REDRAWING NHS BOUNDARIES IN ARGYLL AND CLYDE
UNISON response to NHS Scotland consultation
on redrawing NHS boundaries in Argyll and Clyde 2005
OCTOBER 2005
EXECUTIVE SUMMARY
UNISON Scotland welcomes the opportunity to comment
on the Scottish Executive Consultation on Redrawing NHS Boundaries
in Argyll & Clyde, but would preface comments with an assertion
that we totally oppose the decision taken by the Minister for
Health and Community Care to abolish the Board in the first
instance.
UNISON Scotland has the largest trade union membership
in NHS Argyll and Clyde, NHS Greater Glasgow and NHS Highland
with almost 20,000 members across most groups of staff within
the NHS. We also have a large number of members within local
authorities, in this same geographical area, which any changes
of Health Board areas will impact upon. Our submission is therefore
based on wide consultation with thousands of Health and Social
Care workers delivering services in the Argyll & Clyde (A&C)
and surrounding areas
-
We are also concerned that the consultation
document did not include the option of the status quo and
we further believe an option which would have considered
Renfrewshire & Inverclyde, Cowal & Bute, being placed
within the administrative boundaries of NHS Ayrshire &
Arran.
INTRODUCTION
UNISON Scotland welcomes the opportunity to comment
on the Scottish Executive Consultation on Redrawing NHS Boundaries
in Argyll & Clyde, but would preface any detailed comments
on the options posed in the consultation with an assertion that
we totally oppose the decision taken by the Minister for Health
and Community Care to abolish the Board in the first instance.
UNISON Scotland has the largest trade union membership
in NHS Argyll and Clyde, NHS Greater Glasgow and NHS Highland
with almost 20,000 members across most groups of staff within
the NHS.
We also have a large number of members within
local authorities, in this same geographical area, which any
changes of Health Board areas will impact upon.
Our submission is therefore based on wide consultation
with thousands of Health and Social Care workers delivering
services in the Argyll & Clyde and surrounding areas. These
staff, in addition to their families and friends, and other
service users, rely heavily on good, modern, safe and sustainable
health service provision.
The proposed change has not been sought by UNISON
and the proposals represent the wrong solution to the financial
problems in Argyll and Clyde which were being addressed by the
Financial Recovery Plan.
Any change to boundaries along the lines of any
of the proposed options is likely to present significant organisational
challenges to all three Health Boards and their staff.
NHS Highland is still currently restructuring
to reflect the national NHS changes, in particular, the creation
of CHPs. NHS Highland also has its own financial challenges
at present, and the potential imposition of a further major
change of this nature is likely to impact significantly on other
priorities for restructuring/improvement which NHS Highland
is currently taking forward.
RESPONSE
The abolition of NHS Argyll and Clyde makes no
sense to us, particularly at this time, when the Scottish Parliament
has yet to consider the proposals contained in the Kerr Report,
let alone to make decisions on its implementation. We feel at
the very least that any decision should have been held in abeyance
until the recommendations of the Kerr Report had been fully
considered, especially with regard to cross-health board working
for the delivery of Health services.
In addition, following the abolition of NHS Trusts,
I April 2004, all Health Boards have had to undertake major
reconfiguration which is still ongoing in Greater Glasgow. To
add another tier of restructuring at this time, will cause major
logistical and operational problems.
Any discussions on the overall structure of health
boards across Scotland, if the Executive feels this is required,
would and should require wide consultation. No decisions should
be taken in isolation without a wider assessment of the effects
on the rest of the service, and indeed the communities affected.
In this connection we call on the Scottish Parliament
to rescind this decision forthwith.
In Part One of the consultation document details
some of the reasons for the dissolution of NHS Argyll &
Clyde and we would comment on these reasons as follows:-
-
UNISON would contest the view that the
geography and the urban and rural mix of NHS Argyll and
Clyde area did not contribute to its effective management.
If this is the case then where is the logic in Option
1 which would establish a huge geographical area in NHS
Highland, containing both urban and rural areas. Option
2 would create a much larger and more densely populated
NHS Greater Glasgow containing an urban and rural mix
that it has not, until now ‘had to cater for.
-
In addition, with regard to the financial
overspend, NHS Argyll and Clyde have now had their financial
recovery plan agreed with the Health Department and are
out-performing other Health Boards in the West of Scotland
in terms of waiting lists and a wide range of other targets
set by the Health Department.
-
UNISON is not aware of the structural
problems facing NHS Argyll and Clyde as detailed in Paragraph
4 of the consultation document, as the trade unions and
professional organisations have been working in partnership
to develop and progress single system working across NHS
Argyll and Clyde since July 2003.
OPTIONS
UNISON is unable to constructively comment on
the 3 options for the following reasons:-
(1) lack of financial information and planning;
(2) no indication of proposed models of
care i.e. will the two blue light hospitals remain, or will
they be replaced by either ACAD's or Minor Injury Units;
(3) no information on how options impact
on NHSGG and NHSH clinical strategies;
(4) whether there will be any impact on
composition and functions of CHP's;
(5) impact of David Kerr report;
And it is also our view that the following
should have been included:-
• maintaining the current NHS Argyll
and Clyde structure;
• Renfrewshire, Inverclyde and Cowal
and Bute areas to be included within the administrative
boundaries of NHS Ayrshire and Arran.
UNISON also believes that for the consultation
document to include options that have been rejected in the document
and to seek comments on these has caused uncertainty with the
public and stakeholders who may respond to the document.
There are specific issues for us relating
to any of the options, which would include the fact that NHS
Highland has a very significant partnership with The Highland
Council, with which we are coterminous, and this may be adversely
affected by a requirement to work with all (or part) of another
local authority area. There are various potential service issues
relating to the change in boundaries, some of which are outlined
below.
The view of UNISON NHS Highland is that Option
1 is the "least worst" option in terms of a Highland
perspective.
As stated above, we are unconvinced by the
limited arguments for excluding a variety of options including
that of keeping the existing Argyll & Clyde structure, but
it seems to us that of the available consultation choices, Option
1 may have the fewest disadvantages, due to the relative logic
of working with another complete local authority area, rather
than splitting this up further. However, the problems inherent
in increasing the North-South scale of a revised NHS Highland
by around 50% to a total distance of approx. 300 miles, combined
with an enormous increase in island(s) cover, should not be
under estimated. We have considerable concerns about the feasibility
of providing equality of access to appropriate healthcare services
over such an enormously increased area. We have not been provided
with detailed information about the resources already in place
in the Argyll and Bute part of the Argyll & Clyde area,
or about the way in which Corporate, or other area-wide services
such as Radiation Protection, Electromedical Equipment Management,
Health Promotion, provision of Sterile Services, etc. etc, are
currently provided in Argyll & Bute.
Whatever the outcome of the current public
consultation exercise, it is essential that there is meaningful
involvement of staff in all areas in planning future arrangements
for the management and provision of services. From the outset,
Staff Governance principles must be applied fully to all staff
regardless of their current employer Health Board.
SERVICES TO PATIENTS
The three main options in the consultation
document all have a major destabilising effect on the organisation
and delivery of fragile local health and community services:-
STAFFING
UNISON has substantial concerns that
both NHSGG and NHSH current recruitment and HR strategies may
be liable to prejudice the future interests of employees within
NHS Argyll & Clyde following any implementation of boundary
changes. This could impact on present levels of protection and
lead to possible insecurity for current NHS A&C staff. The
current situation is having a fundamental impact on staff motivation
and local recruitment and retention in NHS A&C.
UNISON would expect the current policy of
no compulsory redundancies to be honoured through this process
should it proceed.
There may be complex employment law issues
which impede the local HR strategies on re-structure and re-design
of services within GGHB and NHSH.
Conclusion
This submission, as stated above, is based on
wide consultation with thousands of Health and Social Care workers
delivering services in the Argyll & Clyde and surrounding
areas. We believe that the current proposals represent the wrong
solution to the financial problems in Argyll and Clyde which
were being addressed by the Financial Recovery Plan.
For Further Information Please Contact:
Matt Smith, Scottish Secretary
UNISONScotland
UNISON House
14, West Campbell Street,
Glasgow G2 6RX
Tel 0845 355 0845 Fax 0141 342 2835
e-mail matt.smith@unison.co.uk
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