Scottish NHS Committee 30.8.2000
The morning session was completely taken up by the guest speaker, Ms. Susan Deacon, Scottish Executive Minister for Health and Community Care. She described where the NHSiS has come from and gave some idea of where it is going to. Since 1997, there has been a complete redrawing of the policy network with the publication of Designed to Care and other papers. The challenge now is to turn stated policy into practice and change existing directions appropriately. The major constitutional changes of 1999 have provided a lot of opportunities. and she said it would be madness to tear up all the existing policy documents and start over again. Instead, there is to be a stepped change in pace and direction of implementation and a change in the way policies are made and implemented in the future. The Scottish Partnership Forum (SPF) has shown how change should happen in future. The first year of the Executive has been spent matching policies, priorities and investments to aims established along the way. A lot has been achieved, but a lot still has to be achieved. She pointed out that, prior to 1997, the link between poverty and health had been denied, but it was now central to the health agenda, and the Scottish Executive was working with schools and communities on a social inclusion agenda. The results may take a generation to show through, but she is certain they will.

There have been big changes in the NHSiS, but a lot more needs to be done. The internal market has gone, but a lot of the elements are still there in attitudes, mechanisms etc. There is a need to unify the NHSiS over the coming years, and to value the staff working in it. Ms. Deacon said that when she took up her post, she did not realise how much damage had been done over the past 20 years by division, fragmentation and spending on the wrong things. The Executive is committed to turning this around, and that is why NHSiS modernisation is so important - massive investment and reform is required to make it happen. The challenge is to ensure the additional investment hits the right targets and the correct priorities. Over the next few months the Health Improvement Plan for Scotland will explicitly set out the range of issues which need to be addressed. She has hope for the future of the most important public service in the UK, and says that the Government has to ensure that they build on the founding principles, since people have an affinity for, depend on and believe in the NHS.

One of the members of the Committee said that staff supported improving standards, but that the experience so far was a great increase in the time spent responding to documents and having meetings etc., all of which takes time away from seeing patients. How can modernisation be streamlined to improve patient care? It is a problem in the acute hospital service but even more severe in primary care. There are also conflicting messages coming from the centre. This was acknowledged by the Minister, who said she was trying to ensure a greater clarity os message from the centre. There have been a lot of changes in structure and personnel in the Health Department (SEHD) over the past few months to support the governments aims. Partnership cannot stop at the door of St. Andrews House. If Trust management are given clear direction by government on what they are to do, it is no guarantee they will do it. However, if they are not given a clear direction, it can be guaranteed it won't get done.

All staff can see are cuts, cuts and more cuts. There is no sign of the extra money. No matter how much money is put into the Health service, demand will always exceed capacity. An additional sum has increased the budget to £5.4b this year, but the government want to see real results for the money. Staff input into bids for the extra money are important. A primary task for the future is to deliver demonstrable improvements in the NHS. Some of that is the way people are handled - as individuals, not a number. There are still major gaps and barriers in the service. It is encouraging that teams are coming together across divisions to organise how services can be rearranged to give a better service. The Minister recognises there is a range of skills available, but the starting point is always how to provide the best service for patients and then work back to see what skills can best be used to achieve this. A flexible workforce is part of the answer, but there need to be organisational changes to allow it to happen. A lot of people have a great fear of change and there is a need to convince them that change is positive. Change is a double edged sword. Some of the changes, if successful, ought to create the conditions for a less stressful, more valued work area. There are wins for staff, but a lot of sensitive issues have to be addressed to get there.

There is a need to properly measure outcomes. The service has been good at measuring inputs and more recently, process issues, but not so good at outcomes.

There are concerns that the framework for mental health is on a back burner with the development of LHCCs. Three years into a five year plan, it seems to be faltering. The Minister asked that specific issues like this should be addressed to her personally, as well as continuing other dialogues.

Now that the Prime Minister has taken responsibility for the NHS in England, how will this affect Scotland? Ms. Deacon thought it was good that Mr. Blair is backing the NHS. However the NHSiS has differences from the NHS in England. A joint ministerial committee brought together the First Ministers, Prime Minister and the Ministers for Health in three sessions. One each in Cardiff, London and Glasgow. It is important not to have an NHS that starts at Carlisle, but one which is uniform across the UK. She was struck by the extent to which the committee shared in its diagnosis of problems and how the solutions would look different in different parts of the UK. The pace of change should not be markedly different over the UK. If measures are working in England, the NHSiS will use them if they are appropriate. The SPF is unique in the UK, and the Minister is proud of the fact. Although it has not been easy along the way, she is proud of its achievements to date. No-one knows what it will look like in the future, but it will be built upon and developed.

Following publication of the NHS Plan for England, it has been widely reported that the projected funding for the NHSiS is substantially less than that for the NHS south of the border. Is there to be an increase in postcode treatment? The Scottish spend on health per head of population is approximately 20% higher than that in England. So the NHSiS is starting from a significantly higher base than England. The service needs of the two countries are different and therefore Scotland will not match England in its investment plans. If people are serious about devolution, there is a need to get out of the mindset of competition with the rest of the UK.

What is happening with Trust deficits? Staff are getting the messages to move forward, but it is also necessary to save money. The pattern is markedly different over the country. Tayside accounts for about one third of the deficit over Scotland. There is a need to separate out funding need and effective financial management. There are a lot of Trusts where the books balance. If there is evidence of poor financial control, why wipe out deficits? This does not mean that there are not areas which require more money, and financial balance cannot be the only measure of efficiency. Money will be released to Trusts when they show how it is going to improve services in the priority areas.

There are major problems in getting doctors and consultants on board with partnership. Who are they responsible to? At a local level, staff side members are saying they are paid to do a job, not to do partnership, and their colleagues have to pick up their work. Management say they don't have a budget for partnership and they need a directive from the Health Department before funding can be used for it. Consultant involvement is a big problem, but there are a lot of clinicians who are keen to grapple with the issues and come together at the table. Although some are very enthusiastic, there are many who think it is not appropriate. Changes to the consultants contract are part of the NHS plan, and the Minister agrees with the direction. Another culture change is required. There are a lot of workforce issues around Agenda for Change. The SPF has been charged with looking at time off and payment for partnership. A PIN Board guideline will be issued in the Autumn will cover the issue, but it will be up to the Trusts how it will be done. Agenda for Change is not heading for a siding. It is now extremely complicated with the 4 administrations. There is a need to balance central and local control to allow local situations to be taken into account. Hopefully a better balance will be created over the next few months.

Other matters
AEEU Merger. A consultative poll will be carried out in October of all members. The result will be fed into the conference on November 11th. Conference will debate one issue only - whether to ballot membership on the merger.

Scottish Conference. Branch officers should have received details of the conference. It will take place at the Station Hotel, Perth over the weekend of 18th and 19th November. Full participation is required.

Glasgow Office. The Glasgow office will close on 6th October 2000. The office is moving to the AEEU offices in West Regent Street. The whole telephone system will be changing, but numbers will be available a couple of weeks beforehand.

NHS Plan. The intention is to produce a Health Improvement Plan for Scotland by the end of November. It is not known when a draft will be available for consultation. Two items are of importance. (1) what is in the plan and (2) the detail and implementation process.

Modernisation Forum. This body now has around 80 members.

Modernising the Workforce. There is to be a meeting about the relationship between the Modernisation Board and the SPF. The SPF has said it needs ownership of the whole area around Modernising the Workforce. The main problem here is the BMA. The BMA is reluctant to break away from the SPF even though it will be looking at consultants contracts at some time in the future. They consider that Modernising the Workforce cannot work unless there is direct input from the SPF and local partnership forums. Agenda For Change. The job evaluation process is unlikely to be finished before the end of October. Harmonisation has not been started because the RCN want to keep it to the end of the talks. It is likely that pay increases each year will be linked to some form of competence assessment. It appears to be grinding to a halt as management cannot agree how to assess competence in the NHS. It may move back to the existing incremental structure or something between the two. It is unlikely that anything will come out before December. MSF schools on the package will not be held until January at the earliest. The Scottish Pay Reference and Implementation Group (SPRIG) has cancelled all its meetings as there is nothing to discuss. Since there will be a three month consultation period before the unions ballot, there is unlikely to be anything in place this side of a general election. Scotland waiting until April 2002 before implementation is looking more likely. There has been no confirmation that the announcement of the package will be made before or after talks on Pay Review Body status. A separate announcement is possible. A significant part of the reason for the delay is the link between the different pay scales. There is still no guarantee that there will be one.

Partnership Conference. November 10th 2000 at Heriot-Watt University again. The day will be divided into two topics - Agenda for Change and Modernising the Workforce.

PIN Board. Family Friendly and Harassment guidelines have been approved by the SPF. Employee Conduct and Safety at Work are still out for consultation. Equal Opportunities and People Performance Management are two new ones out for consultation. All are available from the SPF web site at http://www.show.scot.nhs.uk/spf/index.html.

Guideline Development Groups. Whatever these groups decide has to be agreed by the PIN Board and then agreed by the SPF. A decision was taken that every document should contain a model policy for adaptation at local level in partnership.

Partnership Working. The SPF produces guidelines, based on best practice, setting out some principles. The real issue is what the employer does. They should sit down and quantify the amount of time people spend on partnership. It can then be priced and paid for as a separate budget at trust level. The trust will need to do the same for Education and Training and the Working Time Directive etc., so there is no reason why they cannot do it for partnership working. There is no reason why any trust should not be prepared to apportion new money into partnership. The difficulty lies in pricing it out. If there are no locums available, a permanent replacement may need to be found. Therefore, it would make sense to have secondment as a partnership rep for 2 years. Reps would need to specify how much time they spend doing their own job and how much on partnership. It must be made clear that it is not Trade Union business, it is not partnership business, but it is Trust business. The guidelines will not attempt to quantify the time spent; the principles will be set out but will need to be picked up locally. Staff Governance will make it a Trust responsibility to ensure partnership, and it is getting close to the stage where senior management will be tested on partnership. The final stage would be discussing individuals with SEHD. The SEHD are apparently looking at taking central control of Chief Executive contracts.

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Continuing Professional Development Guideline Development Group
I have been invited to join the above group to produce guidelines for the service on CPD. Unfortunately, the first meeting coincided with the Scottish NHS Committee, so I was unable to attend. If anyone has any burning opinions on this area, please contact me.

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Advice
I have given advice on acting up, mileage allowances and a couple of situations. I have also advised on reapportioning on-call money to cover rota vacancies. Such a scheme is currently in operation at the Western Infirmary in Glasgow.

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Group News
At the last Council meeting, District Members were asked to account for any absences of Group Secretaries from within their District from the Group Secretaries Day. Unfortunately, the Glasgow and West of Scotland Group Secretary was unable to attend as she had only been elected several days prior to the meeting and had no time to make arrangements to attend. Rhona is now also taking a sabbatical for a year, but will be remaining Group Secretary. Head Office has been emailed with a change of address. We still have a vacancy for Vice-chairman of the Group. If anyone is interested, please contact a member of the Group Committee.

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Apologies
Please accept my apologies for not being able to attend this Council meeting as I will be on holiday.

Colin Rodden
6 September 2000

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