BETTER HEALTH, BETTER CARE
UNISON Scotland's response to the Scottish Government
Consultation on Better Health, Better Care: A Discussion Document
UNISON Scotland recognises the challenges described
in the discussion paper and broadly welcomes the Scottish Government's
proposals that build on existing policy. The NHSiS has been the
subject of considerable change over recent years and staff need
some respite from new initiatives to ensure some stability in the
delivery of services. We particularly welcome the concept of a Minister
for Health taking a cross cutting approach to health and most of
the new policies outlined in the paper as these reflect priorities
set out by UNISON over a number of years.
UNISON Scotland supports greater involvement of patients
in the design and delivery of care. This is reflected in our long
standing support for direct elections to health boards. However,
the ‘patient voice' must complement and not replace the ‘staff
voice'. The ‘staff voice' in partnership is the key to informed
policy making and effective implementation. Scotland has a decade
of partnership working which has a proven track record in delivering
a better NHS Scotland, better services and greater patient satisfaction.
The new Scottish Government should capitalise on ‘partnership working'
as a key delivery mechanism for its plans. We are well ahead of
the rest of the UK in making a success of genuine partnership policy.
Partnership Working with the Staff Side is the best means for the
Scottish Government to achieve its objectives for NHS Scotland.
Partnership working is the strong enabling
force which will drive and support; service re-design, role re-design,
increased capacity and skill and better delivery.
Decisions on centralisation must be evidence
based, realistic in terms of staff recruitment and retention and
ensure clinical safety.
UNISON Scotland believes further detail is required
in terms if how the proposed waiting time guarantees would
function e.g. what conditions would it cover, role and freedom of
clinicians to determine need?. There are also questions over the
boards' abilities to fund/resource blanket waiting time guarantees.
UNISON Scotland also believes that a key issue in
determining the success of the provision of service should also
be the outcome of treatment programmes - not just how long
someone had waited for treatment.
UNISON Scotland recognises that NHS Scotland has a
duty to use public money wisely and that we all have a right
to know that money is being used effectively and efficiently to
improve patient care. UNISON Scotland believes that this can be
achieved through promoting and developing the Scottish NHS model
based on co-operation not competition
UNISON Scotland believes that there is no place for
the private sector in capital investment such as hospitals,
GP surgeries; for clinical services delivery (such as at Stracathro);
for community services (such as the ‘Keep Well' pilots); or the
provision of Facility Management Services.
NHS Scotland, through NES, must develop effective
strategies to ‘grow our own' expertise and skills across
all occupational groups, providing skills escalators and
career paths using the KSF framework, backed by equitable investment
across all job families.
The role of the voluntary sector in the provision
on health services cannot be underestimated. However, clarity is
needed in terms of the investment strategy, procurement rules and
assurances on pay and conditions (including pensions) of those involved
in delivering services to ensure the use of voluntary service does
not become another route to contract out services.
UNISON maintains the high cost of large acute projects
is an impediment to the development of community-based services
and the shift of resources necessary to invest in altering
the balance of care.
UNISON fully supports the strategy of addressing health
inequality. We also welcome the recognition within the consultation
document of the link between poor health and other social factors.
We strongly support joint working to reduce the inequalities in
people's environments, income, employment, educational attainment,
skills, housing and other issues that have the biggest impact on
UNISON Scotland supports the abolition of prescription
charges, as we believe them to be inherently unfair, inequitable,
illogical and inconsistent
UNISON sees the introduction
of public sector equality duties as a step towards a society where
diversity is accepted as normal and equality as a benefit to everyone.
New priority should
be given to the transition of services for Young Persons to adulthood,
particularly for the most vulnerable ‘looked after' children.
Allied health professionals
are enablers of self care and self management abilities and require
deployment in sufficient numbers and with proper strategic leadership
at Board level to deliver this agenda.
NHS should use existing
best practice PIN policies to ensure parents working in NHS are
given every support to give their children the best possible start.
cleaning services are key to tackling health acquired infections.
There is a need to
re-focus the E Health Strategy.
UNISON Scotland welcomes the
opportunity to comment on the Scottish Government's Discussion Document:
Better Health, Better Care. UNISON is Scotland's largest
public sector trade union representing over 160,000 members delivering
public services, more than 60,000 of whom work in the NHS. We represent
the majority of the employees in the National Health Service in
Scotland including senior managers, nursing staff at all levels,
Allied Health Professionals, administrative and clerical, ancillary
staff, laboratory staff, technicians and paramedics. We broadly
welcome the thrust of the consultation document on the future of
the NHS in Scotland:
must do all we can to put the expectations of people and patients
at the heart of decision-making in NHS ”(Nicola Sturgeon)>
Scotland fully supports greater patient and community involvement
in health planning and service re-design. Our response to the Kerr
"UNISON supports the KERR recommended actions on p54/55. Our 58,000 members
in Scotland and their families are users of NHS services and deserve
a voice as 'consumer' interests. "
‘patient voice' must however complement and not replace the ‘staff
maintains that the workforce is the key to NHS capacity and service
re-design. It is NHS staff who will deliver the NHS of the future
and therefore their representatives must have a strategic role in
the implementation of any changes. Representatives should be involved
at all levels during the development of the implementation plan
rather than asked to comment on a finished plan. Staff are in a
unique position to contribute to the plan as they view the health
service from within as providers and as patients or carers. Partnership
working with staff representatives needs to be embedded in structures
at all levels (within the Scottish Executive Health Department through
the Scottish Partnership Forum, at Regional Planning Committees,
in Area Partnership Forums and Community Health Partnerships) to
ensure the success of Better Health, Better Care.
‘staff voice' in partnership is key to informed policy making and
effective implementation. Scotland has a decade of partnership working
which has a proven track record in delivering a better NHS Scotland,
better services and greater patient satisfaction. The new Scottish
Government should capitalise on ‘partnership working' as a key delivery
mechanism for its plans. We are well ahead of the rest of the UK
in making a success of genuine partnership policy. Partnership
working with the Staff Side is the best means for the Scottish Government
to achieve its objectives for NHS Scotland.
keen to ensure that UNISON members' experience as health care providers
informs the process of change and is integral to the development
of the Scottish Government's New Action Plan for healthcare in Scotland.
The Challenge of Health and Wellbeing
UNISON Scotland is committed to
transforming and supporting public services. Our Revitalise Scotland's
Public Services principles underpin our approach to the Scottish
public service model. We welcome the Scottish Government placing
these values at the heart of its policy making. We believe the private
sector has no place in helping NHS Scotland deliver better health
and better care, be that in the construction and maintenance of
new NHS facilities (PFI/PPP); clinical service delivery, (e.g. the
Stracathro contract); community services (e.g. care of the elderly),
‘Keep Well' pilots; support services,( e.g. facilities management,
The NHS in Scotland has a highly
trained and committed staff complement. There is a need to build
on the well of human resource through a culture of improved leadership,
collectivism, and engagement with all staff using the partnership
approach described above
and sustained investment in education and training for all
NHS staff groups is the key to unlocking capacity and to modernising
models of NHS care.
UNISON Scotland recognises that
since the publication of "Building a Health Service: Fit for the
Future” in 2005, new insights, evidence and experiences have emerged
which need to be considered in terms of progressing an action plan
for the years ahead.
UNISON Scotland notes the approach
to deliver on the Scottish Government's strategic vision in terms
of health and wellbeing in Scotland, and the proposed new policies
outlined in the consultation document and comment on these below.
CHAPTER 1 - IMPROVING YOUR EXPERIENCE
UNISON Scotland notes the focus
of the consultation document "putting the needs of patients at the
centre of our health Service”. However, we also wish to highlight
that the challenge of change can only in our view be achieved through
mature partnership working with staff side organisations in NHS
Scotland at all levels.
Partnership working is the strong
enabling force which will drive and support:-
increased capacity and skill
This can be achieved within an
employee relations environment which is stable, positive, constructive
Patient Voice - Election to
Our 160,000 members in Scotland
and their families are users of NHS services and deserve a voice
as 'consumer' interests. UNISON believes that directly elected Health
Boards would strengthen the public and patient voice. We assisted
in drafting of the Non-Executive Bill on this issue proposed by
Bill Butler MSP in the last parliamentary session and are therefore
supportive of the commitment to direct elections by the new Scottish
Government. Of course further consultation will be required on the
detail of how boards would be elected.
We accept that many members of
the public believe that NHS care should be delivered locally. UNISON
supports the concept of local care which is safe, effective and
sustainable. We accept the premise that the management of long-term
conditions must succeed at local level, otherwise demand on acute
services will continue to increase and will never be met. There
is a need to invest in primary care and to co-ordinate the management
of long-term conditions, through areas such as multi-disciplinary
teams, integration of Health & Social Care; Continuing Care
of the Elderly, care co-ordination/case management; community hub
Nevertheless, UNISON recognises
that there are cases where centralisation is the most appropriate
method for delivering specialised services. We would much prefer
to see centralisation in Scotland of, say, Cardiac and Thoracic
services, rather than Scottish patients having to go to England
for surgery, as used to happen with Heart Transplants, because there
was no expertise in Scotland.
The debate on centralisation should
also involve the future of the Golden Jubilee Hospital in Clydebank,
currently being used as the National Waiting Times Centre, and soon
to become the West of Scotland Regional Heart and Lung Centre as
well as a centre of excellence for major and minor orthopaedic surgery,
with two additional operating theatres due to open at the end of
UNISON believes that decisions
on centralisation must be evidence based and realistic in terms
of staff recruitment and retention and ensure clinical safety.
Waiting Time Guarantees
UNISON Scotland believes further
detail is required on how proposed waiting time guarantees would
function, e.g. what conditions would it cover, role and freedom
of clinicians to determine need? There are also questions over the
boards' abilities to fund and resource blanket waiting time guarantees.
UNISON Scotland also believes that a key issue in determining the
success of the provision of service should be the outcome of treatment
programmes - not just how long someone had waited for treatment.
of a maximum whole journey time, complemented by annual targets
to reduce the median waiting time, could ensure continued improvement.
This would leave clinicians greater flexibility to use their own
professional discretion about the order in which patients should
A blanket waiting time may have
the inadvertent result of centralising services in some health board
areas e.g. NHS Highland, as many consultants travel to outlying
areas when there are enough patients for a full list to be treated.
As waiting times come down, these remote clinics become less viable,
resulting in a requirement for patients to travel to access clinics
more quickly - when they may have preferred to have been seen locally.
Locally Delivered Services
UNISON supports the concept of
local care which is safe, effective and sustainable. We accept the
premise that the management of long-term conditions must succeed
at local level, otherwise demand on acute services will continue
to increase and will never be met. There is a need to invest in
primary care and to co-ordinate the management of long-term conditions.
UNISON Scotland believes that the
rights of patients should be made clear in NHS Boards patients'
charters as well as a minimum standard of accessibility to information
for service users. These should complement the rights of staff enshrined
in the Staff Governance Standard: to be properly trained;
well informed; involved in decisions which affect them; provided
with a safe working environment; treated fairly and consistently.
UNISON Scotland recognises that
it is important that patients are supported by an effective transport
system if they need to travel far from home in order to receive
the kind of care that is only available in a specialist centre.
However, we also believe that transport
issues are much broader than this, and should include the access
of staff to transport to work as well as charges for parking for
staff, patients and visitors at hospitals in Scotland. These issues
must also be considered and transport and accessibility issues must
be considered early in the planning process of where and when services
will be delivered.
Information and Communications
UNISON Scotland welcomes the commitment
to improving and using technology to deliver health services. However,
we do not believe that this can be realised without significant
financial investment to set up the infrastructure required.
acknowledges the need for an electronic patient, record and quantum
leaps in ICT provision for case management and care co-ordination.
There is partnership engagement around the E-health agenda. However,
UNISON maintains that NHS Scotland is too embroiled in 'partnership'
with private sector companies around key ICT Infrastructure Projects.
We do not believe that this will lead to long-term effectiveness
capacity and capability in ICT needs to be re-introduced and developed
within NHS Scotland to be strategically and operationally effective
in the long run.
Improvement Plans must be supported by shared budgets and shared
accountability for performance. Best Practice should be identified
and shared from current effective examples of joint working. There
is a cluttered planning landscape around joint working and there
needs to be greater clarity around the role and make up of local
community planning partnerships and a clear vision and framework
from the Scottish Government around outcomes and accountability.
also be recognised that the voluntary sector has a major role in
the planning, commissioning and provision of services, as both service
providers and accountable partners. There is a need for relevant
information to be made available to all partners in the community
and Rural Challenge
of locally based services is problematic in a number of remote and
rural areas in Scotland. It is sometimes not safe or sustainable,
not to mention best use of NHS money, to deliver services in some
areas and therefore patients need to travel. A focus on a transport
and accommodation system which supports patients (and their families)
travelling to receive care is vital. It is also important
that the high transport costs of NHS staff working in remote and
rural areas in Scotland are addressed.
services into a community is not a same cost option. Remote and
rural services cost more to deliver and the provision of services
in these areas requires different issues to be considered from urban
areas. The provision of out of hour's services in rural areas such
as NHS Highland is very expensive and whilst health outcomes and
the value of money for these services are reviewed the extra cost
is borne by the Board.
reduction and improved access to the highest quality of care could
be achieved through the rise of tele-health technology. Remote and
rural communities have highlighted in the past that services designed
for urban locations are not always appropriate for island and remote
and rural areas in Scotland. It is also important to recognise that the retention of health
services in some remote and rural areas is what makes many communities
It is important that health policy
is not designed to deliver a one size fits all approach, as this
would effectively reduce the Scottish Government's ambition to deliver
services as close to patients as possible.
Systematic action to address staff survey concerns
will improve staff morale and translate into improved patient experience
on NHS Scotland. A particular priority is a Scotland wide campaign
to eradicate bullying and harassment, in support of the good work
achieved around violence to staff. As UNISON Scotland's recently
survey on violence shows, the NHSiS has made better progress in
improving the monitoring of violent incidents that other public
are extended to enhance access then concerted efforts need to be
made to ensure the full team of staff who support practice operation
are on proper Agenda For Change contracts to safeguard the correct
payments for working unsocial hours. Clinical staff have benefited
from enhanced payments for Waiting Time initiative work denied to
staff groups covered by Agenda For Change.
CHAPTER 2 - BEST VALUE
Scotland recognises that NHS Scotland has a duty to use public money
wisely and that we all have a right to know that money is being
used effectively and efficiently to improve patient care. UNISON
Scotland believes that this can be achieved through promoting and
developing the Scottish NHS model based on co-operation not competition,
and in particular through:
- Directly employing and resourcing cleaning
staff as an important element in improving hospital cleanliness
and tackling infection.
- Developing a Food for Good programme
of improvement to hospital catering that ensures that food is
nutritious locally sourced and prepared by directly employed staff
on fair pay and conditions.
- Ending incentives for the development of
private sector involvement in NHS care and provide a level playing
field between private finance and conventional procurement. Making
sure public procurement ensures full compliance with Equality
- Employing student nurses on a proper salary
as part of a series of measures to tackle drop out rates; reducing
dependency on agency nursing and tackling exploitation and discrimination
against overseas nurses, particularly in the private care sector.
issues which must be considered in terms of investing to developing
sustainable services which address the needs of a changing population
in as efficient, effective and affordable way are;
UNISON Scotland believes that there
is no place for the private sector in capital investment( such as
hospitals, GP surgeries); for clinical services delivery( such as
at Stracathro); or for community services, (such as the ‘Keep Well'
pilots). UNISON Scotland has long been a critic of PFI/PPP over
quality, costs, accountability, inflexibility and the effects on
the terms and conditions of staff. Scottish people want to see
public funding of public services and an end to profiteering at
the expense of hospital patients and the taxpayer.
UNISON Scotland recently asked
all health boards for details of any PPP/PFI contracts and Lothian
Health Board refused to give details of the contract for the Edinburgh
Royal Infirmary. However, following representations by UNISON, the
Scottish Information Commissioner ordered NHS Lothian to release
the whole Edinburgh Royal infirmary PFI Contract. Other Board's
are now responding with greater transparency.
UNISON Scotland's recent report
‘At What Cost?' further highlights the huge additional cost of PFI,
the unnecessary secrecy and most importantly a way forward for capital
investment without PFI. Whilst we have no difficulty in principle
with the introduction of a not-for-profit Scottish Futures Trust
we believe that action can be taken now to abolish PFI without any
lengthy constitutional wrangling.
UNISON believes that a new capital
procurement regime should be established quickly which would enable
health boards to develop essential infrastructure in the most efficient
manner possible, without the expense of PPP/PFI until longer-term
solutions such as the Scottish Futures Trust can be developed.
Investment in all NHS staff
Investment in public services must
include investment in staff and training. Partnership Working is
the key to empowering front-line staff. National Strategies for
service change should be informed by debate in the renewed and refocused
Scottish Workforce and Governance Committee and delivery will be
assisted by the reform of SEHD structures. Strong and effective
leadership is required. Develop its staff and NHS Scotland will
develop its services and enhance quality. The wealth of knowledge,
skills and experience of all NHS staff should contribute to change
and innovation. Best practice needs to be systematic. The reference
to improving and integrating workforce-planning processes for all
staff groups on Page 8 of the consultation document does not make
the link to education and training for staff, which is a vital element.
NHS Scotland, through NES, must
develop effective strategies to ‘grow our own' expertise and skills
across all occupational groups, providing skills escalators and
career paths using the KSF framework, backed by equitable investment
across all job families.
recognises the high levels of current investment in NHS Scotland.
There are however areas where value for money should be examined,
economics of existing and any newly proposed PFI projects, including
the quality and value for money of the provision of ‘soft fm' services.
use of Private consultants by SEHD and Boards to support strategic
projects. There is a need to build up in-house expertise in NHS
Scotland and for it to be a ‘smart' client when it comes to commissioning
large projects, particularly around capital projects.
impediment of the high costs of large acute PFI projects to the
development of community based services and the shift of resources
necessary to invest in shifting the balance of care.
Standards and Quality
Standards can only be raised by
improvements, not only in clinical governance, but also Staff Governance
Role of Voluntary Sector
The role of the voluntary sector
and social economy in the provision on health services cannot be
underestimated. However, clarity is needed in terms of the investment
strategy highlighted on Page 8 of the consultation document, and
assurances on pay and conditions (including pensions) of those involved
in delivering services and ensuring use of voluntary service does
not become another route to contract out services.
Community Based Services
Whilst hospitals can dominate public
debate on the NHS - 90% of patient contact is in community settings.
Action is required to:
- Make more use of salaried GPs working in
NHS health centres supported by other directly employed community
- Develop and resource the implementation of
the 21st Century Review of Social Work.
- Invest in Community and District Nurse Services
- Expand community dentistry staffed by salaried
dentists and their essential support staff.
UNISON Scotland notes the proposal
on Page 8 of the consultation document to "develop incentives
to shift the balance of care” from hospital to community based
services. It is important that it is recognised that delivering
community based services is not a cheap option; clarification will
be required in terms of how this will be funded.
In this connection, however, the generic "Community
Health Nurse” model, proposed by "Visible, Accessible and Integrated
Care, the Review of Nursing in the Community in Scotland”, which
will see a new role of Community Health Nurse replace the time honoured
traditional roles of district nurse health visitor, school nurse,
public health nurse and family health nurse, causes a number of
concerns for UNISON.
Since the publication of the review, consultation
has taken place in many areas throughout Scotland, including the
four development sites in which the model has been tested since
April 2007. In each of these consultation processes, concern has
been raised by practicing nurses, that the impact of the proposed
changes to their roles will result in a reduction in the standard
and range of services that are already available to the people of
It is feared that rather than enhancing nursing
practice within Scotland, the model being rolled out will have a
detrimental effect on motivation, participation and retention of
the many highly skilled and experienced community nurses practicing
within Scotland. It is also feared that the generic post will mean
a dilution of skills, with no benefit to community nursing practice
other than apparently to cover numbers.
One of the primary concerns of staff in relation
to the review of community nursing is that the vital elements of
current posts focussing on public health promotion and ill- health
- prevention will, as a matter of course, be relegated in terms
of priority, against delivering acute health services. This would
be in direct contradiction to the fundamental aims and objectives
of both the review and the stated aims of "Better Health, Better
Care”, particularly in relation to combating health inequalities,
drug misuse, early years provision and services targeted to ill-
health prevention and health education services.
Scottish Government must address the concerns of community nurses
on these issues in order to deliver on the aims and objectives set
out in Better Health, Better Care”.
CHAPTER 3 - TAKING RESPONSIBILITY
Scotland supports the key focus within this section of the consultation
document in terms of helping people to sustain and improve their
health and encouraging and supporting people to take more responsibility
for their health and well being.
Improving Scotland's health should
be the priority recognising that poverty is the underlying cause.
UNISON Scotland believes that key priorities should be to:
- Build on existing cross-cutting partnerships
to address inequalities in health through health promotion and
by addressing issues such as housing, employment, food labelling
and fuel poverty.
- Promote health at school through education
support staff, teachers and others supported by school and community
nurses. Provide free, nutritious school meals, healthy snacks,
sex education and enhanced physical activity.
- Enforce and support the ban on smoking in
enclosed places through targeted smoking cessation programmes
in areas of greatest need.
- Increase support to national programmes for
improving mental health, and focus on high suicide rates, self
harm and drug dependence.
- Introduce a new workplace health initiative
that recognises the impact poor working conditions have on health.
- Developing a better environment through a
comprehensive climate change strategy. The NHS should also lead
the way with greener workplaces. Clean water and the effective
treatment of waste are essential to any public health strategy.
This requires the development of a democratically accountable
public water service.
Health at Work
There is increasing evidence
that many of our most intractable health problems are linked
to the long hours culture and the increasing complexity and
pressure under which many workers are placed.
There is a view that health
conditions such as alcohol abuse, obesity, sexual and mental health,
which are all rising in Scotland, are causally linked to this problem.
We therefore need to consider a new wave of public health solutions.
As an organisation with a key goal of addressing these issues, the
NHS itself should play its part in terms of its own family friendly,
flexible working and occupational health policies. The manner in
which NHS Scotland as an employer deals with its own staff with
addiction problems merits Scottish wide examination.
also maintains that the OHS Extra service, providing a ‘case
management' approach to staff to avoid absence from work and to
hasten return to work has been a success and should be rolled out
The provision of smoking
cessation services and the enforcement of the ban on smoking in
public places will underpin the success of Scottish legislation.
However, UNISON believes that it is important to recognise that
smoking cessation is primarily about tackling a nicotine addiction
and not a lifestyle choice. Specific cessation activity should be
targeted at young people, young mothers and the elderly.
Dental health in children
is a significant priority and should be linked to a healthy diet.
Levels of dental problems in under five-year-olds are on the increase.
Significant difficulties are faced by many individuals in seeking
a NHS dentist and we support the outlined goal of attracting and
retaining dental professionals, developing the school dental service
and the creation of a third Scottish Dental School in Aberdeen.
Community dentistry also requires planning for a high level of elderly
patients with teeth.
Recent television programmes,
such as "Jamie Oliver's School Dinners”, have placed a spotlight
on the quality and accessibility of school dinners. This impacts
on the physical and emotional wellbeing and education attainment
of our children. UNISON Scotland believes free school meals should
be available to all children, which would reduce the stigma faced
by those currently entitled to free school meals as we argued during
the passage of the Schools Nutrition Act. We therefore strongly
support the recently agreed pilot scheme.
values the contribution made by education support staff, teachers,
health and community education staff and others to support health
promotion within schools. We support a multi-disciplinary approach
to working with young people in a range of different settings. There
is a clear need for investment in staff development at all levels
to develop skills mix necessary for individual and group support
activities and to promote a positive experience for young people
trying access services to deal with their health issues. A school
nurse in every secondary school and its primary cluster should be
the minimum provision.
believes that sex and relationships education is a community and
family responsibility which should involve a range of agencies that
have different but complementary roles, including school based programmes.
They should be grounded in broad-based learning that builds on a
wide range of life skills including self-esteem, respect for others,
communication and emotional intelligence. Where young people have
the necessary confidence they should access sexual health services
as a couple. Growing levels of sexual infection require positive
programmes. In addition to initiatives based in schools further
support should be given to nursery staff and child and family centre
staff to work with children and engage with adults to empower them
to raise health issues with their child. Particular emphasis should
be on supporting changes in behaviour with children and how families
can help children live more active and healthier lives.
Physical Activity - Physical activity is an
independent variable for coronary heart disease and stroke. We
support the recommendations within the consultation document
in relation to an increase in physical activity. However, consideration
needs to be given to the access issues of school children and communities
themselves to sports and physical activity facilities.
CHAPTER 4 - TACKLING HEALTH INEQUALITIES
UNISON Scotland welcomes the creation
of the Ministerial Taskforce on health inequalities and the emphasis
on greater targeting of resources to support the most disadvantaged
people in our communities, including those with long- term conditions.
We also welcome the recognition within the consultation document
of the link between poor health and other social factors. We strongly
support joint working to reduce the inequalities in people's environments,
income, employment, educational attainment, skills, housing and
other issues that have the biggest impact on their health.
In terms of "greater targeting
of resources on services that support disadvantaged people and communities”
UNISON Scotland believes that many challenges rest in this area
in terms of cost implications and delivery. It is also important
to bear in mind that in targeting locations of areas of multiple
indicators of deprivation, in many areas, people that require specific
services can be hidden as they live in areas regarded as more affluent.
UNISON recognises the range of
topic-based work to improve public health. With so many initiatives
however, there is a danger of a fragmented approach and the use
of less empowering models. In the interests of joint working, a
more client-based approach is needed to support the efforts of our
members within the local authorities. Community Planning Partnerships
should be encouraged to focus on improving the health of specific
care groups with the recognition that improving living standards
is also an important strand of improving the health of local populations.
Mental Health and related issues
UNISON supported much
of the work taken forward by the previous administration for improving
mental health and well being. However, significant investment is
needed to sustain and mainstream development. Mental health spending
is often the first to be cut from a budget in times of financial
constraint. It is vital that work continues to be taken forward
to raise public awareness and promote positive mental health and
emotional well being; to eliminate the stigma of mental health;
prevent suicide and support recovery.
As is highlighted in the
consultation document, Scotland has a rising rate of suicide, particularly
amongst young men. The rates of self-harm are also high and give
cause for concern, particularly amongst teenage girls and younger
women. Implementation of initiatives like "Choose Life” and "Breathing
Space” must be expanded and supported to tackle these problems.
The contribution of colleagues within the Voluntary Sector, in particular
to mental health services must also be recognised and supported.
Public Sector Equality Duties
UNISON sees the introduction of
public sector equality duties as a step towards a society where
diversity is accepted as normal and equality as a benefit to everyone.
Progress on tackling discrimination has been distinctly slow over
the years and has often led to individual legal remedies that do
not tackle underlying problems. The public sector equality duties
are a fundamental change to this. NHS Boards must demonstrate they
are positively promoting equality rather than solely taking steps
to prevent discrimination, both in terms of an increase in equality
for service users and for staff. Action in this area must be monitored
and reviewed to ensure progress is being made and to ensure they
are delivering results.
Services for Children and Young
UNISON Scotland believes this is
an area that there had not been a great deal of focus on within
the consultation document. It is essential that thought is given
to the provision and funding of services for children and young
adults, particularly in relation to the transition of services for
patients from child to adult. Also, the particular group of ‘looked
after children' should be a high priority for new strategic,
multi agency input of investment and support.
Whilst supporting the broad thrust
of the framework of discussion for tackling health inequalities
in Scotland. UNISON Scotland believes that that further consultation
should take place following the report of the task-force to Cabinet
in May 2008.
5 - ANTICIPATORY CARE & LONG TERM CONDITIONS
"Challenge of shifting from reactive
system of healthcare to one which seeks to anticipate and prevent
health problems before they develop requires significant cultural
change within NHS in Scotland.”
Whilst UNISON Scotland supports
this objective, it recognises that it would involve a huge amount
of funding to bring about such a change of culture. With resources
in many Board areas tied up in PFI contracts, it would by no means
be the same cost option to transfer acute services to being delivered
in the community.
Support and information to help patient and carers
manage conditions would require additional resources to be allocated
to the support of carers, particularly young carers. It must be
recognised that carers are workers, an unpaid army of people who
are providing services to patients that if they did not continue
to provide, would have to be delivered by the NHS. The focus of
resources would need to be in terms of provision of relief and financial
support such as training and basic equipment.
UNISON Scotland supports
the abolition of prescription charges, as we believe them to be
inherently unfair, inequitable, illogical and inconsistent. UNISON
Scotland believes in a National Health Service based on the ideals
of a public service for healthcare which is free at the point of
delivery and accessible to all.
These are the principles
which have underpinned the NHS over 50 years and should still be
the principle on which the current NHS is based. In our view, the
current system of prescription charges is unfair in that it adversely
affects many more people on low incomes and in chronic ill health.
These are the people who find themselves unable to afford the medicines
they are prescribed.
There are believed to be approximately
75,000 prescriptions in Scotland that are not dispensed each year,
due to rises in the costs of prescriptions. According to evidence
from the Citizens Advice Bureau this situation increases in line
with every rise in the charges.
Over a number of years, five separate
studies of the effects of charging for prescription medicines have
concluded that increases in prescription charges lead to a decrease
in the uptake of prescribed drugs. These and other studies have
concluded that when patients do not take their prescribed medicine,
this leads to deterioration in their health and can cause extra
costs to the health service with admission to hospitals and emergency
treatment. This is particularly relevant in treating coronary heart
disease and strokes, the two biggest killers in Scotland. A greater
take-up of medication could play an enormous part in saving Scottish
citizens from the worst effects of these two diseases, which have
a greater prevalence amongst lower income groups.
Other groups particularly vulnerable
are those suffering from mental health problems. Whilst in hospitals,
these patients have their medication freely available, but on discharge,
there are no funds available to ensure that they can afford vital
medicines, even if subject to a Compulsory Treatment Order. The
current system is seen as illogical as there many life-threatening
diseases not given exemption, whilst lesser acute conditions are
included. Prescriptions for conditions such as chronic heart disease,
arthritis, asthma, cancer, including chemotherapy drugs taken in
the community, MS, Chronic Leukaemia, Glaucoma, Hepatitis C, HIV/Aids,
etc. all have to be paid for. UNISON Scotland believes that the
Scottish Parliament should follow the example of the Welsh Assembly
and bring forward a programme to abolish all prescription charges
However, in the event of a successful
passage of a Bill into law, we need assurances that staff employed
in Prescription Pricing/Practitioner Services and Counter Fraud
would be consulted over any changes to their jobs and be given
adequate retraining over changes to their work practices.
UNISON Scotland supports the introduction
of the proposed HPV vaccination programme.
We also approved of the proposals
in Delivering Care, Enabling Health to support Nursing, midwifery
and allied health professionals to become enablers of self-care
and self-management abilities. Our members are keen to implement
these proposals but at present are not allowed to. Such impediments
must be removed.
We support the introduction of
individual health plans for school pupils and would welcome an increase
in the capacity of school nursing across Scotland. However, as
stated above, we believe that the implications of the current Nursing
in the Community Review threatens the role of school nurses
and would be detrimental to the health of children.
CHAPTER 6 - THE BEST POSSIBLE START
"Effective support to help parents
meet the challenge of parenting in the earliest years”
UNISON Scotland supports many of
the measures mentioned in the document which contribute towards
the development of a child's physical and mental health and wellbeing.
We believe strongly that early intervention is crucial to reducing
reliance on care services and can prevent children from any future
involvement in the criminal justice system.
UNISON Scotland believes
in universal, flexible services for all children, provided by the
public sector, delivering high quality early years education and
childcare by appropriately trained professionals receiving appropriate
levels of pay and we welcome the proposals to introduce a new Standard
for Childhood Practice which gives professional recognition to nursery
and childcare workers. The Standard will help build an integrated
qualification and professional development framework for early years
and childcare workers in Scotland.
UNISON Scotland believes that the
public sector provides a better service and with more qualified
staff than other sectors. Public sector providers are subject to
greater scrutiny than those within the private and voluntary sectors
and routinely face inspections by Her Majesty's Inspectorate of
Education and the Care Commission as well as councils' own internal
quality assurance procedures.
UNISON Scotland also has concerns
regarding the funding of this sector. There are far too many funding
streams which are ring-fenced, e.g., Childcare Strategy Funding,
Surestart Funding, Free Education for 3 and 4 year olds and Changing
Children's Lives Funding etc. These should be amalgamated into one
fund to deliver integrated early years education and childcare targeting
more money into providing further flexibility for parents by reducing
The election of a new government
has seen an invigorated campaign to extend the role of teachers
in nursery education - worryingly for UNISON, often at the expense
of nursery nurses. Statements by new SNP ministers before and after
the elections, and increased lobbying by teachers suggest that the
increasing role of nursery nurses in delivering and managing nursery
education is under threat - similarities between the work of a nursery
nurse and a nursery teacher, their relative qualifications and pay,
and the need to ensure that early years workers were not sidelined
in pandering to teachers' status. We believe that nursery nurses
are fully-qualified, early year's professionals whose job requires
professional discussion and reflection, based on a shared vision
of their aims for children.
We believe that our children and
young people deserve the best possible start in life to maximise
their full potential. However, this must also apply to looked-after
children who, after many years of placement in residential care
are left with no support when they reach the age of 18. There are
pilot schemes in some of our cities and these should be evaluated
and rolled out to all boards and local authorities.
PIN Guidelines on Flexible Working
To enable parents working in the
NHS to best support their own children, the PIN guidelines on Flexible
Working should be actively promoted in all Boards.
CHAPTER 7 - CONTINUOUS IMPROVEMENT
UNISON Scotland supports the drive
towards a culture of continuous improvement and the pursuit of quality.
However, it has to be recognised that with an increasing older population
and an NHS no longer being seen as an attractive employer will make
the aim of continuous improvement in Healthcare more difficult to
There needs to be an investment
in staff skills at all levels, using the role of KSF as an integral
part of workforce planning. Real money for training - e.g. clinical
support workers must be provided so that all staff have options
for career paths which suit their circumstances. There is a need
for proper career workforce planning tied to staff development.
It must also be stressed that transition careers for example, from
auxiliary to nurse provide committed members of staff who must be
supported by training and education.
Healthcare Associated Infections
Improving the quality of cleaning
and ensuring that staffing numbers in ancillary and nursing are
improved are one of the key ways to tackle the problems behind HAIs.
The quality of cleaning in hospitals has declined since the introduction
of competitive tendering of hospital cleaning in the 1980s and the
continuing outsourcing of cleaning at PFI hospitals. It is no coincidence
that the lowest levels of HAI in the UK are found where there are
the lowest levels of contracting out - in Wales.
The first comprehensive Scottish
Executive report into HAIs released earlier this year shows that
the problem of HAIs occur across all hospitals in Scotland. UNISON
welcomed the report and the suggested monitoring, but believes that
the service needs to tackle the root problems behind infections.
What is required is to address the issues of cleaning and staffing
that need to be resolved if the good work of the HAI task force
is to deliver reduced levels of infection.
UNISON recommends a series of steps
to tackle infection in hospitals, including: improving the quality
of cleaning, which is more likely to be effective than specific
virus-related control measures; increasing the numbers of staff
- both cleaning and nursing staff and setting minimum safe staffing
levels for cleaning services; end contracting out, and bring back
into the NHS family the cleaners in hospitals. Allow for greater
involvement of staff: cleaners, supervisors, nurses and managers,
in setting and monitoring cleaning standards. Make sure cleaning
staff have the best equipment, materials and training and ensure
that all hospital staff and visitors make sure they abide by cleaning
Whilst UNISON does not oppose pre-admittance
screening for MRSA and other HAIs, it believes that this is not
a panacea which will cure the problem in isolation and that new
measures, in addition to those mentioned above, must be developed
and introduced into hospitals across Scotland.
E - Health
UNISON believes that it is essential
to involve the trade unions in implementing the new E-Health strategy.
Whilst resources are being targeted there is no apparent clear strategy.
An effective E-health strategy will be essential to deliver on many
issues outlined in Better Health Better Care consultation document
and there needs to be a comprehensive assessment of the technology
required to implement such a strategy. There needs to be investment
in skills to provide the IT services needed and these would be better
delivered by using in-house internal skills, rather than outsourcing
to the private sector.
For Further Information Please Contact:
Matt Smith, Scottish Secretary
14, West Campbell Street,
Glasgow G2 6RX
Tel 0845 355 0845 Fax 0141 342 2835
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