HEALTH AND COMMUNITY CARE COMMITTEE
BUDGET PROCESS PRESENTATION

Wednesday, 9^th May 2001
Parliament Committee Chambers

INTRODUCTION

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.

PAY

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.

WORKLOAD

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.

POLICY

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 For Change.

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 local MSPs.

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 Health Committee.

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