UNISON Scotland welcomes the opportunity to comment on the Scottish Executive Consultation on Redrawing NHS Boundaries in Argyll & Clyde, but would preface any detailed comments on the options posed in the consultation with an assertion that we totally oppose the decision taken by the Minister for Health and Community Care to abolish the Board in the first instance.

UNISON Scotland has the largest trade union membership in NHS Argyll and Clyde, NHS Greater Glasgow and NHS Highland with almost 20,000 members across most groups of staff within the NHS.

We also have a large number of members within local authorities, in this same geographical area, which any changes of Health Board areas will impact upon.

Our submission is therefore based on wide consultation with thousands of Health and Social Care workers delivering services in the Argyll & Clyde and surrounding areas. These staff, in addition to their families and friends, and other service users, rely heavily on good, modern, safe and sustainable health service provision.

The proposed change has not been sought by UNISON and the proposals represent the wrong solution to the financial problems in Argyll and Clyde which were being addressed by the Financial Recovery Plan.

Any change to boundaries along the lines of any of the proposed options is likely to present significant organisational challenges to all three Health Boards and their staff.

NHS Highland is still currently restructuring to reflect the national NHS changes, in particular, the creation of CHPs. NHS Highland also has its own financial challenges at present, and the potential imposition of a further major change of this nature is likely to impact significantly on other priorities for restructuring/improvement which NHS Highland is currently taking forward.

RESPONSE

The abolition of NHS Argyll and Clyde makes no sense to us, particularly at this time, when the Scottish Parliament has yet to consider the proposals contained in the Kerr Report, let alone to make decisions on its implementation. We feel at the very least that any decision should have been held in abeyance until the recommendations of the Kerr Report had been fully considered, especially with regard to cross-health board working for the delivery of Health services.

In addition, following the abolition of NHS Trusts, I April 2004, all Health Boards have had to undertake major reconfiguration which is still ongoing in Greater Glasgow. To add another tier of restructuring at this time, will cause major logistical and operational problems.

Any discussions on the overall structure of health boards across Scotland, if the Executive feels this is required, would and should require wide consultation. No decisions should be taken in isolation without a wider assessment of the effects on the rest of the service, and indeed the communities affected.

In this connection we call on the Scottish Parliament to rescind this decision forthwith.

In Part One of the consultation document details some of the reasons for the dissolution of NHS Argyll & Clyde and we would comment on these reasons as follows:-

UNISON is unable to constructively comment on the 3 options for the following reasons:-

(1) lack of financial information and planning;

(2) no indication of proposed models of care i.e. will the two blue light hospitals remain, or will they be replaced by either ACAD's or Minor Injury Units;

(3) no information on how options impact on NHSGG and NHSH clinical strategies;

(4) whether there will be any impact on composition and functions of CHP's;

(5) impact of David Kerr report;

And it is also our view that the following should have been included:-

UNISON also believes that for the consultation document to include options that have been rejected in the document and to seek comments on these has caused uncertainty with the public and stakeholders who may respond to the document.

There are specific issues for us relating to any of the options, which would include the fact that NHS Highland has a very significant partnership with The Highland Council, with which we are coterminous, and this may be adversely affected by a requirement to work with all (or part) of another local authority area. There are various potential service issues relating to the change in boundaries, some of which are outlined below.

The view of UNISON NHS Highland is that Option 1 is the "least worst" option in terms of a Highland perspective.

As stated above, we are unconvinced by the limited arguments for excluding a variety of options including that of keeping the existing Argyll & Clyde structure, but it seems to us that of the available consultation choices, Option 1 may have the fewest disadvantages, due to the relative logic of working with another complete local authority area, rather than splitting this up further. However, the problems inherent in increasing the North-South scale of a revised NHS Highland by around 50% to a total distance of approx. 300 miles, combined with an enormous increase in island(s) cover, should not be under estimated. We have considerable concerns about the feasibility of providing equality of access to appropriate healthcare services over such an enormously increased area. We have not been provided with detailed information about the resources already in place in the Argyll and Bute part of the Argyll & Clyde area, or about the way in which Corporate, or other area-wide services such as Radiation Protection, Electromedical Equipment Management, Health Promotion, provision of Sterile Services, etc. etc, are currently provided in Argyll & Bute.

Whatever the outcome of the current public consultation exercise, it is essential that there is meaningful involvement of staff in all areas in planning future arrangements for the management and provision of services. From the outset, Staff Governance principles must be applied fully to all staff regardless of their current employer Health Board.

The three main options in the consultation document all have a major destabilising effect on the organisation and delivery of fragile local health and community services:-

STAFFING

UNISON has substantial concerns that both NHSGG and NHSH current recruitment and HR strategies may be liable to prejudice the future interests of employees within NHS Argyll & Clyde following any implementation of boundary changes. This could impact on present levels of protection and lead to possible insecurity for current NHS A&C staff. The current situation is having a fundamental impact on staff motivation and local recruitment and retention in NHS A&C.

UNISON would expect the current policy of no compulsory redundancies to be honoured through this process should it proceed.

There may be complex employment law issues which impede the local HR strategies on re-structure and re-design of services within GGHB and NHSH.

Conclusion

This submission, as stated above, is based on wide consultation with thousands of Health and Social Care workers delivering services in the Argyll & Clyde and surrounding areas. We believe that the current proposals represent the wrong solution to the financial problems in Argyll and Clyde which were being addressed by the Financial Recovery Plan.