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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

  • There is a lack of detailed financial information and planning. There is no indication of proposed models of care. There is also no information on how the options will affect the clinical strategies within Greater Glasgow and NHS Highland.

  • 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.

  • The proposals lead to a larger geographical area being created and the boundaries of NHS Glasgow will contain both a rural and urban mix. The benefits of co-terminosity between Highland Health Board and Highland Council will be lost.

  • Since the abolition of Trusts UNISON has been working in partnership along with other staff side organisations towards single system working. As this restructuring is still ongoing these proposals will cause major logistical and operational problems.

  • 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.

 

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:-

    • These changes will have a fundamental impact on the effective establishment of CHP's which are central to the delivery of quality community-based services.

    • Crucial plans on future provision of support services (catering, laundries) will be prejudices by the uncertainty of these planned changes.

    • Programmed changes to improve paediatric services, previously approved by lead clinicians and staff, have been halted again as a result of the destabilising consultation process.

    • Local access to acute services will be lessened. This may result in patients either requiring to travel further or wait longer for treatment.

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.

 

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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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