Briefing 69 on...
NHS Reform (Scotland) Bill
This briefing paper provides an overview of the
NHS Reform (Scotland) Bill as introduced in the Scottish Parliament
on 26th June 2003. This covers the first draft of the
Bill as it has yet to have had a reading in the Scottish Parliament
or be examined by any Parliamentary Committee.
In drafting this Bill the Scottish Executive
intends to legislate to abolish NHS Trusts, establish community
health partnerships, ensure co-operation in delivering regional
services, increase public involvement and promote health improvement.
All of these policy objectives will be underpinned
by new powers for the Scottish Ministers to intervene in the case
of service failure, as a last resort, to ensure that health care
is delivered to acceptable standards.
Each of the issues are described further in the
Dissolution of NHS Trusts
Although the Scottish Executive expects that
the remaining NHS Trusts will be dissolved voluntarily using existing
powers; the Bill will remove all references to NHS Trusts from
the Statute Book.
Community Health Partnerships (CHP's)
The Bill makes provision requiring Health Boards
to submit for approval by the Scottish Ministers schemes for the
establishment of CHP's, which would cover the whole Health Board
The development of community health partnerships
(CHPs) are seen by the Scottish Executive as a key building block
in the modernisation of services, with a vital role in partnership,
service integration and redesign.
The policy intention is to see CHPs, as successors
to Local Health Care Co-operatives (LHCCs), having a more consistent
and strengthened role in service planning and delivery, with better
accountability to local communities.
This will also include the development of a local
public partnership forum (PPF) for each CHP to support effective
dialogue with local communities.
It is not intended that CHPs should become independent
bodies separate from Health Boards, but that they should have
a statutory function within Boards, thereby providing those involved
in the provision of community based care a greater say in the
design and delivery of services.
The Scottish Executive believes that there are
some services that may be better carried out at a national or
regional level. One example is the Managed Clinical Networks (MCN's)
for cancer services which are organised on a regional basis.
This requires closer co-operation between Health
Boards and other agencies (such as the Scottish Ambulance Service,
NHS24 etc). The Bill provides Health Boards with a statutory duty
to co-operate with each other with a view to securing and advancing
the health of the people of Scotland.
The Scottish Executive believes that their current
powers to intervene in any part of the NHS that is failing to
meet key standards are too slow and cumbersome. The Bill therefore
allows Ministers to transfer responsibility for failing services
or those likely to fail, to another Health Board or expert team.
Before invoking these powers the Executive should
have explored other means for restoring the service, or quality
The Bill will impose a duty to secure public
involvement on Health Boards and Special Health Boards while abolishing
local health councils and replacing them with a new public involvement
This new body, the Scottish Health Council, will
monitor the performance and effectiveness of Health Boards in
relation to public involvement, and will report regularly on the
To aid the Scottish Health Council there will
be Local Advisory Councils in each Health Board area, providing
information on local views relating to the involvement activities
of their local health services.
The Local Advisory Councils are also expected
to develop good links with local voluntary organisations and patient
groups to promote good communication and partnership between all
those with an interest in public involvement.
The Bill provides Ministers with a specific duty
to promote health improvement. It enhances both Ministers and
Health Boards capacity to act, other than through the NHS and
voluntary organisations as at present, and to provide a link to
the community planning agenda.
This gives Ministers the powers to allocate funding
directly in support of health improvement as well as allowing
greater opportunities to direct how such monies are spent by local
authorities and other bodies.
The implementation of this Bill will have an
impact on the organisation of the NHS in Scotland. There are a
number of implications of which members should be aware.
Although UNISON Scotland generally supports the
abolition of NHS Trusts there may be implications concerning the
transfer of Trust staff. The Community Health Partnership's also
raise staffing issues, especially concerning those who may be
directly employed by Local Health Care Co-operatives.
There are also other implications relating to
public involvement with some concern that the new Scottish Health
Council will be too centralised.
Action for Branches
This briefing is primarily for information purposes,
however branches should look at the Bill and discuss the implications
for members and for the NHS in general.
UNISON Scotland will also be responding to a
separate consultation on Community Health Partnerships, which
will be on our website.