The Scottish government says discussions have begun with trade unions and other NHS staff-side organisations on moves to reform the NHS and address overspending, with ministers promising continued dialogue. But two key trade unions say telling NHS boards to look at workforce planning to save money ignores the fact that there are already too few staff to do the job.

On 13 November, health secretary Neil Gray combined an announcement on winter preparedness with telling parliament that the next stage of NHS reform will be to ask Scotland’s 14 territorial NHS boards to work together as two regions, West and East – led by NHS Greater Glasgow & Clyde and NHS Lothian respectively – to plan and share resources and “optimise the capacity that there is in our system”.

In a letter published the following day, Mr Gray gave more details and instructed NHS boards to work together to look at common pressures and areas of overspending, adding:

“Areas of recurring overspend could be triangulated with workforce planning and service planning to move towards a sustainable model.”

Both in his speech and in a statement issued afterwards, Mr Gray and the Scottish government were keen to emphasise the importance of ongoing dialogue with staff side organisations.

A Scottish government spokesperson told healthandcare.scot today:

“Our hard-working health workforce is pivotal to delivering this care and the health secretary has held constructive meetings with NHS trade unions that will be followed up by officials in the coming weeks.”

Trade unions say they were not consulted before the announcement – and question the assertion that there is spare, unused capacity.

The nursing staff organisation RCN Scotland says it is concerned by the lack of clarity about how this new way of working will be implemented and wonders what ministers were trying to achieve by linking long term reforms to a statement on preparedness for this winter.

Colin Poolman, Executive Director of RCN Scotland said:

“We accept the need for boards to understand and manage their overspend but funding for health and care services is a political decision and increases in funding have failed to reflect the level of demand today and what we know is coming in years ahead.

“We share concerns about this approach leading to a central belt bias and about the assumption that savings can be made by reductions in the workforce without a negative impact on patient care.

“It is essential to remember that at no point has NHS Scotland employed the number of nursing staff it says it needs to deliver safe and effective care.

“Effective, long term workforce planning that matches service provision against increasing demands is required and nursing staff must be part of the process. Nurses and nursing support workers are the ones with solutions, and their engagement is key if change is to be successful.”

The Scottish government spokesperson rejected the suggestion that having planning for the two regions led from Edinburgh and Glasgow, creates any risk of a central belt bias:

“We want people to have the access to high-quality care, at the right time and in the right place – no matter where they live. This includes ensuring we meet the unique needs of our Highland, rural and Island communities.

“Our approach calls on health boards to work together to achieve significant and measurable positive outcomes to enhance the care offered to patients across Scotland.”

The chair of the doctor’s union, BMA Scotland, Dr Iain Kennedy said NHS reform – and addressing boards’ financial issues – must include investing in staff:

“We know NHS Scotland is suffering the impact of years of underinvestment. This has resulted in a mismatch between capacity and resources which has left patients facing growing and unacceptably long waiting times, while doctors and their colleagues are burnt out and struggling as they face the busiest time of the year.”

Dr Kennedy added:

“We would hope health boards are focused on spending what limited resources they do have wisely, but the answer cannot be to expect overstretched staff to deliver more or to attempt short-term fixes within individual health boards, and any plans to redeploy workforce must not happen without proper consultation with staff and unions. Instead the focus must be on long-term NHS reform, which will result in a sustainable future for the whole of NHS Scotland.”

 

Read more: NHS boards told to collaborate as two regions; New directions to NHS on staffing and deficits; Nurse pay upgrade programme stalls

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