Response to Consultation on the Integration of Health and Social Care Services

Proud to be in UNISON

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 forward.

John Stevenson
Branch President
4 September 2012