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Community Health Partnerships

The UNISON Scotland Submission To the Scottish Executive

On - "Community Health Partnerships: Consultation Paper on Guidance"

September 2003

Executive Summary

    • UNISON is Scotland's largest trade union representing 150,000 members working in the public sector, including community health services.
    • UNISON Scotland welcomes the opportunity to respond to this consultation on Community Health Partnerships (CHPs).

    • UNISON Scotland welcome the abolition of NHS Trusts as well as the commitment that the devolution of powers does not stop at CHP level but should include all frontline staff.

    • UNISON Scotland is disappointed that there is no reference to trade unions as a key partner within both the NHS and the proposed CHPs.

    • In supporting the concept of a ‘shared NHS culture' UNISON Scotland's response is based on the assumption that the consultation does not directly impinge on local authority employees. UNISON Scotland believes that a ‘shared NHS culture' would most easily be achieved by ensuring that the particular NHS Health Board under which the CHP operates directly employs all relevant staff (such as GP practice staff).

    • UNISON Scotland would support the concept of a Scotland-wide HR strategy to provide common conditions of service across all NHS Health Boards.

    • UNISON Scotland has some concern over the issue raised in the consultation document regarding ‘local standards of treatment, access and referral' as this could lead to a variation in care across NHS Health Board areas and Scotland resulting in a ‘postcode lottery' of care.

    • UNISON Scotland believes that not enough emphasis has been paid to the role of maintaining and promoting the health of individuals and communities within the consultation paper.
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Introduction

UNISON Scotland welcomes the opportunity to respond to this consultation exercise. There are a number of issues within the consultation document that UNISON Scotland support, such as the abolition of the NHS Trusts as well as the commitment that the devolution of powers should not stop at the CHP level but should involve all frontline staff. UNISON Scotland also agrees that there is a role for all staff within the development of CHPs, not just one profession.

With regard to public involvement, the Public Partnership Forums (PPFs) may be a start to increasing public involvement and accountability. However there is also a role for public health practitioners and other frontline staff to provide feedback on CHPs' services.

However there are a number of issues that UNISON Scotland would like to raise which cut across the sections contained within the consultation document. These include the organisation of CHPs, the role of trade unions, staffing issues and the services offered by CHPs.

Community Health Partnerships

UNISON Scotland has some concerns over the total number of CHPs within a NHS Health Board area. For instance if all the LHCCs in Greater Glasgow were to evolve into CHPs this could lead to around 16 within one NHS Board area. This could lead to organisational and management problems as well as concerns over extra bureaucracy and financial implications. One of the key issues would surround the access each CHP would have to the NHS Board and whether there would need to be an intermediate body to represent CHPs on NHS Boards.

There are also concerns over the issue of democratic accountability within CHPS. Although they will be receiving public monies the only potential for accountability seems to rest with PPFs (although they are funded by CHPs) or the relevant NHS Health Board. There should be more consideration to public accountability possibly involving direct elections to CHPs or even NHS Health Boards.

Partnerships

As the name implies, the CHPs are partnerships and as such it is disappointing that the role of trade unions seems to have been overlooked in this consultation document. Trade unions should be one of the key partners in the development of CHPs and as such there should be some formal recognition of the staff-trade union partnership within CHPs. For instance the section on key relationships fails to make any specific mention of trade unions which have a key role in staff representation as well as ensuring that staff are consulted on the development of CHPs and their services. Trade unions should also be consulted in the production of development plans, especially in areas relating to workforce planning and capacity issues. UNISON Scotland would like further clarification on how CHPs powers will impact upon local workforce planning.

UNISON Scotland believes that joint working between NHS and local authorities has to be properly resourced and that workers and trade unions need to be consulted and involved throughout the process. UNISON Scotland supports Joint Futures and the Joint Future agenda and the current rules that retain local authorities and the NHS as separate employers without the formation of another employing body.

UNISON Scotland would also like to seek clarification on how CHPs arrangements sit with the diversity of service delivery/joint management schemes evolving under Joint Future?

There is also some concern that the partnership between local authorities and NHS Health Boards in the development of CHPs is not reflected in the issue of performance measurement. Within the consultation document performance measurement is aimed singularly at health issues and does not take into account local government performance measures.

Staffing Issues

The consultation document mentions that CHPs should operate within a shared NHS culture. While UNISON Scotland strongly supports the ‘shared NHS culture' this response is based on the assumption that the consultation does not directly impinge on local authority employees.

With regard to a ‘shared NHS culture', UNISON Scotland believes this would most easily be achieved by ensuring that the particular NHS Health Board under which the CHP operates directly employs all relevant staff. For instance, all GP practice staff on NHS terms and conditions would prevent the problems associated with a two-tier workforce within CHPs. It would also remove the HR administration function from many GP's, allowing more time to treat patients and thus enable them to reach Scottish Executive targets for appointment times.

This would help to develop a NHS ethos and contribute to team working. As CHPs will also be relying on NHS Health Boards, or their operating divisions, for human resource (HR) support it would also make their tasks easier rather than having to deal with different employers, each with their own terms and conditions. UNISON Scotland would support the concept of a Scotland-wide HR strategy to provide common conditions of service across all NHS Health Boards.

If the prospect of taking all the CHP staff into direct employment within the NHS Health Board is not feasible then, in the short term, consideration should be given to moving towards NHS terms and conditions to all relevant staff in order to minimise the difficulties in dealing with a myriad of employers.

Services

UNISON Scotland has some concern over the issue raised in the consultation document regarding ‘local standards of treatment, access and referral' as this could lead to a variation in care across NHS Health Board areas and Scotland resulting in a ‘postcode lottery' of care. There may be a case for NHS Health Boards retaining more powers to ensure more consistent service levels to lessen this concern or establishing a framework requiring local standards to make reference to an overarching health priority (e.g. a reduction of health inequalities).

As mentioned earlier, it is important that all staff and their respective trade unions have a voice in the development of CHPs services. This would especially be important on discussions regarding workforce planning and staff capacity to deliver services.

Health Promotion

UNISON Scotland believes that the consultation paper concentrates too heavily on clinical management and not enough attention has been paid to the role of maintaining and promoting the health of individuals and communities.

For further information please contact:

Matt Smith, Scottish Secretary

UNISON Scotland

UNISON House

14, West Campbell Street,

Glasgow G2 6RX

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Tel 0845 355 0845 Fax 0141 342 2835

e-mail matt.smith@unison.co.uk

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