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 vision’

Scotland has taken a very different model of reform to the NHS.

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 services.

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 efficiency.

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 standards.

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 Government.

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 currently.

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 Trust.

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 users.

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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