A New Public Involvement Structure for NHSScotland
A Scottish Executive Health Department Consultation Document
The UNISON Scotland Response June 2003
UNISON Scotland welcomes the opportunity to respond to the Scottish
Executive's proposals to increase public involvement in NHSScotland
and for the establishment of the new national Scottish Health Council.
We also welcome the Executive's commitment to securing greater
public involvement in the NHS in Scotland. UNISON Scotland believes
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.
UNISON Scotland welcomes the Executives pledge to involve staff
and trade unions in all the stages of the planning process for establishing
the new body. UNISON Scotland is pleased that the Executive has
shown a strong commitment to partnership working and to applying
the key principles of openness, fairness and equity in handling
UNISON Scotland believes that the credibility of Health Councils
has suffered in the past because they have not been seen as sufficiently
independent of Health Boards. UNISON Scotland therefore welcomes
the breaking of the appointments link between the new national Scottish
Health Council and NHS Boards.
UNISON Scotland shares the concerns of those organisations that
support people in their interactions with the NHS 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.
UNISON Scotland welcomes the proposal that the refocused Health
Council be responsible for delivering the three main functions of
assessment, development and feedback. However, we share the concerns
of many within the present Health Council structure about the loss
of some existing roles. In particular, UNISON Scotland would welcome
local offices of the new Scottish Health Council retaining the ability
to monitor local NHS services.
UNISON Scotland is broadly supportive of the arrangements to support
patient focus and public involvement at the local level. However
we also consider it important that local offices be allowed greater
autonomy to speak on, and deal with, local issues without undue
interference from the central body.
UNISON is Scotland's biggest health union representing thousands
of NHS staff throughout the country. Our members include nursing,
ancillary and clerical staff, all of whom the NHS depends upon to
ensure the safe and effective functioning of the Health Service
This paper constitutes UNISON Scotland's response to the consultation
document issued by the Scottish Executive entitled: ‘A New Public
Involvement Structure for NHSScotland'.
The Executive White Paper, ‘Partnership for Care', published in
February 2003, called for a more patient-focused health service
and set out proposals intended to improve public involvement in
planning NHS services and to enhance patient involvement in decision-making
within the NHS.
Against this background of patient focus and public involvement
in NHSScotland the Executive has published the consultation document
‘A New Public Involvement Structure for NHSScotland'.
The document is concerned with achieving a service designed for
and involving patients and specifically with the structures needed
to ensure that the NHS delivers effective patient and public involvement.
Accordingly, the document proposes replacing the existing 15 Scottish
health councils with a new national body the Scottish Health Council.
It is proposed that this refocused health council structure should
have three main functions:
To play a central role in the annual accountability review
process, by ensuring that NHS Boards are discharging their duties
in relation to monitoring the patient experience and to patient
and public involvement.
To provide a critical mass of expertise and experience, available
to organisations representing the interests of service users
and the public throughout Scotland, to help develop and spread
good practice in public involvement in the NHS.
- The individual patient and carer feedback function.
To ensure that individual patients and carers who have views
about their health services that they wish to express have the
opportunity and, where necessary, the support to do so.
The document proposes that by October 2003 the Scottish Health
Council will be established in shadow form, a national chairperson
will have been appointed, members of the public will have been
appointed to the Scottish Health Council's national Council
and a Director will also have been appointed.
- What are the key strengths of health councils currently that
we need to build on?
UNISON Scotland considers the principal strength of Health Councils
to be their local status and local knowledge. UNISON Scotland
recognises that Health Council members are knowledgeable in regards
to their local community and that they recognise the impact of
decisions made in relation to health services in their area.
UNISON Scotland believes that the present decentralised structure
of Scotland's Health Councils (individual Health Councils in each
of the 15 different NHS Board areas) lends itself to more active
and effective engagement with patients and public alike on issues
affecting the local community. UNISON Scotland is concerned that
the proposal to replace the 15 local Health Councils with a new
centralised body, albeit one with a local presence, will see deterioration
in local links.
UNISON Scotland also believes that the voluntary nature and the
diversity of Health Council membership to be a positive feature.
We believe that this diversity and the subsequent input of a range
of different lay perspectives has enabled Health Councils to act
as an effective voice for patients and public in each Health Council
- Do you agree that the key functions of the Scottish Health
Council should be assessment, development and feedback?
UNISON Scotland recognises that under the present structure Health
Councils have a core framework of work activities, which should
be common to all. We are also aware that different Health Councils
carry out these functions to varying degrees and that there is
perhaps a lack of consistency in the way different Councils interpret
these core work activities.
As such, UNISON Scotland welcomes the proposal that the refocused
Health Council be responsible for delivering the three main functions
of assessment, development and feedback. UNISON Scotland believes
that these are appropriate functions for the new organisation
and that by having a clear and consistent remit of duties that
this will help the wider public forge a greater understanding
of the role of the Scottish Health Council.
However, UNISON Scotland shares the concerns of many within the
present Health Council structure about the potential loss of existing
roles. In particular, the present Health Councils have amassed
a great deal of experience in relation to the monitoring of service
delivery and UNISON Scotland would welcome the retention of a
similar monitoring role for the new Scottish Health Council.
UNISON Scotland agrees with the proposal that the Scottish Health
Council assume overall responsibility for assessing whether appropriate
public involvement mechanisms are in place and whether NHS Boards
are acting upon the views of patients and public alike. However,
we share the concerns of others that appropriate resources must
be made available to the new Scottish Health Council to enable
them to work effectively with patient and community groups and
to enable them to promote and monitor public involvement and the
patient's voice in the NHS.
UNISON Scotland recognises the importance of supporting patients
and public alike to engage constructively with the NHS in Scotland
and we agree that the developmental role is a logical one for
a re-focused Scottish Health Council to assume.
UNISON Scotland agrees that it should be the responsibility of
NHS Boards and Trusts to ensure that the views of people who use
their services are actively sought and that mechanisms are in
place to allow patients and public to present their views without
However, we also recognise that many patients, for a variety
of reasons, do not want to approach the NHS with complaints. As
such we are supportive of the Scottish Health Council taking on
the role as an independent channel through which these patients
views can be passed onto the relevant NHS body.
- Have you any comments on what the assessment, development
and feedback functions should include, and how they should be
UNISON Scotland understands that as a result of the proposals
outlined in the document, the new Scottish Health Council will
have a narrower focus and remit than Health Council's in the previous
structure and that NHS Boards will have a greater responsibility
for consulting and involving patients in the decision making process.
Whilst UNISON Scotland does not necessarily view this as a problem
we would strongly urge the Executive to ensure additional resources
are made available to NHS Boards in order that these functions
are carried out effectively at both the local and national level.
UNISON Scotland believes that it is important for the new Health
Council not only to be able to assess levels of public involvement
but also to have the ability to assess the impact of that involvement
on the service itself. UNISON Scotland believes that for the Scottish
Health Council to be able to effectively assess whether NHS Boards
are acting upon the views of patients and public alike it is important
for them to retain the ability to ‘walk the wards' and gather
the views of both staff and patients.
UNISON Scotland acknowledges that the priority for the new Health
Council should be to assist others to have their voice heard but
believes it important that the new Health Council also be proactive
in raising issues. We believe that the new Scottish Health Council
should be able to speak publicly and report on matters of public
- Do you agree that NHS Boards should commission independent
services that offer advice and support facilities to individual
UNISON Scotland believes that the present complaints procedure
reflects a culture of defensiveness and is in many instances unresponsive
to genuine concerns of patients and public alike. As such, UNISON
Scotland broadly welcomes the proposals designed to improve the
complaints procedure within the NHS.
UNISON Scotland agrees with the proposal that independent advocacy
services for complainants be commissioned by NHS Boards with Health
However, UNISON Scotland also believes that establishing the
independence of these support services will be of paramount importance
and that a ‘cosy' relationship between NHS Boards and the service
providers whom they commission must not be allowed to develop.
‘Perception is everything' and how the public perceives the independence
of these services is what will be important.
In addition, UNISON Scotland agrees with the assertion that it
would be very easy for the new organisation to get bogged down
in complaints and become a reactive organisation rather than taking
a proactive role in improving services. UNISON Scotland is supportive
therefore of the proposed strategic role for the new Health Council
in monitoring the effectiveness of these advice and support facilities
in each NHS Board area.
- Do you agree that NHS Boards should provide the support for
networks of organisations with interests in health services?
UNISON Scotland believes in the creation of representative Health
Boards to run NHSScotland and to this end we fully support a directly
elected element and a greater level of staff representation on
NHS Boards. As such UNISON Scotland is disappointed that the document
does not give greater consideration to the principle of democratic
accountability and direct elections in relation to the proposed
governance structures for the new Scottish Health Council.
UNISON Scotland is broadly supportive of the proposal to establish
Health Service User Forums and recognises the importance of establishing
good connections with local concerns and issues. However, we believe
there are a number of practical difficulties, which have the potential
to damage the effectiveness of these new forums.
UNISON Scotland believes that the substantial number of organisations
who are likely to be involved in these Forums raises the very
real potential that they may become too unwieldy and unmanageable.
In addition, we believe that care has to be taken to ensure that
minority interests do not hijack these forums to the detriment
of real service users.
UNISON Scotland also believes that if Boards are seen to be providing
support for the groups who form the network of organisations with
an interest in Health Services then this has the potential to
compromise both the independence and the representational status
of the groups involved in the process.
As such, UNISON Scotland believes that the new Scottish Health
Council, which will enjoy an ‘arms length' relationship with NHS
Boards, should provide this support to networks or organisations
involved in supporting patient and public interests.
UNISON Scotland welcomes the proposal for NHS Boards to establish
and support a single network of local patient and public interest
groups but we would also call on the Executive to give due consideration
to those patient and public networks that are already in existence.
- Do you agree with the local accountability arrangements as
set out in the document?
UNISON Scotland is fully supportive of the proposal to establish
Public Partnership Forums at Local Health Care Co-operative level
and we are in agreement that this Forum will offer an opportunity
for greater patient and public involvement in the preparation
of local health service plans.
UNISON Scotland also supports the proposal to establish local
Advisory Councils to keep the Scottish Health Council structure
aware of local concerns and issues and to advise it of local views
on the quality of the involvement activities of their local Board
and Trusts. In addition UNISON Scotland believes that all members
of the Advisory Council should be required to undertake training
as a condition of them becoming members.
- Should the arrangements to support patient focus and public
involvement at local level be different to the arrangements proposed
in the paper?
UNISON Scotland believes that the new governance and accountability
structure proposed for the Scottish Health Council has the ability
to ensure an effective local approach in promoting a more patient
However, we feel it important that local offices are afforded
a substantial measure of autonomy and are able to speak on, and
deal with, local issues without undue interference from the central
- Please use this space to add any further comments about the
UNISON Scotland is pleased to see the Executive showing such
a strong commitment to partnership working and welcomes the
pledge to involve staff and trade unions in all the stages of
the planning process for establishing the Scottish Health Council.
UNISON Scotland also welcomes the Executives pledge that the
proposed organisational change will not result in any redundancies
and that a ‘no detriment' policy for staff will be operated
in relation to their overall terms and conditions of service.
For Further Information Please Contact:
Matt Smith, Scottish Secretary
14, West Campbell Street,
Tel: 0141-332 0006
Fax: 0141 342 2835
For Further Information Please Contact:
Matt Smith, Scottish Secretary
14, West Campbell Street,
Glasgow G2 6RX
Tel 0141-332 0006 Fax 0141 342 2835
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