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MSPs NHS Reform Bill Stage 1 Debate Briefing

March 2004


On Wednesday 3rd March the Scottish Parliament will undertake a Stage 1 debate on the NHS Reform (Scotland) Bill. Although UNISON Scotland is in favour of some of the proposals, such as the abolition of NHS Trusts, there are some issues that we would like to raise.

Community Health Partnerships

UNISON Scotland welcomes the commitment that the devolution of powers does not stop at CHP level but should include all frontline staff. However UNISON Scotland is disappointed that there is no reference within the Bill or the CHP consultation on the role of trade unions as a key partner within both the NHS and the proposed CHP's.

UNISON Scotland also has a number of concerns relating to CHP's, including adequate resources being provided for NHS Boards and local authorities in establishing and developing CHP's and that performance measurement of CHP's is aimed singularly at health issues and does not take into account local government performance measures.

The separate consultation document also refers to 'local standards of treatment, access and referral'. UNISON Scotland have concerns that 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).

UNISON Scotland has produced a response to the separate consultation on CHP's which highlights our concerns (http://www.unison-scotland.org.uk/response/comhealth.html).

Staffing Issues

UNISON Scotland welcomes the commitment by the Health Minister to use a stage 2 amendment to include staff governance within the Bill. However there are other staffing issues which concern us such as the reference to a 'shared NHS culture' within the separate consultation paper on CHPs. UNISON Scotland believes this would most easily be achieved by ensuring that all relevant staff within CHPs are employed by the relevant NHS Health Board. For instance, all GP practice staff on NHS terms and conditions would prevent the problems associated with a two-tier workforce within CHPs.

UNISON Scotland also believes that the concept of associated NHS employees (where staff would retain accumulated service conditions if they were to transfer within the NHS) should also be introduced. This would aid the retention and recruitment of experienced staff as well as providing opportunities for career development.

Public Involvement

UNISON Scotland welcomes the Scottish Executive's commitment to securing greater public involvement in the NHS in Scotland. We believe that good practice in public involvement needs to be promoted to ensure that quality improvement is driven by the needs of patients and service users.

However UNISON Scotland is concerned that the move to a national body might prejudice the grassroots structure and introduce more bureaucracy. We believe that it is important that any new structure should be rooted in local concerns. This would allow local offices greater autonomy to speak on, and deal with, local issues without undue interference from the central body.

UNISON Scotland firmly believes that all public service organisations (including the NHS in Scotland) should be open, transparent and democratically accountable and should encourage active participation from users, the community and staff and their trade unions and would therefore be supportive of direct elections to Health Boards.

Health Promotion

UNISON Scotland believes that not enough emphasis has been paid to the role of maintaining and promoting the health of individuals and communities. UNISON Scotland believes we need to move the debate on health away from hospitals and illness and onto prevention and healthy living. This includes the banning of smoking in public places, a ban on the sale of junk food in NHS hospitals and other buildings as well as the promotion of healthy eating for patients.

The Scottish Executive should look at standardising the food purchasing policy, including the introduction of UNISON's Food for Good Charter (http://www.unison-scotland.org.uk/nhs/chefs/ charter.html).


UNISON Scotland shares the concern of the Health Committee in their Stage 1 Report on the Bill with regard to funding. We are concerned that the Bill has not been fully costed and that its implementation may have a significant impact on the resources of both the NHS and local authorities unless the Scottish Executive provides additional funding.


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Further Information

UNISON's Food for Good Charter
www.unison-scotland.org.uk/nhs/chefs/ charter.html