HEALTH AND COMMUNITY CARE COMMITTEE
BUDGET PROCESS PRESENTATION
Wednesday, 9th May 2001
Parliament Committee Chambers
UNISON welcomes the significant real terms increase in health spending
as a modest start in addressing the urgent need to rebuild the NHS
in Scotland. However, due to the absence of detailed figures it
is unclear how much of these additional resources will go into in
Hospital and Community Health Services, which as all the recent
indicators show are under severe pressure.
Most of the additional resources appear to be allocated to specific
initiatives which means that Trust and Health Boards are not funded
to deal with financial pressures outwith these targetted areas.
For example the cost of pay awards (Junior Doctors pay in particular),
the implementation of the Working Time Regulations and new drug
costs have not been fully funded. This also has to be put in the
context of the debt crisis which exist in many Trusts.
Low pay is endemic in the Scottish Health Service. The starting
salary for ancillary staff is £4.05 per hour. The top level for
this grade of worker is pay spine point 44, which pays £237.06 per
week or £6.07 per hour. Nearly one in three student nurses leave
prior to completing their training because of poverty. These staff
"earn" the princely sum of £2.80 an hour. A qualified
nurse with a degree earns £5,000 a year less than a 19 year old
starting in Strathclyde Police. Medical Secretaries throughout Scotland
are presently in dispute about their salary. The maximum pay for
many of these staff is £12,815 per year. These staff are central
to the Government's waiting list initiative, yet in the largest
acute trust in Scotland, North Glasgow, at any given time one in
three of these posts are vacant.
UNISON compared the numbers of staff employed in the Scottish Health
Service with the throughput of patients in the years 1985 and 1999
(the last available figures). The results are startling. In 1985
there was one staff member for every 5.6 patients treated, but by
1999 this figure had fallen to one staff member for every 11 patients
treated. Almost 100% increase. There was nearly one doctor for every
70 patients who were treated in the NHS but by 1999 one doctor was
treating nearly 110 patients per year. The nursing workload almost
doubled from one nurse providing care for 13 patients in 1985 and
in 1999 it one nurse providing care for 24 patients. Lab technicians
who are involved in services like cancer screening have seen the
throughput of patients increase by 70% during the same timescale.
Admin and Clerical staff have also endured a similar increase in
workload. The biggest increase has been suffered by domestic staff,
who have seen the throughput of patients rise from 60 in 1985 to
301 per domestic.
The continued use of the Private Finance Initiative is an inefficient
use of resources. One small PFI project in West Lothian is estimated
to be costing the tax payer £200,000 a year more than if
traditional funding methods had been used. By using the Private
Finance Initiative to build new hospitals in Lanarkshire and Lothian
the Scottish Government will have privatised more support workers
jobs over a 7 month period than the Tories privatised in Scotland
over the last 7 years of their Government.
CULTURE AND MORALE
Low morale is still a major problem in the Scottish Health Service.
The average age of a Scottish nurse is 47. The number of trained
nurses aged 30 and under account for only 7% of the total nursing
workforce. This profile can be spread to nearly every other discipline
in the NHS. The Scottish Health Service has major problems recruiting
and retaining staff. A blame culture still prevails within the service.
UNISON was very concerned to learn that the first question that
the Chair of the Audit Committee asked when questioning senior managers
from Tayside was "which one of you is to blame". This
message percolates throughout the Scottish Health Service.
PROPOSALS FOR IMPROVEMENT
1. Fully funded pay deals.
2. Legislation, which has a cost implication for the National Health
Service, should be funded centrally, e.g., working time directive.
3. All Government announcements on NHS initiatives should be fully
costed and funded centrally.
4. A one-off payment should be made to the Scottish Health Service
to standardise Terms and Conditions for staff in advance of Agenda
5. Resource transfer arrangements for Care in the Community need
to be transparent.
6. Remove private contractors from the NHS.
7. Investigate alternative methods to fund the NHS building programme.
8. Re-establish salaried student nurses.
9. Ensure that the new Unitary Boards identify a Senior Manager
with responsibility for liaising with the Scottish Parliament and
10. Extend the role of the Scottish and Local Partnership Forums
to include financial planning and management.
11. Consider extending the role of the Scottish and Local Partnership
Forums to liaise more closely with local MSPs and the Scottish Parliament's
12. Recognising that as 78% of NHS expenditure here in Scotland
is on salaries, that the present ad hoc arrangements to settle pay
and conditions issues on a Scottish basis is inadequate.
JIM DEVINE Scottish Organiser Health
EDDIE EGAN Chair Scottish Health Committee
KARIE MURPHY Vice Chair Scottish Health Committe
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