Stepping up the pace on care integration

The Scottish Parliament’s Health and Sport Committee has published a report on the forthcoming budget. UNISON Scotland gave written and verbal evidence to the inquiry.

The report highlights their ongoing concern over the absence of budget transparency, with specific reference to the new health and care integration authorities. There is no real breakdown of the £8.9bn spent by the IAs overall and they will not set their individual budgets until July next year, well into the financial year. The report gives several examples of how it is impossible to identify spending plans for specific services, with organisations forced to resort to freedom of information requests.

The committee also highlighted one of UNISON’s concerns over the budget, the double counting of social care funding in both NHS Scotland and local government. There also remains a misalignment of budget timescales between councils and health boards.

The lack of transparency means it is also difficult to see how integration funds are contributing to the nine national health and wellbeing outcomes. In evidence to the committee most IAs emphasised the difficulty in achieving linkages with expenditure. This is supposed to be a statutory duty!

There has been an informal push by some IAs towards direct funding. We set out UNISON’s objections to this in an earlier blog post.

The report welcomes the announcement about ending the 1% pay cap and rightly seeks assurances on funding the increase. They also highlight the cost of extending the living wage to sleepover provision. 

The report also calls for long-term budget planning, recognising that the short-term nature of the UK budget setting process hinders this approach. Delivering transformational change by shifting resources to care in the community will not be achieved in the current time frames. Support for investment in preventative spending also requires a longer time frame. Audit Scotland have produced a useful video clip that illustrates the challenges.

The report also highlights UNISON Scotland’s concerns over the potential cut to sports and leisure facilities if the Barclay Review is implemented without additional funding to councils.

Overall the committee is disappointed over the slow progress in integrating health and care services and the lack of transparency in budget allocations. They believe key outcomes such as shifting resources have been allowed to drift and clear leadership is required to deliver this.

NHS Scotland staff speak out

Several examples this month of NHS Scotland staff expressing their concerns over the pressures being placed on the service.

In the annual staff survey two-thirds of NHS staff in Scotland say they can't do their job properly because of staffing shortages. Just a quarter of nurses and less than a fifth of ambulance personnel felt there were sufficient staff to allow them to work well. Even senior managers believe the service is too stretched, with just 38% saying there are enough staff.

Of particular concern, the survey revealed 43% of NHS employees do not feel it is safe for them to speak up if they are concerned about quality or safety issues. 15% indicated they had been bullied or harassed by colleagues in the previous year.

These concerns are reinforced in three UNISON Scotland surveys.

Health and care staff involved in care integration said that while they support care integration, its delivery was being compromised by budget cuts. 68% believe it would get worse, not better next year.

In a separate survey Occupational Therapists had a similar message. An overwhelming majority (82%) reported increased workloads, 60% reported having to cope with reduced members of staff and almost half (48%) reported funding cuts.

Finally, hospital porters reported they are also under pressure and their workloads are going up while the value of their wages are going down. The report also concludes that their training is patchy and there are reports of lack of equipment to allow them to do their job properly.

The NHS budget may have had a degree of ring fencing from budget cuts, but that doesn't mean that the service isn't under real financial pressure. These voices from NHS Scotland staff make that very clear.

The cuts don't work - we need Food for Good in hospitals

14 July 2014

Today’s Herald has an exclusive report on criticism of the quality of food in NHS Greater Glasgow and Clyde hospitals.

The health board are to be praised for allowing a restaurateur David Maguire access to all areas when he volunteered to examine the meals and the preparation process in detail.

However, despite the claimed “increasingly positive feedback” from patients, the board must be wincing from his comments that: “What passes for food in the NHS bears no resemblance to anything that I have encountered...On occasions it looked like food. It rarely had the texture of food. It reminded me of the worst components that I have encountered at school meals.”

He summed up: “I am astonished that anyone eats any of it.”

No-one expects the NHS to serve the kind of food you would get in a top quality restaurant but people in hospital deserve to have, indeed need to have edible meals as part of their recovery. Mr Maguire offered his services after a column in the Herald last year by the paper’s writer Anne Johnstone who was being treated for leukaemia and was appalled at the food dished up to patients at the Beatson West of Scotland Cancer Centre.

UNISON Scotland has long campaigned for fresh, nutritious, locally sourced food in schools and hospitals, highlighted in our Food for Good Charter. We noted that the Scottish Government’s recent discussion document “Becoming a Good Food Nation” called for, among other things, the public sector to lead by example with the NHS, local authorities and Scottish Government signing up to offer fresh, seasonal, local and sustainable produce.

We pointed out on this blog that if we’re serious about creating a real Good Food Nation, such an initiative, broadly reflecting our Charter, should come under public health. And of course, the cuts facing the health service, along with all public services, place enormous pressure on hard-pressed catering staff.

The Herald leader, acknowledging mass catering is very different from restaurant food preparation, points out: “..part of the problem is that the catering budget was cut by almost £1million in 2012 and the board now spends barely £4 per day per patient in some of its hospitals.” We agree with them that cutting back on the quality of food is a false economy. Glasgow is certainly not the only area undergoing cuts and our recent ‘The Cuts Don’t Work’ report shows ‘austerity’ measures leading to even deeper cuts in the next few years.

What kind of Scotland, what kind of health service, what kind of food for hospital patients do we want? Only so much can be done to drive up quality in the face of cuts if resources, equipment, and the times hospital kitchens are open all place big restrictions on what catering staff - who want to feed the patients well - can achieve.

Sticking plasters on NHS Scotland's long term funding problems

Audit Scotland has published its annual report into the finances of NHS Scotland.

The key message is:

“The NHS in Scotland managed its finances well in 2012/13 but needs to focus more on long-term financial planning and sustainability to make the changes needed to meet increasing demands. In 2012/13, pressures on the NHS’ capacity became more apparent and the health service spent more on short-term measures to deal with them.”

Put another way, the NHS is putting sticking plasters on long term funding problems.

The report also indicates that demands on healthcare are rising and signs of pressure on the NHS were apparent. In particular, some boards missed waiting times targets; staff vacancies increased; and spending on bank and agency staff and private health care rose.

Agency staff and private care spending is a good example of short term spending that is hugely wasteful. The report calls for stronger long-term financial planning to address this.

The report also highlights spending of over £115 million on the top ten high-cost, low-volume (HCLV) drugs in hospitals in 2012/13. These can be a pressure on
NHS boards as spending increases at a higher rate than other costs and it can be less predictable. The top ten drugs are generally a specialist type of drug used to treat rheumatology conditions and irritable bowel conditions (anti-TNFs) and cancer drugs. Spending on HCLV drugs increased more than spending on overall hospital drugs and drugs prescribed in general practice over the past two years.

This again highlights the importance of addressing drug costs in NHS Scotland.