The City of Edinburgh Council
4 September 2012 - Item 13 Scottish Government Consultation
on the Integration of Health and Social Care Services
UNISON City of Edinburgh Branch subsmission
UNISON regrets the lateness of this
submission to the Policy and Strategy Committee.
Unfortunately until the Council news blog of 30
August 2012 we had not been aware that this issue
was coming before this Committee.
While we acknowledge that the committee
will only be considering a response to the Scottish
Government consultation, UNISON believes that there
are fundamental service delivery, local accountability
and workforce issues that the committee should be
aware of in approving any response.
We attach the UNISON Scotland position
paper on Health and Social Care Integration which
can also be found at http://www.unisonscotland.
and urge committee members to consider the issues
raised in that paper.
Our experience so far with the Highland
situation has not been positive and we were very
pleased with assurances that Highland would not
be used as a pilot scheme. Apart from complex staff
conditions issues (including pensions), the Highland
situation also exposed a lack of preparatory thinking
about issues like the legislation, enacted for sound
reasons, applying to social care services. One example
was a failure to recognise the important independent
role of Local Authority Mental Health Officers.
There were many others.
However, the level of flexibility
we had hoped for in terms of local solutions to
local problems does not appear to be there in the
consultation document. We are concerned that central
direction through outcomes will be too prescriptive,
undermining local solutions to local circumstances.
The governance and democratic accountability
arrangements in the new Partnerships look too weak
for the major implications their decisions could
have for health boards and councils. For example,
decisions on acute services could impact on the
viability of acute hospitals and typically 15% of
council budgets will be transferred with consequences
for remaining services.
UNISON is not opposed to integrated
services. Staff delivering front line services regularly
work closely together to provide the best service
possible to service users and are often frustrated
by the obstacles they face.
However, merely joining things on
a top down basis without a root and branch look
at long term resources will not improve the service.
For example, UNISON believes that problems like
'bed-blocking' are often laid solely at the door
of local authorities without any examination of
whether health services are providing enough beds
within their services in the first place.
UNISON also believes that, with no
overall increase in resources, problems in providing
adequate health and social care services will continue
irrespective of systems.
Our long experience of organisation
change means that our members will inevitably be
sceptical about the merits of major structural change
without clear and costed strategies for delivering
improvements in care. The danger as always is that
energies will be diverted from service user and
patient care into the structural change itself.
UNISON is also concerned about the
implications for local accountability through elected
councillors in local government and the concept
of health care free at the point of need in the
NHS. For example, those receiving a local authority
service may have to contribute to it while those
receiving NHS services do not. What will occur if
the local authority provision, rather than the NHS
provision becomes the preferred option? In addition,
how ready is the NHS to import large third sector
contracts when in Scotland it works under an ethos
of in-house provision?
We are also concerned about the lack
of clarity about the role of the Jointly Accountable
Officer and how this post will deal with competing
demands on a pooled budget, legislative duties applying
to local authorities which do not apply to the NHS
and inevitably workforce governance issues.
UNISON notes that the authors of the
joint response have consulted managers and councillors
but have not so far engaged with the workforce,
even though the consultation itself states that
there is to be a central role for professionals.
UNISON would urge the committee to
recognise the need to formally engage with the trade
union structures in both the local authority and
the NHS in any initiatives planned to take the process
4 September 2012