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A New Public Involvement Structure for NHSScotland

A Scottish Executive Health Department Consultation Document

The UNISON Scotland Response June 2003

Executive Summary

UNISON Scotland welcomes the opportunity to respond to the Scottish Executive's proposals to increase public involvement in NHSScotland and for the establishment of the new national Scottish Health Council.

We also welcome the Executive's commitment to securing greater public involvement in the NHS in Scotland. UNISON Scotland believes that good practice in public involvement needs to be promoted to ensure that quality improvement is driven by the needs of patients and service users.

UNISON Scotland welcomes the Executives pledge to involve staff and trade unions in all the stages of the planning process for establishing the new body. UNISON Scotland is pleased that the Executive has shown a strong commitment to partnership working and to applying the key principles of openness, fairness and equity in handling organisational change.

UNISON Scotland believes that the credibility of Health Councils has suffered in the past because they have not been seen as sufficiently independent of Health Boards. UNISON Scotland therefore welcomes the breaking of the appointments link between the new national Scottish Health Council and NHS Boards.

UNISON Scotland shares the concerns of those organisations that support people in their interactions with the NHS that the move to a national body might prejudice the grassroots structure and introduce more bureaucracy. We believe that it is important that any new structure should be rooted in local concerns.

UNISON Scotland welcomes the proposal that the refocused Health Council be responsible for delivering the three main functions of assessment, development and feedback. However, we share the concerns of many within the present Health Council structure about the loss of some existing roles. In particular, UNISON Scotland would welcome local offices of the new Scottish Health Council retaining the ability to monitor local NHS services.

UNISON Scotland is broadly supportive of the arrangements to support patient focus and public involvement at the local level. However we also consider it important that local offices be allowed greater autonomy to speak on, and deal with, local issues without undue interference from the central body.

Introduction

UNISON is Scotland's biggest health union representing thousands of NHS staff throughout the country. Our members include nursing, ancillary and clerical staff, all of whom the NHS depends upon to ensure the safe and effective functioning of the Health Service in Scotland.

This paper constitutes UNISON Scotland's response to the consultation document issued by the Scottish Executive entitled: ‘A New Public Involvement Structure for NHSScotland'.

 Background

The Executive White Paper, ‘Partnership for Care', published in February 2003, called for a more patient-focused health service and set out proposals intended to improve public involvement in planning NHS services and to enhance patient involvement in decision-making within the NHS.

Against this background of patient focus and public involvement in NHSScotland the Executive has published the consultation document ‘A New Public Involvement Structure for NHSScotland'.

The document is concerned with achieving a service designed for and involving patients and specifically with the structures needed to ensure that the NHS delivers effective patient and public involvement. Accordingly, the document proposes replacing the existing 15 Scottish health councils with a new national body the Scottish Health Council.

It is proposed that this refocused health council structure should have three main functions:

  • The assessment function

To play a central role in the annual accountability review process, by ensuring that NHS Boards are discharging their duties in relation to monitoring the patient experience and to patient and public involvement.

  • The development function

To provide a critical mass of expertise and experience, available to organisations representing the interests of service users and the public throughout Scotland, to help develop and spread good practice in public involvement in the NHS.

  • The individual patient and carer feedback function.

To ensure that individual patients and carers who have views about their health services that they wish to express have the opportunity and, where necessary, the support to do so.

The document proposes that by October 2003 the Scottish Health Council will be established in shadow form, a national chairperson will have been appointed, members of the public will have been appointed to the Scottish Health Council's national Council and a Director will also have been appointed.

 

Responses

 

  1. What are the key strengths of health councils currently that we need to build on?
  2. UNISON Scotland considers the principal strength of Health Councils to be their local status and local knowledge. UNISON Scotland recognises that Health Council members are knowledgeable in regards to their local community and that they recognise the impact of decisions made in relation to health services in their area.

    UNISON Scotland believes that the present decentralised structure of Scotland's Health Councils (individual Health Councils in each of the 15 different NHS Board areas) lends itself to more active and effective engagement with patients and public alike on issues affecting the local community. UNISON Scotland is concerned that the proposal to replace the 15 local Health Councils with a new centralised body, albeit one with a local presence, will see deterioration in local links.

    UNISON Scotland also believes that the voluntary nature and the diversity of Health Council membership to be a positive feature. We believe that this diversity and the subsequent input of a range of different lay perspectives has enabled Health Councils to act as an effective voice for patients and public in each Health Council area.

     

  3. Do you agree that the key functions of the Scottish Health Council should be assessment, development and feedback?
  4. UNISON Scotland recognises that under the present structure Health Councils have a core framework of work activities, which should be common to all. We are also aware that different Health Councils carry out these functions to varying degrees and that there is perhaps a lack of consistency in the way different Councils interpret these core work activities.

    As such, UNISON Scotland welcomes the proposal that the refocused Health Council be responsible for delivering the three main functions of assessment, development and feedback. UNISON Scotland believes that these are appropriate functions for the new organisation and that by having a clear and consistent remit of duties that this will help the wider public forge a greater understanding of the role of the Scottish Health Council.

    However, UNISON Scotland shares the concerns of many within the present Health Council structure about the potential loss of existing roles. In particular, the present Health Councils have amassed a great deal of experience in relation to the monitoring of service delivery and UNISON Scotland would welcome the retention of a similar monitoring role for the new Scottish Health Council.

    UNISON Scotland agrees with the proposal that the Scottish Health Council assume overall responsibility for assessing whether appropriate public involvement mechanisms are in place and whether NHS Boards are acting upon the views of patients and public alike. However, we share the concerns of others that appropriate resources must be made available to the new Scottish Health Council to enable them to work effectively with patient and community groups and to enable them to promote and monitor public involvement and the patient's voice in the NHS.

    UNISON Scotland recognises the importance of supporting patients and public alike to engage constructively with the NHS in Scotland and we agree that the developmental role is a logical one for a re-focused Scottish Health Council to assume.

    UNISON Scotland agrees that it should be the responsibility of NHS Boards and Trusts to ensure that the views of people who use their services are actively sought and that mechanisms are in place to allow patients and public to present their views without encountering difficulties.

    However, we also recognise that many patients, for a variety of reasons, do not want to approach the NHS with complaints. As such we are supportive of the Scottish Health Council taking on the role as an independent channel through which these patients views can be passed onto the relevant NHS body.

     

  5. Have you any comments on what the assessment, development and feedback functions should include, and how they should be delivered?
  6. UNISON Scotland understands that as a result of the proposals outlined in the document, the new Scottish Health Council will have a narrower focus and remit than Health Council's in the previous structure and that NHS Boards will have a greater responsibility for consulting and involving patients in the decision making process.

    Whilst UNISON Scotland does not necessarily view this as a problem we would strongly urge the Executive to ensure additional resources are made available to NHS Boards in order that these functions are carried out effectively at both the local and national level.

    UNISON Scotland believes that it is important for the new Health Council not only to be able to assess levels of public involvement but also to have the ability to assess the impact of that involvement on the service itself. UNISON Scotland believes that for the Scottish Health Council to be able to effectively assess whether NHS Boards are acting upon the views of patients and public alike it is important for them to retain the ability to ‘walk the wards' and gather the views of both staff and patients.

    UNISON Scotland acknowledges that the priority for the new Health Council should be to assist others to have their voice heard but believes it important that the new Health Council also be proactive in raising issues. We believe that the new Scottish Health Council should be able to speak publicly and report on matters of public concern.

     

  7. Do you agree that NHS Boards should commission independent services that offer advice and support facilities to individual service users?
  8. UNISON Scotland believes that the present complaints procedure reflects a culture of defensiveness and is in many instances unresponsive to genuine concerns of patients and public alike. As such, UNISON Scotland broadly welcomes the proposals designed to improve the complaints procedure within the NHS.

    UNISON Scotland agrees with the proposal that independent advocacy services for complainants be commissioned by NHS Boards with Health Council involvement.

    However, UNISON Scotland also believes that establishing the independence of these support services will be of paramount importance and that a ‘cosy' relationship between NHS Boards and the service providers whom they commission must not be allowed to develop. ‘Perception is everything' and how the public perceives the independence of these services is what will be important.

    In addition, UNISON Scotland agrees with the assertion that it would be very easy for the new organisation to get bogged down in complaints and become a reactive organisation rather than taking a proactive role in improving services. UNISON Scotland is supportive therefore of the proposed strategic role for the new Health Council in monitoring the effectiveness of these advice and support facilities in each NHS Board area.

     

  9. Do you agree that NHS Boards should provide the support for networks of organisations with interests in health services?
  10. UNISON Scotland believes in the creation of representative Health Boards to run NHSScotland and to this end we fully support a directly elected element and a greater level of staff representation on NHS Boards. As such UNISON Scotland is disappointed that the document does not give greater consideration to the principle of democratic accountability and direct elections in relation to the proposed governance structures for the new Scottish Health Council.

    UNISON Scotland is broadly supportive of the proposal to establish Health Service User Forums and recognises the importance of establishing good connections with local concerns and issues. However, we believe there are a number of practical difficulties, which have the potential to damage the effectiveness of these new forums.

    UNISON Scotland believes that the substantial number of organisations who are likely to be involved in these Forums raises the very real potential that they may become too unwieldy and unmanageable. In addition, we believe that care has to be taken to ensure that minority interests do not hijack these forums to the detriment of real service users.

    UNISON Scotland also believes that if Boards are seen to be providing support for the groups who form the network of organisations with an interest in Health Services then this has the potential to compromise both the independence and the representational status of the groups involved in the process.

    As such, UNISON Scotland believes that the new Scottish Health Council, which will enjoy an ‘arms length' relationship with NHS Boards, should provide this support to networks or organisations involved in supporting patient and public interests.

    UNISON Scotland welcomes the proposal for NHS Boards to establish and support a single network of local patient and public interest groups but we would also call on the Executive to give due consideration to those patient and public networks that are already in existence.

  11. Do you agree with the local accountability arrangements as set out in the document?
  12. UNISON Scotland is fully supportive of the proposal to establish Public Partnership Forums at Local Health Care Co-operative level and we are in agreement that this Forum will offer an opportunity for greater patient and public involvement in the preparation of local health service plans.

    UNISON Scotland also supports the proposal to establish local Advisory Councils to keep the Scottish Health Council structure aware of local concerns and issues and to advise it of local views on the quality of the involvement activities of their local Board and Trusts. In addition UNISON Scotland believes that all members of the Advisory Council should be required to undertake training as a condition of them becoming members.

     

  13. Should the arrangements to support patient focus and public involvement at local level be different to the arrangements proposed in the paper?
  14. UNISON Scotland believes that the new governance and accountability structure proposed for the Scottish Health Council has the ability to ensure an effective local approach in promoting a more patient focused NHS.

    However, we feel it important that local offices are afforded a substantial measure of autonomy and are able to speak on, and deal with, local issues without undue interference from the central body.

     

     

  15. Please use this space to add any further comments about the document

UNISON Scotland is pleased to see the Executive showing such a strong commitment to partnership working and welcomes the pledge to involve staff and trade unions in all the stages of the planning process for establishing the Scottish Health Council.

UNISON Scotland also welcomes the Executives pledge that the proposed organisational change will not result in any redundancies and that a ‘no detriment' policy for staff will be operated in relation to their overall terms and conditions of service.

 

  For Further Information Please Contact:

Matt Smith, Scottish Secretary

UNISON Scotland

UNISON House

14, West Campbell Street,

Glasgow

G2 6RX

Tel: 0141-332 0006

Fax: 0141 342 2835

E-mail:matt.smith@unison.co.uk

 

 

 

 

 

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For Further Information Please Contact:

Matt Smith, Scottish Secretary
UNISONScotland
UNISON House
14, West Campbell Street,
Glasgow G2 6RX

Tel 0141-332 0006 Fax 0141 342 2835

e-mail matt.smith@unison.co.uk

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