UNISON's
approach
The focus of health policy should be on tackling Scotland’s
health inequalities. Only by tackling the root cause of
disadvantage and poverty will real progress be made in addressing
relative life expectancy.
The delivery of care should be through the
NHS Scotland partnership model and the democratisation of
health boards.
The principle of cooperation and not competition
should be developed and promoted. There is no place for
the private sector in capital investment such as hospitals,
GP surgeries; for clinical services delivery for community
services or the provision of Facility Management Services.
Improving services can’t be separated
from continually developing skills and expertise of staff.
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.
BACKGROUND AND OUTLOOK
Health and wellbeing
Health inequalities do not exist separate from
other inequalities. The evidence which has been found to
link social inequality with poor health not only explains
health inequalities, but it explains why so many attempts
to deal with health inequalities fail – including
policies such as targeted health projects, area regeneration,
and health promotion initiatives. And it helps us to understand
why even an institution like the NHS, founded on a principle
of equal free access to healthcare, has not been able to
redress the health inequalities which exist in Britain or
Scotland.
UNISON Scotland has long campaigned to improve
health in and out workplace across Scotland, particularly
in the public sector and we were proud of the role we played
in the promotion of the ban on smoking and the introduction
of healthy food, including fruit into schools. UNISON Scotland’s
Food for Good charter, produced in 2003 highlighted our
commitment for healthy, locally sourced food to be introduced
across Scotland’s public services.
Designing services
Democracy requires that there is adequate opportunity
for the public to participate in and influence the policy
making process. This is more than being asked to comment
on plans drawn up in private. It is also about defining
the desired outcomes and the methods to achieve them. UNISON
has supported the election of Health Boards as this will
improve accountability by: allowing individuals to become
board members; promoting debate about health care in local
communities via the election process and help make boards
more directly accountable to the people they serve.
Promoting the ‘patient voice' must however 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.
Delivering services
An improved and strengthened NHS which remains
publicly owned, democratically controlled and not subject
to privatised interests must be at the heart of any health
policy in Scotland. There is no place for the private sector
in capital investment such as hospitals, GP surgeries; for
clinical services delivery for community services or the
provision of Facility Management Services. UNISON Scotland
has proposed a realistic plan to deliver alternatives to
PFI/PPP. We have argued for No new PPP contracts and a review
of existing contracts, with 'buyouts' where that benefits
the taxpayer. There should be a level playing field for
Scottish government grants for new capital projects, irrespective
of the method of procurement. Health boards should have
Prudential Borrowing powers. In the event that this
cannot be achieved there should be a stronger PPP staffing
protocol, and at minimum staff should be excluded from transfer.
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. Substantial and sustained investment
in education and training for allNHS staff groups
is the key to unlocking capacity and to modernising models
of NHS care.
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.
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.
KEY QUESTIONS
Health inequalities are linked to wider inequality in society.
How can we ensure that this link is recognised in health
policy?
How can we ensure that moving services to the community
is done to improve them rather than to save money?
How do we build on the partnership model to increase the
role of staff in designing more effective services?
What can be done that the equality agenda is pursued by
employers?
Draft published: 5 December 2009
Current version updated: 20 January 2010
Members and branches can help to develop these
policy ideas further.
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voices for change - PUBLIC WORKS!
