Analysis: Scotland's NHS boards are being told to look again at staffing for services that consistently overspend their budgets as part of plans to bring their multi-million pound overspends back into balance. The Scottish government says, while there will continue to be no compulsory redundancies, NHS staff may need to be redeployed to improve workforce models and service configuration.

Health Secretary Neil Gray outlined the next stage in the Scottish government's promised reform of the NHS in a statement to the Scottish parliament on Thursday but it wasn't until the following day that much of the detail was revealed with the publication of a Scottish government letter giving instructions to NHS chief executives.

The letter signed by Mr Gray is accompanied by a series of "directions" issued to NHS boards, a mechanism under the National Health Service (Scotland) Act 1978 to give instructions that are, in effect, legally binding.

After telling parliament that Scotland will be split into two sub-national regions for planning and service coordination – the 14 NHS boards’ boundaries, legal entities and responsibilities remaining unchanged – the letter reveals what the combined boards in the two regions will be expected to deliver.

Each will prepare a ‘consolidated financial plan’ to be presented to ministers ahead of the start of next financial year.

The letter states:

‘This would allow review of the consolidated position, common pressures and for areas of overspend to be identified. Areas of recurring overspend could be triangulated with workforce planning and service planning to move towards a sustainable model.’

The letter adds that:

‘By year three of this approach (i.e. financial year 2028-29), we expect that these sub-national structures will result in significant reductions to certain health boards’ deficits.’

Workforce

healthandcare.scot asked the Scottish government to clarify what ministers mean by triangulating workforce planning and service planning to cut spending. Do ministers, we asked, envisage boards reassigning staff to different teams or different boards?

A Scottish government spokesperson responded:

“We expect health boards to align financial, workforce, and service planning as they plan to deliver services. Where persistent overspends occur we expect health boards to improve workforce models and service configuration to move towards financial sustainability.

“Health boards will continue to manage their workforce flexibly within their own organisations, including redeployment where appropriate, to support service redesign and sustainability. There is no policy for routine transfers between boards. Any such moves would require local agreement and partnership working.’

The Scottish government spokesperson also confirmed that the long-standing commitment to no compulsory redundancies in the public sector, remains.

Consulting with unions

In his statement to the Scottish parliament, Neil Gray made a point of stating that he looked forward this week to “engaging with staff side colleagues on the effective implementation” of the new planning approach.

Likewise, the Scottish government spokesperson prefaced their comments on workforce planning with:

“We value the importance of ensuring trade union and staff voice is represented in the reform of our NHS and we will engage closely with staff on the development of workforce plans.

It is clear that the Scottish government did not engage some NHS staff organisations before announcing the changes.

Two trade unions – both commenting on Thursday after the statement to parliament but before the publication of the letter to NHS boards – expressed disappointment not to have been consulted in the run up to the statement to parliament.

UNISON Scotland’s head of health, Matt McLaughlin said:

“Neil Gray has made a big mistake by failing to involve NHS unions in these plans. They don’t look like a genuine effort to tackle the many health challenges Scotland faces.”

Colin Poolman, Executive Director of RCN Scotland said:

“The lack of engagement with NHS staff and their trade unions on developing these proposals raises questions about how much difference these can actually make. But we wait to discuss the detail of what’s been announced when we meet Mr Gray next week.”

Two regions

The letter to the NHS boards clarifies which NHS boards will fall into the two regions:

• Scotland East will be made up of NHS Borders, NHS Fife, NHS Grampian, NHS Lothian, NHS Orkney, NHS Shetland, and NHS Tayside.
• Scotland West will comprise NHS Ayrshire and Arran, NHS Dumfries and Galloway, NHS Forth Valley, NHS Greater Glasgow and Clyde, NHS Highland, NHS Lanarkshire, and NHS Western Isles.

The chairs and chief executives of NHS Greater Glasgow and Clyde and Lothian will be responsible for leading the West and East regions respectively.

The move to two regions replaces a three region model that placed six boards together in a North Scotland region: Highland, Grampian, Tayside, Western Isles, Orkney, Shetland.

 

Read more: NHS boards told to collaborate as two regions; Half billion pound GP investment ‘largest ever’; Scotland’s NHS and social care app timeline unveiled; Government to merge two national NHS boards

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