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UNISON Scotland welcomes the opportunity
to respond to this consultation on Community Health Partnerships
(CHPs).
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UNISON Scotland welcome the abolition
of NHS Trusts as well as the commitment that the devolution
of powers does not stop at CHP level but should include
all frontline staff.
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UNISON Scotland is disappointed that there
is no reference to trade unions as a key partner within
both the NHS and the proposed CHPs.
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In supporting the concept of a ‘shared
NHS culture' UNISON Scotland's response is based on the
assumption that the consultation does not directly impinge
on local authority employees. UNISON Scotland believes
that a ‘shared NHS culture' would most easily be achieved
by ensuring that the particular NHS Health Board under
which the CHP operates directly employs all relevant staff
(such as GP practice staff).
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UNISON Scotland would support the concept
of a Scotland-wide HR strategy to provide common conditions
of service across all NHS Health Boards.
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UNISON Scotland has some concern over
the issue raised in the consultation document regarding
‘local standards of treatment, access and referral' as
this could lead to a variation in care across NHS Health
Board areas and Scotland resulting in a ‘postcode lottery'
of care.
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UNISON Scotland believes that not enough
emphasis has been paid to the role of maintaining and
promoting the health of individuals and communities within
the consultation paper.
Introduction
UNISON Scotland welcomes the opportunity to respond
to this consultation exercise. There are a number of issues
within the consultation document that UNISON Scotland support,
such as the abolition of the NHS Trusts as well as the commitment
that the devolution of powers should not stop at the CHP level
but should involve all frontline staff. UNISON Scotland also
agrees that there is a role for all staff within the development
of CHPs, not just one profession.
With regard to public involvement, the Public
Partnership Forums (PPFs) may be a start to increasing public
involvement and accountability. However there is also a role
for public health practitioners and other frontline staff to
provide feedback on CHPs' services.
However there are a number of issues that UNISON
Scotland would like to raise which cut across the sections contained
within the consultation document. These include the organisation
of CHPs, the role of trade unions, staffing issues and the services
offered by CHPs.
Community Health Partnerships
UNISON Scotland has some concerns over the total
number of CHPs within a NHS Health Board area. For instance
if all the LHCCs in Greater Glasgow were to evolve into CHPs
this could lead to around 16 within one NHS Board area. This
could lead to organisational and management problems as well
as concerns over extra bureaucracy and financial implications.
One of the key issues would surround the access each CHP would
have to the NHS Board and whether there would need to be an
intermediate body to represent CHPs on NHS Boards.
There are also concerns over the issue of democratic
accountability within CHPS. Although they will be receiving
public monies the only potential for accountability seems to
rest with PPFs (although they are funded by CHPs) or the relevant
NHS Health Board. There should be more consideration to public
accountability possibly involving direct elections to CHPs or
even NHS Health Boards.
Partnerships
As the name implies, the CHPs are partnerships
and as such it is disappointing that the role of trade unions
seems to have been overlooked in this consultation document.
Trade unions should be one of the key partners in the development
of CHPs and as such there should be some formal recognition
of the staff-trade union partnership within CHPs. For instance
the section on key relationships fails to make any specific
mention of trade unions which have a key role in staff representation
as well as ensuring that staff are consulted on the development
of CHPs and their services. Trade unions should also be consulted
in the production of development plans, especially in areas
relating to workforce planning and capacity issues. UNISON Scotland
would like further clarification on how CHPs powers will impact
upon local workforce planning.
UNISON Scotland believes that joint working between
NHS and local authorities has to be properly resourced and that
workers and trade unions need to be consulted and involved throughout
the process. UNISON Scotland supports Joint Futures and the
Joint Future agenda and the current rules that retain local
authorities and the NHS as separate employers without the formation
of another employing body.
UNISON Scotland would also like to seek clarification
on how CHPs arrangements sit with the diversity of service delivery/joint
management schemes evolving under Joint Future?
There is also some concern that the partnership
between local authorities and NHS Health Boards in the development
of CHPs is not reflected in the issue of performance measurement.
Within the consultation document performance measurement is
aimed singularly at health issues and does not take into account
local government performance measures.
Staffing Issues
The consultation document mentions that CHPs should
operate within a shared NHS culture. While UNISON Scotland strongly
supports the ‘shared NHS culture' this response is based on
the assumption that the consultation does not directly impinge
on local authority employees.
With regard to a ‘shared NHS culture', UNISON
Scotland believes this would most easily be achieved by ensuring
that the particular NHS Health Board under which the CHP operates
directly employs all relevant staff. For instance, all GP practice
staff on NHS terms and conditions would prevent the problems
associated with a two-tier workforce within CHPs. It would also
remove the HR administration function from many GP's, allowing
more time to treat patients and thus enable them to reach Scottish
Executive targets for appointment times.
This would help to develop a NHS ethos and contribute
to team working. As CHPs will also be relying on NHS Health
Boards, or their operating divisions, for human resource (HR)
support it would also make their tasks easier rather than having
to deal with different employers, each with their own terms
and conditions. UNISON Scotland would support the concept of
a Scotland-wide HR strategy to provide common conditions of
service across all NHS Health Boards.
If the prospect of taking all the CHP staff into
direct employment within the NHS Health Board is not feasible
then, in the short term, consideration should be given to moving
towards NHS terms and conditions to all relevant staff in order
to minimise the difficulties in dealing with a myriad of employers.
Services
UNISON Scotland has some concern over the issue
raised in the consultation document regarding ‘local standards
of treatment, access and referral' as this could lead to a variation
in care across NHS Health Board areas and Scotland resulting
in a ‘postcode lottery' of care. There may be a case for NHS
Health Boards retaining more powers to ensure more consistent
service levels to lessen this concern or establishing a framework
requiring local standards to make reference to an overarching
health priority (e.g. a reduction of health inequalities).
As mentioned earlier, it is important that all
staff and their respective trade unions have a voice in the
development of CHPs services. This would especially be important
on discussions regarding workforce planning and staff capacity
to deliver services.
Health Promotion
UNISON Scotland believes that the consultation
paper concentrates too heavily on clinical management and not
enough attention has been paid to the role of maintaining and
promoting the health of individuals and communities.
For further information please contact:
Matt Smith, Scottish Secretary
UNISON Scotland
UNISON House
14, West Campbell Street,
Glasgow G2 6RX
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Tel 0845 355 0845 Fax 0141 342 2835
e-mail matt.smith@unison.co.uk
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