Happy Birthday to our NHS

Happy Birthday to our National Health Service, one of Labour’s finest achievements in government. A brilliant socialist concept that shows the benefits of collective action to tackle the challenges facing our society.

There are a range of celebrations in the coming week to mark the 70^th anniversary of the NHS. I was pleased to be speaking at one of those today in Glasgow, organised with the new Scottish Labour Westminster candidate for Glasgow North, Pam Duncan-Clancy. One of a great group of UNISON women who will be contesting the next UK general election in Scotland.  

Some people, including NHS staff, can be a bit cynical about NHS anniversary celebrations. While they welcome the praise and celebrate the NHS they have dedicated their careers to, they wish politicians would also be thinking of those warm words when they are allocating budgets and funding their pay and conditions. A bit like Firefighters after Grenfell - warm words from the Prime Minister after she had slashed the fire budgets in the name of austerity.

None the less we should welcome these celebrations and I argued today that NHS 70 offers two broad opportunities.

Firstly, to remind everyone of the importance of the NHS - something we can take for granted. For most of us it has literally been there from the cradle to the grave. In a column in the Guardian this week – Emma Brockes coming back from the USA, compared the two approaches. She said:

"For all its faults and in spite of terrible under-investment, the very fact of the welfare state when seen from the US is nothing short of a miracle. I used to take it for granted, but that has gone. We are not supposed to think of the world in terms of us and them, yet it is impossible, moving between the two countries, not to see the welfare state, the NHS, and the philosophy that underpins them, as the greatest bulwarks between society in the UK and life as it is lived in the US. I know which side I’m on."

Most people in Scotland don't get to experience that comparison. However, on the train the other day I listened to two young women discussing an American medical drama - The Resident. This drama highlights the shocking profit driven approaches of a big US hospital. They concluded 'thank god we have the NHS'.

Well apologies to those of a religious persuasion, but the NHS isn't an act of God. It was campaigned for by organisations like the Socialist Health Association and delivered by a visionary health minister in a radical Labour Government. And it has been Labour government’s that have funded it better than any others.

We only have to look at the shambles of marketisation in NHS England to see how easy it is to drift into privatisation. So, we should also thank the Labour health ministers Susan Deacon and Malcolm Chisholm who took Scotland in a different direction in the early years of devolution.

Secondly, while we should celebrate achievements - should take the opportunity to recognise the challenges and look forward. These are set out in the SHA Scotland paper launched today, and Professor David Conway outlined these at today’s event. 

 It is important to emphasise that while the NHS does a lot of preventative work it is largely about patching and mending us when we get ill. So, preventing ill health requires action outwith the NHS.

With the exception of Asthma, you are more likely to suffer every other illness the lower your income group. That points to the fundamental challenge facing health of the nation - inequality. The research in the book the Spirit Level showed us how unequal societies are also unhealthy societies. Interestingly, it also showed that even the relatively affluent members of society also do worse in unequal societies.

And the NHS points the way towards the collective action we need to take to seriously tackle inequality. The NHS commands widespread support because we all use it. Even the rich understand that while they can buy a luxury room in a private hospital, it will be an NHS paramedic or the staff in an A&E dept who will save their lives in an emergency.

In Glasgow in the 19th century the council delivered many of the great projects that did so much to improve health in the city. It wasn't just hospitals. It was clean water from Loch Katrine and many other public health measures that made the difference. You can imagine one of those rich merchants saying to another on the council, why should I pay for these things. The answer was that disease knows no boundaries, even the rich couldn't inoculate themselves. 

It's that collective approach, yes socialism, that should drive our thinking as we move forward. In housing, social care, the economy and the broader welfare state. 

I may not make the 100th anniversary of the NHS, but if I do, I hope that we will have addressed the 21^st century challenges, which will reduce the demand on the NHS. By creating a more equal society that will honour the socialist giants, like Nye Bevan, on whose shoulders we stand.

Pensions reform isn't easy, but scale matters

Scotland’s largest pension scheme is considering major changes in the way it’s £42bn worth of assets are administered.

The Scottish Local Government Pension Scheme (SLGPS) Advisory Board is asking employers and trade unions to compare the current structure against three options that, by degrees, consolidate the functions of the scheme’s 11 constituent funds by collaboration, pooling and merger. Today’s launch seminar in Edinburgh heard from speakers outlining the options and experts who advised the Board on the available options.

Current SLGPS governance structure 

There is an international movement towards greater scale in pension management that makes the status quo very difficult to sustain. This was set out very clearly by Iain Clacher, from the University of Leeds at today’s seminar. With greater scale in pensions come economies of scale, which reduce costs, increase efficiencies, and this ultimately secures the pension benefits of members. Every basis point (0.01%) shaved off costs equates to £3.5m. 

UNISON's own research reinforces the benefits of scale. While UNISON would normally champion the cause of localism, there are very few local factors in pension management that make local control the determining factor. 

Given the case for scale the status quo does not look like a viable option. Some scale could be achieved through collaboration. This has been tried by Lothian and Falkirk, but it offers only modest gains in scale while retaining complex governance arrangements. 

The English model of pooling assets provides scale, although the funds retain their responsibilities for administering the scheme. Governance is a problem with this model and UNISON colleagues in England and Wales have significant concerns. 

The most radical option would result in a full merger of funds, which would have the advantages of scale. However, governance would need to be centralised either on a joint board or NDPB model. There would also be significant implementation challenges. 

This is not a straightforward or easy decision. However, pension funds are consolidating across the world for good reasons. When I meet fellow union pension negotiators across the world, they are astonished that we voluntarily retain such small funds.

Scale gives greater investment clout, tackles fee transparency, enables in-house expertise to invest in new areas like infrastructure, and reduces duplication and cost. It’s not a decision that we can afford to duck.

A Quality Service Needs to Pay Quality Wages

The provision of a free at the point of use public childcare service has been a demand of the trade union movement for over a hundred years. Investment in the provision of quality childcare is therefore very welcome. But the service model must be one that closes rather than widens the attainment gap. There is a very real risk that done the wrong way we could make inequality worse rather than better. There is growing evidence that this has been the case following the move to 30 “free” hours per week in England . UNISON’s full response to the consultation is available here.

To be fully effective the proposed expansion of “free hours” in ELC will also require investment in a range of public services not just nurseries. The services also need to work together. This is why it important that all education services including early years are embedded in local authorities where links to social work, libraries, youth work, leisure and cultural services as well as social work, welfare rights, educational psychologists and housing can be best coordinated.

The government consistently state that they are focused on the provision of a quality service. The quality of an ELC services is entirely based on the quality of the staff. Stating that the Living Wage is the minimum pay for the sector contradicts that ambition. It should be shocking that that around 80 per cent of practitioners and 50 per cent of supervisors in partner settings are paid less than the Living Wage . So while the commitment will bring a welcome pay rise for many it is much less than is being paid in the public sector.

UNISON believes that the government has substantial underestimated the number of extra staff needed to meet their ambition but even accepting their figures it will be very difficult to attract sufficient people at that rate of pay. Why would anyone undertake the training (in-work or at college) needed to become an early years practitioner with all the responsibilities, the demands of maintaining professional registration and required ongoing professional development to earn the same rate of pay you could cleaning or in a supermarket?

In the short term the better rates of pay and pensions in the local authorities mean that authorities will be able to fill their current vacancies by attracting qualified staff from other sectors and lower paying authorities. The average earnings for practitioners across the sectors are
• public £28,000
• private £15,000
• voluntary £16,000

A practitioner moving from the private to the public sector is looking at an average wage rise of £13,000 per year plus a final salary pension. A recent report from the National Day Nurseries Association (Scotland ) states that private nurseries currently lose 3 staff per year to the public sector. Lower payers are going to struggle to keep and recruit staff during such a massive expansion According to the Skills Development Scotland report the current vacancy rate is 19% and 35% report problems filling vacancies. This will only get worse without proper pay. Low pay puts the whole expansion at risk.

The evidence is clear that an anti-poverty early learning and childcare service (ELC) needs to follow a supply side model rather than the “funding follows the child” “provider neutral” model laid out by the Scottish government.

As the Joseph Rowntree Foundation state
“international evidence and the best examples of high quality provision in the UK suggest that the most effective approach to funding pre-school childcare is supply side funding, where investment is made directly in services. This approach provides the means to offer universal access to services and effectively shape quality, affordability and flexibility. .....demand side subsidies do not offer the same means to achieve integration and deliver improvements in services. The case for supply-funded childcare is simple. It is the most effective means of delivering reliable access to affordable, flexible and high quality childcare regardless of parents’ ability to pay”

We really want this expansion to work. This could be a life changing investment in public services. There's still time for the Scottish government listen and make the right choices.

Time for coordinated workforce planning

Workforce planning in Scottish local government is largely a local and ad-hoc approach, which is simply inadequate for the challenges created by austerity and will not cope with future demand. It is time to develop a more coordinated approach.

Today, I was giving evidence to the Scottish Parliament's Local Government Committee inquiry into workforce planning. Workforce planning is the process that organisations use to make sure that they have the right people with the right skills in the right place at the right time. 

With nine out of ten austerity job losses in Scotland in councils, the impact of job cuts on the workforce has been huge. This is highlighted in UNISON Scotland's damage series of reports in which staff describe the daily stress and plate spinning, which is how they do their best to keep services going.

Added to this we have an ageing workforce, with around 40% of the public sector workforce in Scotland likely to retire within ten years. That has huge consequences for service delivery, particularly in local government. We already have experienced staff retiring, leaving junior staff, often without the necessary skills or knowledge, to muddle through.

In this context you would have hoped that workforce planning would be high on the agenda. In practice workforce planning in Scottish local government is generally very limited, at best local and largely ad-hoc. There is some national discussion with specific professions, or when a recruitment crisis highlights specific difficulties, such as planning. There is little strategic engagement with workforce representatives across the sector.

A current example of short-term thinking is the planned closure of the Master of Public Administration programme at Queen Margaret University in Edinburgh. This would leave Scotland with one MPA programme. I was in Wales recently and was impressed by their approach, while in Scotland we appear to be relying on others. Where is the next generation of public service leaders going to come from if we close down quality teaching and research programmes?

There are some local plans as well as guidance from CIPD, Audit Scotland and the Improvement Service. However, there is little national coordination, with silo working the most common approach. There have been some early attempts at a national approach in the care sector. Even here with a looming crisis, we are only at the early stages of a challenging process, given the fragmented nature of the service. 

Effective workforce planning requires access to good workforce data. Our experience of collating data shows that councils often struggle to produce even the most basic workforce data. In some councils the data is only held at departmental level and because every council has a different structure, it is very difficult to put together a national picture.

A new approach to workforce planning is required across the public sector, including local government. Service integration means that this can no longer be undertaken in silos. Here are six steps we could take:

Democracy Matters - The Local Governance Review

Modern Scotland needs a major devolution of power, placing responsibilities and resources with citizens and communities. This means strengthening democracy through the ballot box and by giving people an active role in decision making.

In December 2017, the Scottish Government and COSLA jointly launched a Local Governance Review, which aims to make sure local communities have more say about how public services in their area are run. Last month, the Scottish Government published a suite of materials to support a highly inclusive conversation about community decision-making.

The Review brings a wide range of Scotland's public services into scope, not simply limited to local government. The first stage consultation will run until November and will focus on local engagement - how local decisions could be made more effectively. The second stage, which will have a degree of overlap, will look at how decisions are made at council level or regionally. This will bring into focus the complex structure of public service delivery in Scotland. Legislation is pencilled in for 2020 to implement any changes, although where there is local consensus change could be fast tracked under existing powers.

The commissioning partners have agreed some guiding principles and a process, but they do not, at present, share a common direction of travel for reform. The Scottish Government has been centralising services, either on a regional or national basis, together will strengthened powers of direction from the centre. Albeit with a narrative around local voice. COSLA on the other hand wants to see devolution extend further than the Scottish Parliament, down to councils and communities. Brexit is another opportunity to extend devolution locally.

The starting point for any review of local governance are the Christie Commission principles, which almost everyone remains committed to, even if the application has been a patchy in practice. The ink was barely dry on the report before services were centralised, but it sets out the case for local engagement very clearly.

There is also a growing civil society movement that makes the case for local decision making and rejects a 'one size fits all' approach to local governance. The 'Our Democracy' initiative has been holding a range of local meetings to develop some ideas and they are bringing this together at a national conference this month.

There are no shortage of ideas developed by think tanks with a good track record of supporting local governance. The IPPR, Carnegie Trust, Fabian Society, LGIU and others, have all made solid contributions to this debate. Service design could be done with citizens and front line staff adopting ideas from Systems Thinking, The Enabling State, Participatory Budgeting and Co-operative councils.There are some common themes, illustrated by practical case studies, in these reports. In short, local is best.

COSLA's Local Democracy Commission has a good analysis of why over centralisation doesn't work. They also floated some quite radical ideas around the structure of public services, pointing to the already highly centralised structure of local government in Scotland. We have fewer councils and councillors than any European country. There may well be a case for regionalisation of some services, but the building lock of local democracy should be smaller, not ever larger councils.

Unsurprisingly, I would also point to my own contribution to the debate in my 2017 Reid Foundation paper 'Public Service Reform in Scotland'. I argue that public services should be built from the bottom up based on nine principles that reform proposals should be tested against. Democratic accountability, subsidiarity, transparency, equality, effectiveness, fair work, integration, outcomes and a public sector ethos. I have recently developed some of these ideas in a new Reid Foundation paper on municipal socialism.

The latest Scottish Social Attitudes Survey confirms that there is support for greater engagement. Work done with UNISON members confirms this, although there is also some cynicism that this might be just another government consultation, or a means of papering over the cracks caused by austerity. People will only give up their valuable time for engagement if they believe it will make a difference.

The voice of staff in service design was highlighted by the Christie Commission. There has been limited progress in achieving this, although staff governance initiatives in NHS Scotland and elsewhere is a step forward. I was at a meeting in Edinburgh today when the Cabinet Secretary and the President of COSLA both confirmed that staff voice was 'crucial' to the review.

So, the review is an opportunity to contribute to the debate. It couldn't be simpler to post an idea or respond to the simple open questions in the consultation paper.

As Richard Daggers put it in his 1997 book, "The virtuous citizen must be free, but not simply free to go his or her own way. Instead the citizen is free when he or she participates in the government of his or her community". We should take the opportunity of this review to make this a reality.

Rebuilding the intergenerational contract

The gulf between the earnings of younger and older people has increased by 50% in the last 20 years, leaving young workers struggling to survive. Does this mean the Intergenerational contract is breaking down?

The TUC report, Stuck at the start: young people’s experience of pay and progression, reveals that the pay gap between over and under-30s has grown from 14.5% in 1998 to 21.9% in 2017 – meaning that younger workers get on average £2.81 per hour less than their older colleagues.

And it's not only about pay. The number of 21 to 30-year-olds working in precarious, often low-paid work has exploded, particularly in private care and the hospitality sector. A YouGov poll of 1,500 young people carried out for the report found that only three in 10 felt their current job made the most of their experience and qualifications; four in 10 had been given little or no training in the last 12 months, while one in five had worked on a zero-hours contract in the last five years.

As the TUC's Frances O'Grady puts it; “We’re creating a lost generation of younger workers. Too many young people are stuck in low-paid, insecure jobs, with little opportunity to get on in life,”

So why don't young people just get organised? Some argue that young people can’t organise in the workplace because they’re too narcissistic. They can’t afford houses because they eat too many avocados. They don’t need living rooms because they’re always out eating £15 burgers. They’re anxious because they’re snowflakes.

These arguments simply miss the point. As Zoe Williams argues in the Guardian, there are structural reasons like student debt which means that buying a house is out of the question for young people who don't have the bank of mum and dad to support them. The “gig economy” is a euphemism for chronic precariousness. Internships are no more than the repudiation of the precept of a fair day’s work for a fair day’s pay. Apprenticeships are code for exploitation.

And there is no shortage of activism amongst young people. In particular, young trade unionists are at the cutting edge of new campaign techniques. They are tuned into party politics, appreciate the wider labour movement and give confident speeches to the public. Jeremy Corbyn’s overwhelming support among 18- to 24-year-olds is written off as naivety by those whom it pleases to believe that anything not resembling the status quo is unrealistic. 

The Resolution Foundation has taken a detailed look at the intergenerational contract.  Their report argues that the intergenerational contract works because everyone puts in and everyone takes out. We are happy to support and feel obligated to older generations because we believe and expect that we will be treated the same when we are old. We support children as they develop just as we were supported and nourished when we were young. 

We celebrate the good times and deal with the nation’s challenges together, across the generations. This feels natural, but that does not mean that we can take the intergenerational contract for granted. Increasingly, there is a sense that it is under threat, on pay, working conditions, housing and pensions. Young people are making no income progress and accumulating less wealth.

The recommendations in the report are politically challenging but should stimulate a debate. The costs of social care should be met by a property-based contribution towards care costs. There should be greater employment and housing security while turning around our housing crisis. A legislative framework for ‘collective defined contribution’ pensions that better share investment risk. 

Possibly the most radical recommendation is abolishing inheritance tax and replacing it with a lifetime receipts tax that is levied on recipients with fewer exemptions, a lower tax-free allowance and lower tax rates. The extra revenues should support a £10,000 ‘citizen’s inheritance’ – a restricted-use asset endowment to all young adults to support skills, entrepreneurship, housing and pension saving. This would be an important step towards breaking intergenerational inequality.

People are increasingly concerned about the prospects of other generations within their families and communities, and electoral turnout gaps by age are narrowing. We need a policy agenda that addresses the concerns of both old and young, and in so doing rebuilds the intergenerational contract. We need to step up to the challenge of building a sustainable society.