Joint Future Briefing
BACKGROUND
In October 2000 Susan Deacon, the then Scottish Health Minister,
announced the Scottish Executive's response to the Royal
Commission on Long Term Care (Sutherland Report).
Following this, the Community Care & Health Bill 2001 introduces
a range of measures designed to meet the residential and non-residential
care needs of Scotland's older population
Part 1 of the Bill provides for the introduction of free personal
and nursing care of the elderly; regulation of charging for
home care services; promotion of choice in care provision; and
introduces a new carers' right to assessment for services.
Part 2 introduces measures to enable greater joint working
between the NHS and local authorities. This part of the Bill
is known as the Joint Future Agenda.
Part 3 refers to GP Lists held by Health Boards. It extends
the Scottish Executive's powers to insist that all GPs providing
personal medical services in Scotland, not just the principals
in a practice, must be on a list maintained by the Trust, bringing
them within the provisions of the NHS Disciplinary Procedures
and the NHS Tribunal system.
The Bill was passed on 6 February 2002 and will receive its
Royal Assent in 4 weeks.
JOINT FUTURE AGENDA
The Scottish Executive set up the Joint Future Group (JFG)
in 1999 to improve partnership working between agencies and
to secure better outcomes for service users and their carers.
Recommendations published in 2000 included:
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Rebalancing care of older people
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Improving joint working
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Planning financial and service management frameworks
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Charging
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Establishing good practice
To progress these objectives, Section 2 of the Bill aims at
removing remaining obstacles to joint service delivery. For
example, the creation of pooled budgets, the delegation of responsibility,
and scope for financial transactions between the NHS and local
authorities.
Agencies will also be able to delegate functions to one another,
to allow, for example, one of the partner bodies to provide
all mental health or learning disability services locally, avoiding
two or more agencies providing similar services for the same
group of people.
WHAT DOES IT MEAN?
There are six main areas where joint working will take place
Balance of Care means better assessment of whether an
individual needs residential care or whether additional domicilary
services would enable them to remain at home.
Single Shared Assessment means that one member of a
multi-agency team, drawing on other professionals, as appropriate
should carry out an assessment. All agencies involved
in a particular project should agree who does the assessment
and accept the outcome, including the budgetary implications.
Information Sharing. The JFG wants information sharing
to be introduced across all agencies, leading to information
systems integration. Care must be taken to reassure users that
the information obtained about them will be treated sensitively
following their consent being obtained. A protocol will be issued
shortly to deal with this issue and ensure compliance with any
relevant legislation, e.g. the Data Protection Act (1998)
Equipment and Adaptations Rehabilitations Services. Agencies
are to jointly resource and manage equipment and adaptations
services by April 2002, with combined storage facilities
being introduced thereafter. A national Strategy Forum has been
set up to review existing services and their interaction, to
identify standards and make recommendations. This will impact
on the work of occupational therapists and the role of OTs will
need to be assessed as full integration of occupational therapy
services is reached and OTs become more involved in management
of the intensive care services.
Intensive Care Management
The current form of care management should be redefined as
'Intensive Care Management'. This service will be for
people with complex or frequently changing needs. Staff from
different agencies need to be trained to the required level
within multi-disciplinary, multi-agency teams.
Joint Resourcing and Joint Management.
Every area/community care service/ individual care user group
is expected to introduce joint resourcing and joint management
of services for older people from April 2002.
Joint resourcing is about all resources at agencies'disposal
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Staff
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Buildings
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Money
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Equipment
In recent years there have been examples of joint working between
NHS and local authorities. However, whilst there has been some
joint resourcing, the Bill will now make it possible to actually
pool resources and allow staff from either agency to develop
packages of care for individuals irrespective of whether health
or local authority money is used. A joint body/single manager,
as appropriate will take decisions on the use of these resources.
Joint management brings together the relevant agencies
– local authorities (social work and housing) health boards
and NHS trusts, Scottish Homes – under a single manager who
can come from any of the specialities listed above.
WHAT ARE THE STAFFING IMPLICATIONS?
An Integrated Human Resources Group has been set up by the
Joint Future Unit to "design and develop a joint framework
to facilitate the integration of staff as services integrate".
UNISON's Head of Health and Head of Local Government are both
members of the group, which has recently held discussion workshops
across Scotland to discuss the issues involved.
Several sub-groups have been created to take forward different
strands of the HR strategy, who have been asked to report and
make recommendations to ministers by the end of April.
Their remits include:
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A staffing framework, including accountability arrangements
to be agreed between the various agencies and the trade
unions.
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Alignment between the varying terms and conditions and
pension arrangements, wherever possible
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Joint training which will support joint community care
plans
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Professional training to reflect joint provision of services
and effective teamworking.
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Flexibility from regulatory bodies to allow dual registration
or transfer between bodies, and continued recognition of
all professional development requirements
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Frontline staff developed to meet requirements of new competencies.
To give staff confidence in the new agenda, agencies must set
up a joint staff forum, providing a statement of intent and
a clear training and organising development agenda by April
2002.
WHAT ARE THE ISSUES FOR UNISON MEMBERS?
There is potential for great confusion amongst members working
in Joint Future projects as there is no clear indication who
the lead employers will be. Each management grouping will determine
which service is most appropriate as the lead employer and Staff
may find themselves be working under a manager from a different
service than their employer.
At present there are no plans to create a new employer, with
both staff and posts able to be seconded or attached to other
employers, leaving terms and conditions unchanged. This will
create tensions between staff doing similar jobs but receiving
different pay and conditions of service.
Where staff are attached to projects, there could be confusion
about line management and accountability.
Some staff, e.g nurses and social workers will wish to retain
their professional status and will need to maintain professional
training so that their registration is kept up to date.
Current managers will not have expertise of the work done by
other services, and will need training on conditions in the
other services
There is potential for job losses, particularly in management
posts which might be duplicated at present.
Adequate training will need to be put in place to ensure staff
are familiar with the required competencies if they are expected
to undertake new roles
TIMETABLE
Certain aspects of joint working have been ongoing for some
time in an informal way, but will now be formalised, There have
also been pilot projects in Perth, Glasgow and Dumfries.
Some of the measures listed above are already in place and
the rest will be introduced during 2002-03. However, the Scottish
Executive has identified key issues that they insist
agencies must put in place by April 2002. This "bottom
line" includes assessment of resources; deciding which
single management arrangements to adopt and deciding whether
to "align" or "pool" budgets.
Single shared assessment procedures including the "tool"
to be used, must also be put in place by April 2002. Rapid Response/hospital
discharge teams and home care support teams are already in place
in most areas
Three separate bodies have been set up to consider the sharing
of information and guidance is expected early in 2002. This
must incorporate the need to obtain explicit client approval,
and the protocol must be in place by April 2002.
A Strategy Group was established in June 2001 to consider the
issue of equipment and adaptations services with a view to integration.
Pilot studies on integrated OT services are ongoing
WHAT IS THE UNISON POSITION AND WHAT MUST BRANCHES DO?
A motion was passed at the meeting of the Scottish Council
on 1 December 2001, calling on the Scottish Committee to expedite
co-ordination of discussions between local branches. In addition,
the Scottish Committee agreed to leave overall organisational
and operational oversight with the Health & Community Care
Policy Pool.
It further agreed to ensure that presentations were made to
the Scottish Council and to the Service Group Conferences in
April 2002.
All branches are required to follow the Joint Future Action
Plan drawn up by the Health & Community Care Policy Pool
as outlined below.
Branches must enter into negotiations with their relevant employers
to ensure that employment status is determined and that mechanisms
are put in place to protect terms and conditions and to minimise
any job losses.
Wherever possible branches must ensure that UNISON is represented
on local committees considering these issues.
ACTION PLAN
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Each Branch should appoint a Joint Future contact person.
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Joint Future should be on all local, branch and Scottish
agendas.
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In areas where joint conferences have not been held with
health and local government branches, they should be organised
as a matter of urgency and co-ordinated by the lead officer.
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Develop a communications strategy to brief activists on
policy and training in partnership and organisation for
Joint Future.
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Review appropriate UNISON structures at branch and Scottish
level to meet the needs of members affected by Joint Future.
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New initiatives need to be analysed and advised to the
Scottish Organisers of local government and health.
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Any Joint Future initiative should be reported to the appropriate
policy pool and thereafter will be subject to monitoring
and evaluation with a report from the lead officers.
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A Conference will be held each year to bring together all
branches throughout Scotland involved in Joint Future, including
health, local government and the voluntary sector.
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UNISON will maintain their input to the Joint Future HR
group and papers will be circulated to all branches.
FURTHER INFORMATION:
Community Care and Health (Scotland) Bill Plus Explanatory
Notes (and other Accompanying Documents)
http://www.scotland.gov.uk/health/ltc/legislation.asp
Scottish Parliament Information Centre Research Paper 01/18
– 7 November 2001 (Available from P& I Team)
Joint Future Group – Report on progress
http://www.scotland.gov.uk/health/jointfutureunit/p
Joint Future Group – Practical Advice
http://www.scotland.gov.uk/health/jointfutureunit/new.asp
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Scotland's
public service union