Big challenges highlighted in latest NHS statistics

There are some mixed messages in the latest batch of NHS Scotland statistics. Workforce numbers are up last year, although still less than before the crash and vacancies are high. Some health boards are struggling to meet waiting time targets and most missed the four hour A&E wait target. Perhaps most challenging is increased bed blocking.

The workforce statistics show that the total number of NHS Scotland staff in post increased last year with 135,881 whole time equivalent (WTE) and 159,058 headcount on 3 June 2014. The annual increase in staff of 1.9% WTE is mainly due to increases in nursing and midwifery (1,309.6 WTE), administrative services (345.5 WTE), medical (286.2 WTE) and allied health professions (226.4 WTE).

Welcome though this year’s increase is, it’s worth remembering that the highpoint for NHS staff in Scotland was September 2010 when the WTE was 135,964. When the council staff transferred into NHS Highland are taken into account, the NHS is still around 1000 staff down since the financial crash.

In addition, the total number of vacancies remains high. Consultants 346.7 WTE, a rate of 6.9%; Nursing and midwifery 1,865.3 WTE, a rate of 3.1%; Allied health professions 481.2 WTE, a rate of 4.1%. The Health Secretary argues that this is a mixture of hard to fill specialists and increasing staff numbers. Others suspect that some health boards are balancing their books by deliberately not filling vacancies.

The statistics on waiting times and bed blocking highlight significant regional variations. Grampian, Lothian and Forth Valley missed a target to treat the majority of people within 18 weeks. Only two health boards managed to treat most patients in A&E departments within four hours. Five health boards missed an interim target to treat 19 out of 20 patients within that time frame. Only five of the 14 health boards have achieved the 26 week waiting time for treating children and young people who need care for mental health problems.

175 patients remained in hospital six weeks after being fit enough to be discharged. The main reason given was the lack of a place in a care home. The target is that no patient should be delayed in hospital for more than four weeks and that will fall to two weeks by April next year. 518 patients are waiting more than two weeks at present. In total, nearly 900 patients are in hospital when they have been assessed as ready for discharge - the equivalent of Scotland’s largest hospital.

All these numbers have increased over the last year and exclude the 300+ patients classified as Code 9, which means there is an approved cause for their delayed discharge. Interestingly, there are significant regional differences as the chart below highlights. This will be a key challenge for the new integration boards.

Cross posted at SHA Scotland

 

Posted with Blogsy

Cleaners are Worth It

Cleaners are the neglected workers that most of us take for granted. They often begin their shift before or after most of us, but their job is vital to a healthy workplace and in some settings, critical to preventing the spread of infection.

UNISON Scotland has been surveying cleaning staff in areas where we organise to get a picture of how they are faring in the era of cuts and austerity. The report we published, 'Dishing the Dirt' paints a picture of a workforce largely, but far from exclusively, female, mostly part time, and trying simultaneously to deal with an increase workload and wages that don’t go as far as they used to.

A particular impact of the austerity cuts is that standards of cleanliness are declining. Across a range of environments there are complaints of either a lack of cleaning material or of switching to cheaper, less effective cleaning materials. As one NHS cleaner put it:

“Some of our cleaning products have stopped being supplied due to cut backs. We are told to use cold water or hot water with no product added. Hoovers fall apart and are held together with tape.” 

Another concern was work intensification. This usually takes the form of increasing the area to be cleaned without any expansion of working time. The result is that areas are not cleaned to either the standards that cleaners are happy with or that the public should be able to expect. As one school cleaner put it:

“Not enough time for size of area to clean. Was six hours per day between two people, now only me on three hours per day. Raised concerns to supervisor but told just to use initiative and clean what looks dirty. Not constructive answer and adds pressure to daily tasks. I never feel area is clean enough for purpose because of lack of hours”

Cleaners in the public sector have seen their wages cut in real terms by at least 10% due to government pay policy. Even with the welcome application of the Scottish Living Wage, many cleaners have real earnings less than they were a few years ago. The survey shows that cleaners are finding it harder to make ends meet and optimism about the future is in scarce supply. Years of declining living standards have impacted on morale. As a university cleaner put it:

“It has got worse in past three years. The wages don’t change but the cost
of living just seems to go up and up. How can people live healthily when the healthy foods cost so much and the prices keep going up.” 

A particular concern is that nearly one in five cleaners had been in a pensions scheme, but had opted because they couldn’t afford the contributions. This will lead to greater inequality in the long term and higher levels of pensioner poverty.

Employers are not even getting the soft skills right, with many cleaners reporting that they feel under valued. As a college cleaner put it:

“Not very often we get any positive feedback. Doesn’t seem to matter how hard you work, it’s never enough. Only really get comments if something’s wrong.” 

This survey should be a wake up call for employers who are ignoring their hidden workforce. Everyone should be concerned about the impact on hygiene and infection control. Cleaners matter – not just because they have as much right to dignity and respect in the workforce as any manager or Chief Executive. But because the work they do is vital in every respect. This should be recognised, by both ensuring that they are given the environment to do their job properly but also in recognising its value where it is most obvious – in their pay packets. Cleaners are Worth It. 

Staff who keep our food safer deserve a pay rise

The Food Standards Agency (FSA) hasn't had the best of press recently, now they have forced their staff out on strike and refused to resolve the dispute at ACAS.

There has been growing concern over the way the FSA handles food safety across the UK. It's part of the reason why Scotland is in the process of establishing a separate body, although many of the problems are likely to remain here as well.

A recent survey for the Food Standards Agency showed 59% of raw chicken bought at supermarkets contained the potentially deadly bacteria Campylobacter. As an article in the Scotsman put it, "After a decade of trying to get the poultry industry to clean up its act, the Food Standards Agency had promised to name and shame the worst offenders in the first quarter of its year-long survey. However, pressure from the industry has led the FSA to back down".

Few lessons also appear to have been learned from the horsemeat scandal. The Guardian discovered that the publication of the inquiry into the scandal has been blocked amid government concerns that the public would be frightened by the idea that criminals were still able to interfere with their food.

UNISON members in the FSA will be taking strike action on 26th and 27th August. For the second year in a row, the FSA imposed a pay rise of 0.75% on our members, while most other public sector workers have been offered a 1% increase. Even as late as last week, UNISON asked them to reconsider and go to ACAS for arbitration, but they refused.

The primary job of meat ispectors is to ensure the meat we eat is slaughtered safely and that contaminated meat doesn't enter the food chain. Since April 2012 meat inspectors and vets have prevented over a million instances of diseased animal carcasses from entering the food chain in Scotland. This included:

659,000 instances of the Liver Fluke parasite

427,000 instances of pneumonia in red meat carcasses

100,000 instances of adult tape worm

100,000 tumours in chickens

1100 instances of parasitic lung worm in cattle, from entering the food chain.

We all know from hard experience in many sectors that light touch regulation doesn't work. It's a message that hasn't yet been understood by the UK and Scottish government's. Independent chicken inspections have already been diluted and the Scottish Government has recently done the same for pigs. Meat inspectors, official veterinarians and support staff cost each person in the country just 38 pence per year. A small price to pay for safer food.

To add insult to injury they are being offered pay rises below even the miserly government pay policy. Staff in slaughterhouses work in some of the most dirty, difficult and stressful conditions, surrounded by blood and faeces, to keep the public safe from contaminated meat. They deserve a fair pay rise.

 

 

Posted with Blogsy

Big challenges remain in delivering care integration

Delivering health and care integration is proving every bit as a complex as we anticipated.

I was at a seminar in Ayrshire today that brought together our council, health and community sector activists to discuss the implementation of the health and care integration plans in the Public Bodies (Joint Bodies) Act. Ayrshire has three Shadow Integration Boards but are planning to adopt a pragmatic local approach by sharing lead roles and manage some services on a pan-Ayrshire basis. None the less it will be a complex matrix structure, on top of what is already a complex array of services.

More clarity is needed on how the new organisations work with NHS, councils and partners in the third sector. Wherever you draw boundaries there will always be a need to work in a connected way with other services outwith the new structures. Front line social workers in Ayrshire very clearly highlighted the problems the private sector in particular is having in delivering the home care hours they have been contracted to deliver.

In my overview, I drew attention to international evidence of what works in care integration. It's a long list on the slide, but the common feature is that it's about people. Sadly, in this whole process that's the bit that has been given the least attention. Most workforce issues have not been resolved, like different procedures; disciplinary, grievance etc. Different salaries and conditions also apply for workers doing similar jobs. There is a national group working on these issues but it is making very slow progress.

There are also different industrial relations models and cultures. However, the positive news is that there is a willingness to adopt a positive best practice and employee reps on the integration boards will help that.

There is a risk that as we focus on the mechanisms of integration boards, we lose focus on the wider changes that are impacting on this sector. Issues like self directed support and budget cuts are happening at the same time. There are also different views on the role of third and private sector in service delivery and different approaches between councils in Ayrshire. Some understand ethical care issues better than others and procurement strategy is an important issue for everyone involved.

There is also demographic change with growing numbers of older people. How this is addressed is not consistent across Scotland. The common picture is the reduction in residential care beds and increasing demand for more intensive home care. However, there are very different patterns of unscheduled admissions to hospitals, and delayed discharges. That is a big cost that was always intended to fund social care. I remain sceptical that much of this revenue cost will actually be released.

Integrating and connecting services remains a desirable objective. However, the challenges colleagues flagged up in Ayrshire today are reflected across Scotland. Structures are of course important, but it's people that deliver quality care services.

 

Posted with Blogsy

Strengthening local democracy

Fifty years of centralisation hasn't solved Scotland's biggest challenges, so let's try strengthening local democracy.

That's the conclusion of the final report of the Commission on Strengthening Local Democracy. It argues that the level of inequality remains intolerable after years of centralisation and has left us with huge social and financial costs. They also identify a link between the absence of strong local democracy and the prevalence of inequalities. It is communities that empower governments at all levels, not governments that empower people.

The report starts by making the case for local democracy. Put simply, they argue that strong local democracy means putting local people in charge of their own lives, and leaving national government to focus on outcomes for the whole of Scotland. They do recognise the countervailing forces of centralisation - consistency, efficiency and public support. As others have put it, one person's postcode lottery reflects another's local circumstances.

The Commission has identified seven principles that they believe provide a powerful basis for renewing Scottish democracy. They have also concluded that the evolution of Scotland’s democratic system across the past 50 years has more or less undermined or inverted all these principles, albeit often with good intentions.

It's recommendations start with the need for a fundamental review of the structure, boundaries, functions and democratic arrangements for all local governance in Scotland. They recognise that calling for another review might appear a bit inadequate, but it requires a bottom up engagement on a scale that is outwith the scope of this Commission.

They do however point to different approaches in different parts of Scotland, in particular, between cities and more rural areas - no one size fits all solutions here. They strongly oppose the 'supersizing' of councils and suggest that 60 to 80 councils might be the way forward. This would bring Scotland more in line with the rest of Europe. It should also consider bringing the array of services currently delivered by national quangos under local democratic control, through a 'right to challenge' national delivery. This would also enable councils to connect services more effectively. Where this isn't practical, councils should have the power to veto the local plans of national bodies.

Unsurprisingly, they identify the lack of local fiscal powers as the biggest limitation on local democracy. They recommend that local government should have full local control of the whole suite of property taxes and a general competence to set and raise new taxes, subject only to not duplicating taxes already set elsewhere. This chimes with the Scottish Parliament's call for a cross party approach to council finance and UNISON's own approach.

Another interesting recommendation is making Ministers undertake ‘subsidiarity impact assessments’ on national policy and legislation, as a way of restraining the drift to centralisation. This is balanced by a duty on councils to support and resource community participation in all local decision making about tax, spend and service delivery priorities. This means deliberative engagement, not just more consultation. As they say, language is important here. The report captures this as the choice between ‘ceding’ power and ‘seeding’ power. In other words it is about subsidiarity, not decentralisation.

The report also discusses how the role and powers of local government could be embedded in the constitution, as is the norm elsewhere in Europe. In particular, the European Charter of Local Self Government should be put on a statutory basis within Scotland.

While the Commission's recommendations will take some time to deliver, they helpfully suggest ways in which we could start the journey now. Community planning, decentralisation schemes and other local initiatives offer a way forward to embed a different approach to developing local democracy. The powers already exist to do much of this. However, we need to take the opportunities of additional devolution or independence to ensure that we don't simply swap Holyrood for Westminster. Scotland is few people's definition of local.

In conclusion, the report argues that communities across Europe have enjoyed the benefits of strong local democracy for decades. Scotland must be no different. Real change can create a vibrant new democracy for this century and a stronger, more equal society.

I would argue that there is much in this report that will be welcomed by those who support genuine local democracy. It gets the balance right between recognising that democracy doesn't end in the council chamber and the rather woolly community development approach that risks capture by unrepresentative interest groups. I suspect many will find the lack of firm recommendations in key areas like structure and finance frustrating. However, there is a direction of travel on these issues that is consistent with some well thought through principles. What stands out from the report is the clear articulation of the case for local democracy. It is welcome for that alone.

Women are shut out of the economic recovery

Women, especially those on low pay, are firmly shut out of the economic recovery.

That’s the conclusion of a new report - The changing labour market 2: women, low pay and gender equality in the emerging recovery’, published by the Fawcett Society.

The key findings include:

Since the start of the crisis in 2008, almost a million (826,000) extra women have moved into types of work that are typically low paid and insecure. Since 2008, female under-employment has nearly doubled (to 789,000) and an additional 371,000 women have moved into self-employment, which is typically very low paid. 1 in 8 low paid women now describe themselves as on a zero hours contract.

The increasing levels of women in low paid work, along with the declining value of low pay, is contributing to the widening inequality gap between women and men. Last year the gender pay gap increased for the first time in five years and now stands at 19.1 per cent for all employees.

Low paid women are feeling the cost of living crisis sharply: nearly 1 in 2 say they feel worse off now than five years ago; nearly 1 in 10 have obtained a loan from a pay day lender in the last twelve months; nearly 1 in 12 low paid women with children have obtained food from a food bank in the past twelve months

This report is published on the same day as the Prime Minister announces that all government policies must pass the ‘family test’. You might therefore expect some action on the issues highlighted in the Fawcett Society report. You will be disappointed. The initiative focuses on age ratings for music videos and a throwing a few pennies at the counselling service Relate. Not a mention of the impact of welfare cuts on the family, the closure of sure start centres or the consequences of his austerity economics.

The Fawcett Society report sets out the harsh reality of a Britain the Prime Minister simply doesn’t understand.

A new framework for industrial relations in Scotland

The 'Working Together' Review has set out a positive new framework for industrial relations in Scotland.

Last February the Scottish Government commissioned an independent review of progressive workplace policies and practices in the public and private sectors in Scotland. It was Chaired by Jim Mather and had a broad based membership from employers, trade unions (including UNISON's Lilian Macer) and academics. The aim was to identify best practice to promote collective bargaining and innovation in the workplace.

In many ways the strength of this report is in the description of industrial relations in Scotland today. It dispels many of the myths about relations between unions and employers, highlighting the positive relationships that rarely get media coverage. Scotland does of course benefit from significantly higher union density than the rest of the UK, but this report goes further in setting out the range and depth of industrial relations practice. This is helpfully illustrated with case studies and examples from a range of sectors.

The Review Group identified a shared ambition to embed progressive workplace practices to boost innovation and productivity and deliver successful organisations, sustainable business and economic growth, high-quality jobs and a more equitable society. This is reflected in the key themes for action that include:

• investing in the capacity of union members and staff - and enhancing employer capacity in the same way - to deliver economic, social and civic benefits;
  
• investing in dialogue and communication about fair work to achieve a broader and deeper recognition of the benefits that accrue from unions and employers working together, and a shared commitment to progressive workplace policies;
  
• fostering real opportunities for unions, employees and employers to work together which embeds these values more systematically and maximises the benefits of shared knowledge and distributed leadership;
  
• a willingness to resource, evidence, share and learn from what works.

There are 30 recommendations in the report that seek to deliver practical actions in support of the key themes.

They recommend that there should be a new strategic stakeholder body to provide leadership and support the development of better industrial relations. The model is to be promoted through procurement and the other policy levers of government. Practical measures that I particularly welcome, include recognition of the valuable role equality and green union representatives can play in the workplace. A number of UNISON projects have shown the value of these and the proposed environmental workplace fund would aid the development of green reps.

For the public sector there is a recognition of the merits of the NHS partnership model and the benefits of a degree of common best practice. This reflects the Christie recommendations and UNISON's case for a national workforce strategy. Extending worker directors to all public bodies is also welcome and the Scottish Government has an opportunity to deliver on this in the Food (Scotland) Bill.

The basic premise behind these recommendations is that the economic and social challenges and opportunities facing Scotland are more likely to be addressed successfully in an environment where unions play their full part. Those in trade unions who cling to the Marxist school of industrial relations, or the 'race to the bottom' employers, won't find a lot in this report to encourage their approach. However, most employers and trade unions in Scotland will welcome this report and look to the Scottish Government to translate their response to the recommendations into action.

 

Posted with Blogsy