.

  • Flexibility from regulatory bodies to allow dual registration or transfer between bodies, and continued recognition of all professional development requirements

  • Frontline staff developed to meet requirements of new competencies.

To give staff confidence in the new agenda, agencies must set up a joint staff forum, providing a statement of intent and a clear training and organising development agenda by April 2002.

WHAT ARE THE ISSUES FOR UNISON MEMBERS?

There is potential for great confusion amongst members working in Joint Future projects as there is no clear indication who the lead employers will be. Each management grouping will determine which service is most appropriate as the lead employer and Staff may find themselves be working under a manager from a different service than their employer.

At present there are no plans to create a new employer, with both staff and posts able to be seconded or attached to other employers, leaving terms and conditions unchanged. This will create tensions between staff doing similar jobs but receiving different pay and conditions of service.

Where staff are attached to projects, there could be confusion about line management and accountability.

Some staff, e.g nurses and social workers will wish to retain their professional status and will need to maintain professional training so that their registration is kept up to date.

Current managers will not have expertise of the work done by other services, and will need training on conditions in the other services

There is potential for job losses, particularly in management posts which might be duplicated at present.

Adequate training will need to be put in place to ensure staff are familiar with the required competencies if they are expected to undertake new roles

TIMETABLE

Certain aspects of joint working have been ongoing for some time in an informal way, but will now be formalised, There have also been pilot projects in Perth, Glasgow and Dumfries.

Some of the measures listed above are already in place and the rest will be introduced during 2002-03. However, the Scottish Executive has identified key issues that they insist agencies must put in place by April 2002. This "bottom line" includes assessment of resources; deciding which single management arrangements to adopt and deciding whether to "align" or "pool" budgets.

Single shared assessment procedures including the "tool" to be used, must also be put in place by April 2002. Rapid Response/hospital discharge teams and home care support teams are already in place in most areas

Three separate bodies have been set up to consider the sharing of information and guidance is expected early in 2002. This must incorporate the need to obtain explicit client approval, and the protocol must be in place by April 2002.

A Strategy Group was established in June 2001 to consider the issue of equipment and adaptations services with a view to integration. Pilot studies on integrated OT services are ongoing

WHAT IS THE UNISON POSITION AND WHAT MUST BRANCHES DO?

A motion was passed at the meeting of the Scottish Council on 1 December 2001, calling on the Scottish Committee to expedite co-ordination of discussions between local branches. In addition, the Scottish Committee agreed to leave overall organisational and operational oversight with the Health & Community Care Policy Pool.

It further agreed to ensure that presentations were made to the Scottish Council and to the Service Group Conferences in April 2002.

All branches are required to follow the Joint Future Action Plan drawn up by the Health & Community Care Policy Pool as outlined below.

Branches must enter into negotiations with their relevant employers to ensure that employment status is determined and that mechanisms are put in place to protect terms and conditions and to minimise any job losses.

Wherever possible branches must ensure that UNISON is represented on local committees considering these issues.

ACTION PLAN

  1. Each Branch should appoint a Joint Future contact person.

  2. Joint Future should be on all local, branch and Scottish agendas.

  3. In areas where joint conferences have not been held with health and local government branches, they should be organised as a matter of urgency and co-ordinated by the lead officer.

  4. Develop a communications strategy to brief activists on policy and training in partnership and organisation for Joint Future.

  5. Review appropriate UNISON structures at branch and Scottish level to meet the needs of members affected by Joint Future.

  6. New initiatives need to be analysed and advised to the Scottish Organisers of local government and health.

  7. Any Joint Future initiative should be reported to the appropriate policy pool and thereafter will be subject to monitoring and evaluation with a report from the lead officers.

  8. A Conference will be held each year to bring together all branches throughout Scotland involved in Joint Future, including health, local government and the voluntary sector.

  9. UNISON will maintain their input to the Joint Future HR group and papers will be circulated to all branches.

FURTHER INFORMATION:

Community Care and Health (Scotland) Bill Plus Explanatory Notes (and other Accompanying Documents)
http://www.scotland.gov.uk/health/ltc/legislation.asp

Scottish Parliament Information Centre Research Paper 01/18 7 November 2001 (Available from P& I Team)

Joint Future Group Report on progress
http://www.scotland.gov.uk/health/jointfutureunit/p

Joint Future Group Practical Advice
http://www.scotland.gov.uk/health/jointfutureunit/new.asp

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FURTHER INFORMATION:

Community Care and Health (Scotland) Bill Plus Explanatory Notes (and other Accompanying Documents)
www.scotland.gov.uk/health/
ltc/legislation.asp

Scottish Parliament Information Centre Research Paper 01/18 7 November 2001 (Available from P& I Team)

Joint Future Group Report on progress
http://www.scotland.gov.uk
/health/jointfutureunit/p

Joint Future Group Practical Advice
http://www.scotland.gov.uk/
health/jointfutureunit/new.asp