The NHS but not as we know it?
John Gallacher, Regional Organiser, looks at the Westminster
Health and Social Care Bill - and contrasts with the ‘Scottish
Scotland has taken a very different model of reform to
NHS Scotland’s two most distinctive features are: opposition
to the use of the market in the delivery of NHS services
and the partnership system of industrial relations and policy
making. In 2004 Scotland completed the process of abolishing
the internal market.
New Community Health Partnerships were established with
resources and decision making power to work with boards
and involve patients and a broader range of staff in their
work. Legislation prevents corporation bidding to run GP
The one Independent Treatment Centre (Stracathro, Tayside)
has been brought back into the publicly delivered NHS.
The current Scottish Government has, as a matter of policy,
determined that cleaning and catering services will not
be market tested.
Procurement is an NHS success and Scotland has an NHS
national distribution centre, strategies which have produced
millions in efficiency savings.
This overall ‘public’ approach has delivered success in
terms of quality of service, patient satisfaction and cost
Scotland’s is the longest established national-level NHS
partnership agreement in the UK. It aims to provide for
high levels of staff involvement in improving patient services;
it is legally mandated and backed by broader Staff Governance
The partnership approach receives significant support from
the Scottish Government, employers and staff-side representatives.
Professor Nicolas Bacon & Dr Peter Samuel of Nottingham
University have described the NHS Scotland partnership model
in the following terms: “It is arguably the most ambitious
and comprehensive labour-management partnership so far attempted
in the UK public sector.”
These mechanisms ensure that UNISON Scotland’s vision for
the NHS is heard at the highest levels of policy determination
locally and nationally.
Neither of these policy planks faces any immediate threat,
however there are significant challenges within NHS Scotland
which is not immune from the policies of the UK Coalition
Due to shrinking public finances, further structural change
may be on the agenda from 2011.
The role of functions of the Special Health Boards is
receiving policy attention. Universal benefits, like free
personal care for the elderly, free prescriptions are also
the subject of political debate.
The financial challenges to NHS Scotland over the next
three years are unprecedented since Devolution. There are
significant workforce reductions and redesigns, though the
policy of no compulsory redundancies is being maintained
The reforms in England will directly impact on some health
services delivered to the Scottish people. Scotland funds
35 sets of specialist services at around 80 different NHS
Trusts in England.
Other services will be affected, for example, Organ Donation
which is delivered on a UK basis by the English Blood Transfusion
Under the ‘Sewell’ motion parliamentary process, the Westminster
parliament requires, on devolved matters, to get the Scottish
parliament to approve the English Bill. UNISON Scotland
will make clear to political parties in Holyrood driving
the reform of the English Health Service, that the marketisation
of services will impact on Scottish taxpayers and service
The last major Scottish NHS Policy document, Better Health,
Better Care (December 2007) provides for:
*Stronger public involvement is a key theme – improving
patients’ experience, clearer patients’ rights and enhanced
local democracy such as through elections to health boards.
And independent scrutiny of major service changes.
*A shift from viewing people as consumers – with only rights
– but as owners with both rights and responsibilities.
The overall strategic objective is to help people to sustain
and improve their health, especially in disadvantaged communities,
ensuring better, local and faster access to healthcare.
This is Scotland’s vision for moving towards world class
NHS services. In England the ConDem Government is proceeding
apace to destroy the NHS. Here’s to good health and Devolution!
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